Proper insertion technique can help prevent many problems, such as infection, expulsion, and perforation.
Follow proper infection-prevention procedures.
Use high-level disinfected or sterile instruments. High-level disinfect by boiling, steaming, or soaking them in disinfectant chemicals.
Use a new, presterilized IUD that is packaged with its inserter.
The “no-touch” insertion technique is best.
This includes not letting the loaded IUD or uterine sound touch any unsterile surfaces (for example, hands, speculum, vagina, table top). The no-touch technique involves:
– Loading the IUD into the inserter while the IUD is still in the sterile package, to avoid touching the IUD directly
– Cleaning the cervix thoroughly with antiseptic before IUD insertion
– Being careful not to touch the vaginal wall or speculum blades with the uterine sound or loaded IUD inserter
– Passing both the uterine sound and the loaded IUD inserter only once each through the cervical canal
Giving Advice on Side Effects
Important: thorough counseling about bleeding changes must come before IUD insertion. Counseling about bleeding changes may be the most important help a woman needs to keep using the method.
Describe the most common side effects
Changes in her bleeding pattern:
− Prolonged and heavy monthly bleeding
− Irregular bleeding
− More cramps and pain during monthly bleeding
Explain about these side effects
Bleeding changes are not signs of illness.
Usually become less after the first several months after insertion.
Client can come back for help if problems bother her.
Inserting the IUD
Talk with the client before the procedure
Explain the insertion procedure (see below).
Show her the speculum, tenaculum, and the IUD and inserter in the package.
Tell her that she will experience some discomfort or cramping during the procedure, and that this is to be expected.
Ask her to tell you any time that she feels discomfort or pain.
Ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever may be given 30 minutes before insertion to help reduce cramping and pain. Do not give aspirin, which slows blood clotting.
Talk with the client during the procedure
Tell her what is happening, step by step, and reassure her.
Alert her before a step that may cause pain or might startle her.
- Ask from time to time if she is feeling pain.
Explaining the Insertion Procedure
A woman who has chosen the IUD needs to know what will happen during insertion. The following description can help explain the procedure to her. Learning IUD insertion requires training and practice under direct supervision. Therefore, this description is a summary and not detailed instructions.
1. The provider conducts a pelvic examination to assess eligibility (see Screening Questions for Pelvic Examination Before IUD Insertion). The provider first does the bimanual examination and then inserts a speculum into the vagina to inspect the cervix.
2. The provider cleans the cervix and vagina with appropriate antiseptic.
3. The provider slowly inserts the tenaculum through the speculum and closes the tenaculum just enough to gently hold the cervix and uterus steady.
4. The provider slowly and gently passes the uterine sound through the cervix to measure the depth and position of the uterus.
5. The provider loads the IUD into the inserter while both are still in the unopened sterile package.
6. The provider slowly and gently inserts the IUD and removes the inserter.
7. The provider cuts the strings on the IUD, leaving about 3 centimeters hanging out of the cervix.
8. After the insertion, the woman rests. She remains on the examination table until she feels ready to get dressed.
Supporting the user
Giving Specific Instructions
Expect cramping and pain
She can expect some cramping and pain for a few days after insertion.
Suggest ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever as needed.
Also, she can expect some bleeding or spotting immediately after insertion. This may continue for 3 to 6 months.
She can check the strings
If she wants, she can check her IUD strings from time to time, especially in the first few months and after monthly bleeding, to confirm that her IUD is still in place (see Question 10).
Length of pregnancy protection
Discuss how to remember the date to return.
Give each woman the following information in writing and explain:
– The type of IUD she has
– Date of IUD insertion
– Month and year when IUD will need to be removed or replaced
– Where to go if she has problems or questions with her IUD
A follow-up visit after her first monthly bleeding or 3 to 6 weeks after IUD insertion is recommended. No woman should be denied an IUD, however, because follow-up would be difficult or not possible.
“Come Back Any Time”: Reasons to Return
Assure every client that she is welcome to come back any time—for example, if she has problems, questions, or wants another method; or she has a major change in health status. Also if:
- She thinks the IUD might be out of place. For example, she:
– Feels the strings are missing.
– Feels the hard plastic of an IUD that has partially come out.
She has symptoms of pelvic inflammatory disease (increasing or severe pain in the lower abdomen, pain during sex, unusual vaginal discharge, fever, chills, nausea, and/or vomiting), especially in the first 20 days after insertion.
She thinks she might be pregnant.
General health advice: Anyone who suddenly feels that something is seriously wrong with her health should immediately seek medical care from a nurse or doctor.
Her contraceptive method is most likely not the cause of the condition, but she should tell the nurse or doctor what method she is using.