IUD insertion

6 steps1 video

The most effective reversible method, placed at the fundus with a sound and an inserter, in a few minutes.

Consent and trauma-informed practice

Explain what the examination involves, why it is proposed, and what the alternatives are, in plain language, before anyone undresses.
Ask for permission, and make clear the patient can stop at any point, by saying so or by raising a hand. Stopping is honoured immediately, without persuasion.
Offer a chaperone and record the offer and the response; a student never examines without the supervising clinician present and the patient's specific agreement to the student's involvement.
Privacy: a door that locks or a sign, a sheet, undressing only what is needed, time to undress and dress alone.
Trauma-informed: assume a history you have not been told. Explain each step before it happens, keep talking, avoid sudden touch, ask about pace, and notice dissociation or distress and pause.
Never examine a patient under anaesthesia for teaching without their specific prior consent to that examination.

The sequence

6 steps

01
Speculum and cleanse
Visualise the cervix; cleanse with antiseptic.
02
Stabilise
A tenaculum on the anterior lip straightens the canal (warn before applying; local anaesthetic reduces the pinch).
03
Sound
Measure the cavity (usually 6 to 9 cm); resistance at the internal os is passed gently; never force.
04
Insert
Load and insert the device to the fundus per its instructions; release; withdraw the inserter.
05
Trim
Threads to about 3 cm; show the patient how to check them; document the length and the device.
06
Aftercare
Cramping and spotting are expected; return for persistent pain, fever, or missing threads; a follow-up check by preference.

Consent; reasonable exclusion of pregnancy; STI screening by risk (insertion need not wait for results); analgesia discussed honestly (NSAIDs, local anaesthetic options); a bimanual examination for size and position
Sterile technique; the device, tenaculum, sound, scissors