Tips for Placement

• Provide objective data about pain and expectations of placement (2-3 on a 10-point scale, reports and experiences by women)
• Suggest the woman brings a friend in the event she experiences discomfort or a vagal episode
• A tenaculum should always be used to reduce the axis of the uterus and reduce perforation
• Have the woman cough upon tenaculum placement to reduce pain
• Sound the uterus, and do not use the device as a sound
  •   Warn women that they may experience discomfort at the point when the sound reached 4cm (internal os of the cervix)
• An os finder can be extremely useful when sounding is difficult
• For steeply angled uterus and when no plastic sound is available, an endometrial biopsy pipelle can be used
• Do not open the IUC package until sounding has been successful
• For a retroverted uterus, consider grasping the posterior lip of the cervix with the tenaculum
• For a retroverted uterus, rotate the IUS inserter upside down so that the tip of the inserter points downwards.
• For an anteroflexed uterus, apply suprapubic pressure to correct angle of the uterus.

Expert consensus (CNIC)