Instructions For Placement

If ultrasound equipment is available in your facility, an ultrasound examination is the ideal way to assess the size, shape, and position of your patient’s uterus. Women appreciate not having to go through a physical bimanual examination. In the case that no ultrasound technology is available, the physician will perform the bimanual examination and measure with uterine sound, which may cause some patient discomfort. Physicians should recommend that the patient take two paracetamol or an ibuprofen 30 minutes before the procedure.

To set up the portio of the cervix, the physician will use a self-containing speculum which allows them to use both hands. The measurement to the cervix determines which speculum is the right size for each patient. Choosing a speculum with the shortest length possible makes it easier to stretch the cervix before insertion. When the speculum is the incorrect size, insertion is difficult and, in some cases, impossible. Once the portio is ready, the physician will use an antiseptic solution to disinfect the cervix.

Note: Local anesthetics are optional and are not available in every country.

If the patient requests local anesthetics, use a 10cc syringe with a short needle to reach the cervix. Take 2cc of the anesthetic such as lidocaine into the syringe and place the needle against the cervix approximately 2 mm above the external OS and give a slight tap to insert. Avoid tapping too slowly, which can push away the cervix. Inject approximately ½ mm in the location where you will place the tenaculum. The injection will produce a whitening of the area. If the cervix is large, inject in two or three different areas.

To grasp the cervix, the physician will fix a tenaculum to the cervix, positioning the tenaculum carefully directly above the external orifice. Then, close the tenaculum just enough to fix it to the cervix. Usually, it is unnecessary to close the tenaculum completely, which may cause patient pain and discomfort.

The physician will use a dilator and hegars to enlarge the tissue temporarily and to simplify insertion. The dilation also prevents the Flexi-T from turning down or bending during the insertion or passing the external and internal orifice. Using the hegars, the physician can stretch the internal orifice half a millimeter. 

Before inserting the dilator, the physician should carefully pull the tenaculum to stretch the uterus. It may be necessary to pull the speculum back slightly. 

After measuring the uterus sound length and dilation for easy insertion, take out the Flexi-T, holding it at the end of the inserter tube. Place the blue ring in the correct measured sound distance. Then, the blue thread will loosen. Fix the blue thread between thumb and forefinger on the insertion tube. This ensures the Flexi-T is fixated firmly against the insertion tube. The Flexi-T will remain in position, making it easier to insert. Not holding the blue thread can result in the Flexi-T turning around during insertion or even falling out of the tube.

An experienced gynecologist will be able to feel when the IUD has reached the fundus, so the blue ring is not always necessary.

The physician can use the ultrasound to verify the IUD is in the correct position. The patient may also see for herself by looking at the ultrasound. However, if no ultrasound technology is available, gently pull on the thread coming from the inserter tube. This will help you to determine whether the IUD’s arms are unfolded and the lateral muscular wall of the uterus is properly holding the device in place. After verifying placement, use the device to gently push the inserter tube toward the fundus, ensuring the blue thread remains loose. 

In the case no ultrasound technology is available, verify secure placement with a bimanual examination.

To remove the insertion tube, begin by removing the tenaculum. Then, very carefully, using a rotating movement, remove the inserter tube without pulling the Flexi-T downward or out. Avoid removing the entire tube.

Before removing the entire inserter tube, cut the wire at 1.5 cm. Remove the speculum.

Some patients may experience a vaso-vagal reaction due to stimulation of the vagus nerve that sometimes occurs after dilation of the internal orifice. This is more common in women who have never given birth. A physician with knowledge and control of the vasal-vagal reaction will be able to properly monitor and assist the patient.

The physician should verify the presence and position of the Flexi-T after the first cycle and again after ± six months. Although patient self-examination is possible, it may not provide the correct information.

If you have additional questions about the physician instructions for insertion of the Flexi-T IUD, contact the trusted experts.