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How is a Mirena intrauterine contraceptive system (IUS) inserted?

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How is a Mirena intrauterine contraceptive system (IUS) inserted?

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A vaginal speculum is inserted and the cervix is visualized. The cervix is cleansed using an aqueous antiseptic solution. Local anaesthetic (e.g. lidocaine 1%) can be injected into the anterior lip of the cervix, prior to application of a tenaculum, and it can also be used to establish a para-cervical block, particularly in nulliparous women. The tenaculum on the anterior lip of the cervix though not mandatory is often extremely helpful in straightening and aligning the cervical canal with the uterine cavity (thus decreasing the risk of perforation). The uterus is usually sounded. The IUS is then loaded into the barrel of the inserter, using sterile technique and following the manufacturer’s recommended method and making sure that the arms are perpendicular to the barrel. The strings are held in place in the groove found at the end of the barrel. The flange on the outside of the barrel is adjusted to the depth of the uterine cavity (as measured by the sound). The tip of the inserter ba

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