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Obstertrics - Cut Insertion & Removal

Home Obstertrics – Cut Insertion & Removal

Introduction

If you have finally stumbled upon IUDs in your search for the most suitable birth control and contraceptive method, let me tell you your search pretty much ends here. By providing birth control, with a failure rate as low as 0.7% in a year and working perfectly as a contraceptive if taken within 5 days of unprotected sex, IUDs (especially IUDs containing Cu) have proven to be more effective than even the hormonal emergency control pills currently available. Also, the effectiveness of the Cu IUDs does not drop in the 5 days after unprotected sex.

With the longevity of as much as 12 years, these Cu IUDs have been found to be safe for women of all ages past their menarche. The most preferred of these Cu IUDs are TCu380A and TCu280s due to their very low failure rate (just about 0.8%). As we can see here, the T-shaped Cu IUDs provide the best success rates. The reason for this is the large surface area of the Cu present on those IUDs. These Cu IUDs are typically long-acting reversible birth control methods with very few chances of side effects.

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What Is the Working in Copper-T (IUD)?

Cu IUDs have two functional attributes. They can be used as a birth control agent and a contraceptive method. Both these functionalities are attributed to different causes. These IUDs raise the copper-ion levels in the uterine fluid as well as tubal fluid. Copper being spermicidal prevents fertilisation and acts as a birth control method.

Though this does not have much circumstantial evidence, it is more or less accepted by most that these Cu IUDs prevent implantation in the uterus, especially when used as emergency contraception. Also, there has been evidence of raised Prostaglandin and WBC levels due to the use of Cu IUDs. Considering the superiority of copper IUDs as contraceptive and birth control methods over other options, you might have many questions about their use and safety. You may wonder if it is painful. Let us learn more about the insertion and removal of Cu IUDs.

What Is the Insertion in Copper-T (IUD)?

Cu IUDs are inserted into one of the most delicate parts of women, the uterus. It is inserted going in via the vagina and then the cervix. Thus, it is clear that only a trained medical practitioner, preferably a gynaecologist or obstetrician, with the right instruments at his/her disposal handles its insertion. This is essential for the correct insertion of the device without injuring a patient and for the correct positioning of the device in the uterus so that it does not move within the uterus in the months post-insertion.
The device can be inserted into the uterus at any time during a woman’s menstruation cycle. However, the best time might be just after menstruation since that’s when a woman’s cervix walls are the softest, and the chances of pregnancy are minimal. These Cu IUDs are safe for use even during postpartum or post-abortion, provided there’s no incidence or complication of an infection.

The process of device insertion is simple. It can be done even in your doctor’s office and barely takes about 5 minutes. Most women do not feel unbearable pain or experience side effects, though some may experience mild cramping and pain that soon subsides.

What Is the Procedure in Copper-T (IUD)?

Patients must be tested for gonorrhoea and chlamydia before device insertion since they have a high chance of contracting Pelvic Inflammatory Disease post insertion of a Cu IUD. A pelvic exam is performed to ascertain the position of the uterus. Right after, the vagina is kept open using a speculum. The cervix and the uterus are kept steady by the tentaculum. A uterine ultrasound may be suggested to confirm the length and direction of the cervical canal and the uterus, thus preventing cervical perforation.

A narrow tube is inserted into the uterus via the cervix. The device is put in via this narrow tube into the uterus. The device has short strings of nylon or plastic hanging downwards via the cervix to the vagina. These strings are meant to help patients or doctors know that the IUD is still in position and enable easy removal or replacement of the device. After the insertion of the device, patients can resume all normal activities, whether sex, swimming, playing, etc., once they feel comfortable. These activities hardly affect the device’s position.

What Is the Removal of IUD?

Whether a woman wants to get pregnant or is looking to replace the device if she has used it for too long or has been experiencing undesirable side effects, removing these devices is as easy as its insertion. It barely takes 5 minutes.

What Is the Removal Procedure of IUD?

For most women, the doctor just gets a hold of the hanging strings in the vagina by ring forceps and gently slides out the device, while the two arms of the device stretch outwards.

If this does not work, a hysteroscope is inserted. This allows the insertion of various small instruments to facilitate the removal procedure. Hysteroscopy can take anywhere between 5 minutes to an hour. Hysteroscopy will probably need a patient to be anaesthetised.

Another possible way of doing this and making it simpler is through ultrasonography-guided device removal. This procedure has multiple benefits. It prevents injury to the cervix and uses much less invasive methods. Moreover, it is also quite cost-effective.

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FAQ's

Can the Use of an IUD Make Women Infertile?

IUDs are mostly long-acting and completely reversible birth control methods. They are provided with plastic/nylon strings to facilitate easy removal. Removing the IUD means a woman can become fertile again within a very short period.

Can the Use of an IUD Cause PID?

No. The use of an IUD by itself can never cause PID. PID can occur due to the insertion of an IUD in a patient who already has gonorrhoea or chlamydia. Even in patients who contracted an STD post-insertion of the IUD, the chances of PID are very low. Also, this is precisely why a test for these diseases is prescribed before IUD insertion.

Is the Use of an IUD for Nulliparous Women Feasible?

Yes, an IUD can easily be used even by women who have never had a baby. Though in this case, they must be aware that their uterus is smaller than someone who has had a baby, and thus there is a rare risk that the IUD may slip out occasionally.

What is the Lower Age Limit to Use an IUD, and What is the Upper Limit?

An IUD can be used by any woman past her menarche, and this includes even adolescents. There is no age restriction for IUD use.

Should There be a Break Between the Removal of a Previously Placed IUD and the Insertion of a New One? For Example, When an IUD has Already been in the Uterus for its Validity Period?

No, usually, a gap is not recommended between the removal of an old and insertion of a new IUD for multiple reasons. First, the chances of infection will be reduced if there is less or no gap between the two procedures, and second, there is a chance that a woman may conceive during this gap, which may probably be unwanted.

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