Intrauterine techniques: contentious or consensus opinion?
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.