Insertion of an IUD should always be done by a trained practitioner, either a doctor or a paramedical person fully trained in IUD. Successful of an IUD generally depends on whether the woman is relaxed, whether the correct size of IUD has been chosen, and the skill and experience of the practitioner. Insertion can be done at any stage of the menstrual cycle, but is preferable during or just after a period. This makes insertion easier, as the cervix is softer and more open, and also there is very little chance that the woman may be pregnant. However, the incidence of expulsion is also a little higher at this time. Iuos can be fitted immediately after childbirth, or abortion, but then too the expulsion rate is higher; the optimum time if an IUD is to be fitted straight away seems to be about four days after the pregnancy has ended. Most practitioners prefer to wait until about six weeks after the birth.
The practitioner inserts a speculum, and examines the cervix and vagina to check that they are healthy. If the internal os is abnormal or damaged there is a high risk of IUD expulsion; if there is a cervical erosion, it is preferable to treat this before an IUD is fitted. A Pap smear may be taken at this stage. The woman is given a pelvic examination to check that her reproductive organs are normal and healthy. If the uterus is retroverted or acutely flexed this can make thedifficult.
The cervix is cleaned with antiseptic, and a local anaesthetic may be given if the woman is very tense or if the doctor will need to manipulate the uterus or cervix a great deal. A sound is inserted to check the length of the uterus. The chosen (sterile) IUD is fitted into a narrow tube, and the tube is inserted through the cervical canal. The IUD is released into the uterine cavity, and the tube withdrawn so that the IUD strings trail down through the cervical canal into the vagina. The strings are trimmed to about 3-5cm.
During fitting about 1 in 1000 women will collapse with so-called ‘cervical shock’; IUD fitting rooms should always be equipped to cope with this kind of attack. Epileptics may run the risk of having an attack at the time of insertion, and the practitioner should be aware of this risk. Many women may experience backache or cramping discomfort soon after fitting; this can generally be relieved with ordinary analgesics. Some women may expel the IUD almost immediately, and others within the first couple of days; the woman should return to the clinic if bleeding or pain continues for more than a day or two.
IUD users will be taught how to check with the fingers that the strings are in place. This should be done after every period, at mid-cycle, and after sex. The effectiveness of the IUD begins immediately, so no back-up method is necessary. The woman should attend all follow-up appointments, and any appointments to have the IUD replaced if necessary.