Counseling for insertion of IUCD and procedure of insertion

Counseling the woman before insertion of IUCD:
Before insertion of IUCD the woman should empty the bladder, perineum should be draped.
Per speculum examination done by the medical person to note any infection or local lesions or menstrual flow.
Pap smear taken to rule out any premalignant conditions.
Per vaginal examination done to know the position of cervix, position and size of uterus, to know the mobility of uterus and to make out any adnexal masses.
Then the anterior lip of the cervix held with vulsellum and the uterus is sounded to know the length and version.

Procedure for loading the IUCD eg. Cu-t:
IUCD should be loaded not more than five minutes before insertion. Have to bend the arms of the Cu-t between thumb & index finger and push the insertion tube to pick up the folded arms.
Check the position of the plastic adjustable collar accordingly.

Then we have to gently introduce the inserter until the adjustable collar snugly fits the external os. Then hold the plunger firmly with left hand and outer inserter tube is retracted over the plunger with right hand for about 2 cms , withdraw the plunger and inserter tube.
Then cut the threads.


Instructions after the procedure: Patient should be informed that she can have cramping pain, vaginal discharge, heavier menstrual periods and bleeding between the periods.
But all this will settle down normally.
Checking the IUD should be done, once a week in the 1st month then after each menstrual period.
The woman should not pull the strings.