gynecology and obstetrics
Intrauterine Device (IUDs; IUD)
Insertion of the IUD
Clinicians do not need to do a Papanicolaou (Pap) test or human papillomavirus (HPV) test before they insert an IUD, unless the patient is due for cervical cancer screening. Testing for Overview of Sexually Transmitted Infections (STIs)—gonorrhea and chlamydia—prior to IUD insertion should be based on "risk-based" screening (age ≤ 25 years, multiple sexual partners, inconsistent condom use, and/or history of a STI) ( The package insert for the IUD should be read before insertion to review the insertion technique. When IUDs are inserted, sterile technique is used as much as possible. Bimanual examination should be done to determine the position of the uterus and a tenaculum should be placed on the anterior lip of the cervix to stabilize the uterus, straighten the uterine axis, and help ensure correct placement of the IUD. A uterine sound device may be used to measure the length of the uterine cavity before IUD insertion. Before insertion, a paracervical block may be used to decrease pain during insertion ( References ). An IUD may be inserted at any time during the menstrual cycle if a woman has not had unprotected intercourse during the past month. A routine follow-up visit after IUD insertion is not necessary. Patients should be counseled to return for evaluation if they experience symptoms or complications (eg, pain, heavy bleeding, abnormal vaginal discharge, fever, expulsion) or are dissatisfied with the method ( References ). An IUD may be inserted immediately after an induced or a spontaneous abortion during the 1st or 2nd trimester and immediately after delivery of the placenta in a cesarean or vaginal delivery. 