Insertion and removal of intrauterine devices
Kovacs, G.T.
Australian Family Physician 19(5): 703-704
1990
ISSN/ISBN: 0300-8495 PMID: 2346424 Document Number: 240735
Proper selection of candidates for IUD insertion is critical. IUD use is absolutely contraindicated in women with pelvic inflammatory disease (PID), known or suspected pregnancy, congenital or uterine abnormalities that distort the uterine cavity, and those at risk of sexually transmissible diseases (STDs). A history of ectopic pregnancy, bleeding disorders, valvular heart disease, and heavy or painful menstrual periods are relative contraindications. In general, the IUD is not recommended for nulliparous women given the greater risk of expulsion, heavy bleeding, and PID. Potential IUD acceptors should be advised that the device has a failure rate of 1-3/100 woman-years, which is slightly higher than that for the pill. Before insertion, the presence of any cervical infection should be ruled out. The position, size, and flexion of the uterus should be determined by bimanual examination. In most cases, a forcep must be applied to the anterior lip of the cervix before insertion, and a sterile uterine sound should be passed to ensure the canal can be negotiated. The IUD should be inserted with a non-touch technique and the string trimmed so that 2-3 cm are protruding. A follow-up examination should be scheduled for 6 week postinsertion, with annual review visits thereafter. Although IUD removal is most often motivated by the desire to achieve pregnancy, infection, abnormal bleeding, and excessive pain may also necessitate removal. This procedure can usually be completed by gentle, steady traction exerted on the string.