Screening Questions for Pelvic Examination Before IUD Insertion

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 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?

NO    YES Possible STI.

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

NO    YES Possible PID.

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

NO    YES Possible PID.

4.    Is there a purulent cervical discharge?

NO    YES Possible STI or PID.

5.    Does the cervix bleed easily when touched?

NO    YES Possible STI or cervical cancer.

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

NO    YES 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?

NO    YES 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.