A pelvic examination and STI risk assessment should be done before IUD insertion. (See Assessing Women for Risk of Sexually Transmitted Infections.) When performing the pelvic examination, asking yourself the questions below helps you check for signs of conditions that would rule out IUD insertion. If the answer to all of the questions is “no,” then the client can have an IUD inserted. If the answer to any question is “yes,” do not insert an IUD.

For questions 1 through 5, if the answer is “yes,” refer for diagnosis and treatment as appropriate. Help her choose another method and counsel her about condom use if she faces any risk of sexually transmitted infections (STIs). Give her condoms, if possible. If an STI or pelvic inflammatory disease (PID) is confirmed and she still wants an IUD, it may be inserted as soon as she finishes treatment, if she is not at risk for reinfection before insertion. 

 

1.    Is there any type of ulcer on the vulva, vagina, or cervix?

Check Here for No NO   Check Here for YesYES Possible STI.

 

2.    Does the client feel pain in her lower abdomen when you move the cervix?

Check Here for No NO   Check Here for YesYES Possible PID.

 

3.    Is there tenderness in the uterus, ovaries, or fallopian tubes (adnexal tenderness)?

Check Here for No NO   Check Here for YesYES Possible PID.

 

4.    Is there a purulent cervical discharge?

Check Here for No NO   Check Here for YesYES Possible STI or PID.

 

5.    Does the cervix bleed easily when touched?

Check Here for No NO   Check Here for YesYES Possible STI or cervical cancer.

 

6.    Is there an anatomical abnormality of the uterine cavity that will prevent correct IUD placement?

Check Here for No NO   Check Here for YesYES If an anatomical abnormality distorts the uterine cavity, proper IUD placement may not be possible. Help her choose another method.

 

7.    Were you unable to determine the size and/or position of the uterus?

Check Here for No NO   Check Here for YesYES Determining the size and position of the uterus before IUD insertion is essential to ensure high placement of the IUD and to minimize risk of perforation. If size and position cannot be determined, do not insert an IUD. Help her choose another method.

 
LNG-IUD for Women With HIV
  • Women living with HIV can safely have an LNG-IUD inserted if they have mild or no clinical disease, whether or not they are on antiretroviral therapy.
  • Women who have HIV infection with advanced or severe clinical disease should not have an IUD inserted.
  • If a woman becomes infected with HIV while she has an IUD in place, it does not need to be removed.
  • An IUD user living with HIV who develops advanced or severe clinical disease can keep the IUD but should be closely monitored for pelvic inflammatory disease.
  • Urge women who have HIV or are at risk for HIV to use condoms along with the IUD. Used consistently and correctly, condoms help prevent transmission of HIV and other STIs.
  • Women who are at risk of HIV but not infected with HIV can have an IUD inserted. The IUD does not increase the risk of becoming infected with HIV.

 

LNG in hand