(58) Full Bladder IUD Insertion Without Tenacle

Background: Pain at insertion is one of the barriers for IUD use in adolescents. Most of it, is due to tenacle placement in the cervix to align the cervical angle to the endometrial cavity. This same alignment can be achieved with a full bladder.
The objective is to describe a novel IUD insertion technique that avoids the use of the tenacle and thus, can reduce the pain at insertion, the triggering of vasovagal response and a shorter procedure duration.

Case: Patients were instructed to arrive to the appointment with a full bladder, using the same instructions as for an abdominal gynecological ultrasound (US). Informed consent was obtained. Upon arrival, full bladder is corroborated with US. After the placement of the speculum, an endometrial sound was inserted without tenacle use. This can be achieved because the full bladder straightens the angle between the cervix and uterus, similarly as what the tenacle does by pulling the cervix. If sounding cannot be achieved, a tenacle was used for a regular IUD insertion technique. Placement of the IUD is corroborated post insertion by ultrasound.
We describe a preliminary data of 69 full bladder IUD insertions in nulliparous patients 12-24 yo, in a PAG clinic of the Adolescence Center, at Clínica Alemana Hospital in Santiago, Chile, between 2022 and 2023. The types of IUD used were: Kyleena (n=33), Mirena (n=33),copper IUD (n=3). The uterine position of this patients was anteverted (n=63) retroverted (n=6). Vasovagal reactions occurred in 5 (7,2%) of the patients. All IUDs were correctly placed.
Outcomes:
71% (n=49) of insertions were achieved without tenaculum.
Insertions without tenaculum were successful in 67% (n= 22) of Kyleena IUDs, 73% (n=24) of Mirena IUDs and 100%(n=3) of Copper IUD.
Insertions without tenaculum were successful in 71.4% (n= 45) anteverted uterus and 67% (n= 4) retroverted uterus.
Insertions without tenaculum had 4%(n=2) of vasovagal reactions compared to 15% (n=3) of the cases when tenaculum was used.

Comments: This high rate of full bladder insertions without tenaculum suggest that this is a very useful strategy that can ease IUD insertion in nulliparous individuals. Avoiding the tenaculum, has the potential of making the procedure easier, shorter, and less painful, with a better post-procedure recovery time improving the overall patient experience during the IUD insertion. Further comparative research of this technique versus traditional insertion with tenaculum is needed to quantify differences between in success rate between IUDs, uterine position, patient pain and procedure time.