[silence]

This leader permits the projectionist

to adjust focus and soundfor the picture that follows

the insertion and removalof the intrauterine device or IUD.

This IUD is the Lippes loop.

It is a small, flexible plastic device.

It rests in the uterine cavity and ishighly effective in preventing pregnancy.

The Lippes loop is designedto be straightened out

and inserted through a plastic tube.

As shown on this model,the tube called the inserter

is slipped into the cervical canaland the device is pushed into the uterus.

Once inside the uterine cavity,the IUD recoils to its original shape

and may remain in place for many years.

The threads enable the patientto determine that the IUD is in place.

They also permit easy removal.

The IUD differsfrom all other methods of contraception

in that, once inserted,it requires little further attention.

As shown in these drawings,the technique of insertion depends

on the doctor's abilityto locate accurately

the position of the uterus,the anterior position, the mid position,

the posterior position,

and to place the IUDin the frontal plane of the uterine cavity.

The instruments needed for insertionare the speculum, the sponge forceps,

the inserter, the plunger, and the IUD.

The metal instruments are sterilized.

Since the plastics cannot be boiled,they are sterilized in iodine solution.

Preparation of the solution is as follows.

To tap water,

tincture of iodineis added until an orange color is obtained.

Yellow is not strong enough.

The plastic equipment should be immersed

in the orange iodine solutionfor five minutes before using.

The sterile tray is set up for the patient.

The clinical procedurebegins with the insertion of the speculum.

Then the physician takesa Papanicolaou smear

if none was obtained during the last year.

Next, he performs a bimanual examinationto detect any abnormalities

and to note the uterine position.

With the routine examination completed,the speculum is reinserted.

The cervix is swabbed with cotton.

Sterile gloves are put onbefore handling the Lippes loop.

Because the plasticdevices have a limited ability to recoil,

the IUD is placed in the inserterimmediately before the actual insertion.

The IUD should be loadedso that when the black indicator

is horizontal at the cervical os,the IUD will extrude in the frontal plane.

The inserter is slipped gentlyinto the cervical canal past

the internal os

and the IUD is inserted.

The plunger is removed first

so that the strings will not be caughtand the device accidentally pulled out.

On some patients,

abdominal pressure will simplify insertionby straightening an anterior uterus.

Press, hold, push in.

Occasionally, the uterus may needto be straightened with a tenaculum.

A uterine sound will helpto confirm the position of the uterus.

The inserter passes easilyinto the straightened uterus

and the IUD  is inserted.

A fluoroscopic view of the pelvis shows

the speculum with a Lippes loop enteringthe frontal plane of the uterine cavity.

In the normal procedure,after the routine examination,

the speculum is reinserted.

The cervix is swabbed with cotton.

The inserter is pushed in gentlyto the black rubber mark

and the IUD is inserted.

The ID may cause increased menstrual flowduring the third three months.

The plungerand then the inserter are removed.

The strings should be in placeat the cervical os.

The IUD can be removed easilyby pulling the strings.

In brief review,

if the physician notes accuratelythe position of the uterus,

if he places the IUD so that it will enterthe frontal plane of the uterine cavity,

insertion  is performed without difficulty.