Intrauterine techniques: Contentious or consensus opinion?

Abstract

Context. Insertion of intrauterine devices (IUDs) is a routine procedure in Contraception & Sexual Health (C&SH) Service clinics. Techniques for IUD insertion vary between practitioners. Objective. To describe the preferred approach to various aspects of IUD provision of experienced doctors working in three large, teaching C&SH Services, including policies on screening for chlamydia, antibiotic prophylaxis, use of tenaculae, use of analgesia/anaesthesia and use of assistants at the time of IUD insertion. Design. An anonymous questionnaire to all doctors working in three neighbouring services. Setting. Three community C&SH Services in Hampshire seeing in total approximately 92 000 patients each year. Participants. Doctors working regularly in target C&SH Services. Results. A total of 94% of doctors cleanse the cervix prior to IUD insertion, 96% test for chlamydia before fitting an emergency coil and 18.5% always prescribe prophylactic antibiotics. For routine IUD insertions, 50% of doctors always screen for chlamydia prior to fitting the device. A total of 86% of doctors always stabilise the cervix with an Allis or similar instrument, with 14% reporting using an Allis 'sometimes' or 'rarely/never'. Instillagel® was the most commonly used method of anaesthesia. A total of 75% of doctors have an assistant present for every insertion, eight doctors 'sometimes', and one 'rarely/never'. Discussion. Arguments for and against each area of contention are discussed, and evidence reviewed. Conclusion. Practice varies between practitioners, and doctors training in intrauterine techniques may be given conflicting advice. All clinicians should be able to justify their practice on clinical grounds and audit outcomes.