What are the initial steps in intrauterine device (IUD) insertion?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Insertion of both the levonorgestrel-releasing IUDs and copper T380A IUD begins with a bimanual examination to ascertain uterine size and position.

Next, a speculum is used to gain clear visualization of the cervix. At this time, cervical gonorrhea and chlamydia tests should be obtained if indicated. The cervix and adjacent vagina are then cleansed with povidone-iodine or chlorhexidine. From this point forward, sterile gloves should be worn by provider.

Although the majority of women will tolerate placement of IUD without a local anesthetic, if placement has previously been challenging or patient preference dictates, a paracervical block may be performed at this time.

Using a single-tooth tenaculum, grasp the anterior lip of the cervix. Gentle traction on this tenaculum will facilitate both sounding of the uterine cavity and IUD placement by bringing into line the cervical canal and the uterine cavity. If the uterus is retroverted, placing the tenaculum on the posterior lip of the cervix may better facilitate alignment of the cervix and the uterine cavity.

While providing gentle downward traction on cervix, use a uterine sound to assess the size of the uterine cavity. Sounding helps the provider appreciate the direction of the cervical canal and endometrial cavity, allows for assessment of patency, and allows for a basic assessment of intrauterine anatomy. If the uterus sounds to less than 6 cm or greater than 10 cm, insertion should be stopped and further assessment of intrauterine anatomy with ultrasound should be considered.

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