# Paragard Insertion

## Overview

This module describes how to insert a Paragard, a copper-based intrauterine contraceptive device.

## Indications

## Contraindications

## Patient information and consent

Patients should be fully counseled about their contraceptive options. Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“You have chosen the Paragard intrauterine device for family planning. The Paragard is a very small device which is stored in a thin tube. I will place the tube through your cervix into your womb, where the wings will pop out to keep it in place. I will then remove the tube.”

### What can my patient expect?

“Some patients do not find this painful, but other patients get moderate to severe pain during insertion. Afterwards, you can get cramping and minor spotting for a few days, but bleeding should be minimal. You or your sexual partner will not feel the Paragard device in your womb.”

### What is my patient’s role?

“Tell me if you have any illnesses, symptoms of sexually transmitted infections, or allergies. Tell me if the pain becomes too much, or you need a break before we go ahead. If at any point you feel you do not want to continue with the procedure, tell me and I’ll stop immediately. Let me know if you feel faint.”

## Preparation

Prepare a trolley with equipment. A female chaperone should be present.

### Documentation

### Equipment

## Site & Positioning

The patient should be positioned in dorsal lithotomy. A bimanual examination using non-sterile gloves should be performed to determine uterine position and size.

## Procedure

Follow medical asepsis with sterile gloves.

## Troubleshooting

The cervical os is too tightly closed to pass the Paragard.

You may need a set of graduated cervical dilators to dilate the cervix before insertion.

I want to manage IUD insertion and post-insertion pain.

There is no evidence that using a cervical block, misoprostol, or NSAIDs reduces insertion pain, but a cervical block may reduce tenaculum application pain, and NSAIDs may reduce cramping post-insertion. Procedural sedation may be necessary in patients experiencing severe insertion pain.

## Risks

## References