Bimanual Exam
The process for inserting an intrauterine device (IUD) begins with a bimanual exam. To do this, the doctor has the woman lay on the examining table with her knees bent, in stirrups if necessary. The doctor then places one hand on the woman's abdomen and inserts fingers on the other hand into the vagina. The doctor then checks the size and orientation of the uterus. Once this information is determined, the doctor will conclude the bimanual exam.
Speculum Exam
After the bimanual exam, the doctor will insert a speculum into the woman's vagina. He will then check the cervix to ensure that inserting the IUD is appropriate for the woman. After he has checked the cervix, he will sterilize the vaginal area using an antiseptic solution approved for use in the genital area. He will then insert a tenaculum to straighten the cervix and hold it straight. A tenaculum is a specialized type of foreceps that has teeth-like notches on one end. The teeth are used to grasp the tender cervical tissue and hold the cervix in place during the procedure without damaging the cervix.
IUD Insertion
While the manufacturer's directions may vary slightly, most IUDs are inserted using a method called the withdrawal technique. In this technique, the IUD is loaded into an insertion tube and secured with a plunger. The tube is then inserted into the vagina and pushed into the cervix. The insertion tube is removed, but the plunger and IUD remain in place. Once the insertion tube is removed, the plunger is pulled out. This leaves the IUD in place.
Completing the Procedure
Once the insertion tube and plunger are removed, the doctor must trim the strings that hang out of the cervix. Using small scissors, the strings should be cut to approximately three centimeters. The doctor should then remove the speculum and provide the woman with instructions for ensuring the IUD remains in place by feeling the strings periodically. She should also be informed of possible side effects during the first week after the insertion of the IUD, including spotting, abdominal pain and lightheadedness. The doctor will provide her with towels to clean up before getting dressed.
