Military clinical practice. the intra-uterine device. Part II. Technical problems
Alexander, I.
Journal of the Royal Army Medical Corps 126(3): 135-139
1980
ISSN/ISBN: 0035-8665 PMID: 7205760 DOI: 10.1136/jramc-126-03-06Document Number: 451887
Proper clinical practice in the military for IUD insertion is outlined. Bimanual examination of the pelvis is prerequisite; a Cusco speculum should be used to visualize the cervix and vagina. Cervical erosion and vaginal discharges should be treated before insertion. The basic insertion method is to fix the blades of the speculum in open position and then seize the cervix with a tenaculum. Tenaculum and inserter should be held securely to prevent rotation and incorrect orientation of the IUD. Uterine sounding may be necessary in obese patients or in other patients where bimanual examination does not reveal uterine position. Uterine perforation is avoided by lightly holding the device for insertion. For copper IUDs, high fundal placement without perforation is essential because the close association of copper and endometrium is important. A Gravigard can be inserted by either the push-in or withdrawal technique. The push technique is best with Lippes Loops. Cooper T models are slightly larger once loaded in their inserter than Copper 7s making this IUD less suitable for nulliparas. A small Saf-T-Coil is indicated for nulliparas. Timing of insertion should be just after the period, when the cervix is partly dilated, although IUDs can be inserted at any time in the cycle. Copper models have been found successful as postcoital contraceptives when inserted within 5 days of coitus.