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Now that you have learned the indications for and the risks and benefits of IUD use, you are ready to insert the IUD. The IUD can be placed anytime during the menstrual cycle, but insertion during menses provides additional reassurance that your patient is not pregnant. There is no evidence supporting routine antibiotic prophylaxis prior to insertion, but your patient may take ibuprofen to minimize discomfort. Whether you are placing the copper-releasing or progestin-releasing IUD, the initial steps are the same.
The initial steps of IUD insertion:
Obtain consent and give the informational brochure to your patient
Confirm a negative pregnancy test, if needed
Perform a bimanual exam to determine the size and position of the uterus
Insert a sterile speculum with good visualization of the cervix
Switch to sterile gloves and follow sterile procedure
Cleanse the cervix and adjacent vaginal fornices with antiseptic solution
Gently insert a uterine sound to determine the depth of the uterine cavity (avoid contact with the vagina and the speculum blades)
May require stabilization of the cervix with a tenaculum applied to the anterior lip of the cervix
May use an endometrial aspirator instead of a metallic sound to determine the uterine depth
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