How are IUDs inserted?
Inserting an IUD is usually done in a doctor’s rooms or clinic, though if you’re in hospital for some other gynaecological procedure, it may be convenient to insert the device while you’re there. General anaesthetic is rarely warranted. Whether or not local anaesthetic is used is a matter of choice. I prefer to use some local in the cervix: it makes insertion more comfortable for you and easier for me.
Most doctors will explain the insertion procedure to you before going ahead, but I’ll briefly outline the steps.
1 The position of the uterus is checked by pelvic examination at the same time making sure that all the internal reproductive organs feel normal.
2 A speculum is inserted into the vagina to give good access to the cervix, which is swabbed with antiseptic.
3 Local anaesthetic (if used) is injected into the cervix.
4 A tenaculum is attached to the cervix to steady the uterus.
6 The device is loaded into its inserter that is set to the depth measured (some devices need no loading). Then it is inserted into your uterus. You may feel another contraction as the IUD goes into place.
7 The string is trimmed so that about 4 cm protrude from the external os. This length usually curls up behind your cervix. If the string is trimmed too close to the os, it can ‘spike’ or scratch your partner during intercourse.
IUD insertion usually takes 5-10 minutes. Most doctors like you to rest lying down for a further 10 minutes and stay in the waiting room for another 20-30 minutes after you’ve dressed. This is because some women get a reflex faintness a short while after insertion. If you’re going to feel faint, it’s better to be in the doctor’s rooms than in the street or on a bus.
A checkup is usually advised about a month after insertion, and annually while the IUD is in place. Also, your doctor will tell you how to feel for the string after each period to check that the device has not been expelled. Copper and hormone-releasing IUDs need to be replaced from time to time, as recommended by the manufacturer.
What’s the best time for inserting an IUD?
Most importantly, insertion must be at a time when you and your doctor can be quite sure that you’re not pregnant. For this reason, insertion during menstruation used to be advised. Now that we know that the risk of expulsion is higher if insertion is during a period, most doctors advise it during the second week of the cycle. Insertion may be at any time in a cycle in which there’s no chance of pregnancy (which means no intercourse since the last normal period).
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