Challenging IUD Procedures

Abstract

Nulligravid and nulliparous adolescents and young adults have similar rates of successful intrauterine device (IUD) placement compared to older and multiparous individuals. Provider experience with IUD procedures is the most important factor contributing to successful provision of IUD services with patients of any age or parity. Most challenges that arise during IUD placement can be successfully resolved using strategies that do not require advanced training. When advanced skills are required, mechanical or pharmacologic dilation with or without ultrasound guidance will generally result in successful placement. Using algorithms to identify and overcome challenges that arise, such as those provided in this book, will improve success with adolescent and young adult IUD procedures. This chapter will provide clinical strategies to address the common factors that contribute to challenging IUD placements for adolescents and young adults, describe techniques to facilitate IUD placement in challenging scenarios, and discuss approaches to manage difficult IUD removals.