IUD without authorization and the correct process for its placement

Category: Health Issues Topic: IUD without authorization and the correct process for its placement When we decide to choose a contraceptive method, there are many criteria to take into account. The IUD has become one of the preferred choices for many women due to the safety and comfort it offers but, like any other system, its incorrect use can lead to ineffectiveness and even result in health problems that affect fertility in the woman. The case that occurred in Mexico of a woman who had an IUD inserted without authorization has reopened the debate on this contraceptive method, a conflict in which both the possible risks derived from this circumstance and the violation of rights that having subjected are questioned. Woman to this process without her authorization.

How to check the correct placement of the IUD

• Irma López, a 28-year-old Mexican indigenous woman, went to the San Felipe Jalapa de Díaz health center due to her advanced state of pregnancy. Despite the fact that she was in the process of labor, she was not attended to or admitted by medical personnel, and after a nurse told her to "go for a walk" she ended up giving birth naturally in the hospital garden. Only then did they come to care for her, when her son was still attached to her by the umbilical cord.
• In addition to the lack of attention, Irma López denounced that after a previous pregnancy, the doctors had inserted an IUD without her authorization, a practice that has already been denounced in the country before. Due to the wrong placement of the IUD, the IUD failed and the woman became pregnant again. This is one of the reasons why it is a violation of human rights, since the IUD, despite being a safe method, requires supervision by the woman, which she cannot do if it has been inserted without her consent knowledge.
• To place the IUD in the cervix, it is inserted folded and opened once the gynecologist has introduced it into the cervix, allowing it to recover its T-shape and block the passage of sperm. To verify that there are no problems, some threads are left that must be checked regularly to verify that they remain in place, otherwise it loses its effectiveness as well as causing problems such as tears and uterine infections.

## How to confirm correct placement — practical, step-by-step checks The list above explains the basics; here I add detailed, actionable steps you or your clinician should follow to confirm correct IUD placement. These are practical, evidence-based measures I use in clinic. - Immediately post-insertion (in-clinic) - Confirm you (the patient) can feel the strings at the external cervical os with a speculum check. This is routine immediately after the insertion. - Visual confirmation: the IUD arms should be at or near the uterine fundus. Insertion depth should feel fundal on the inserter — if the inserter does not meet the fundus, gently reposition if needed. - Cut strings to about 3–4 cm beyond the external os. This length allows self-checking and clinician retrieval without protruding into the vagina where they can irritate. - Day-of self-check - At 4–6 weeks after insertion, and then monthly for the first 3 months, feel for the strings (not the device). Wash hands and insert one finger into the vagina to locate the cervix and the thin strings emerging from it. If you feel hard plastic or you cannot find strings, contact your clinician promptly. - When to use ultrasound - If strings are not palpable or you suspect expulsion, a transvaginal ultrasound is the first-line imaging to confirm intrauterine location and fundal placement. - If ultrasound is inconclusive and you still cannot find the IUD, obtain a pelvic x-ray (IUDs are radiopaque) to rule out perforation and intraperitoneal migration. - Signs that placement is incorrect (seek care if any occur) - Missing or shorter strings - New pelvic pain or severe cramping after insertion - Abnormal heavy bleeding exceeding your expected pattern - Pregnancy symptoms or a positive pregnancy test Real clinical tip: if a patient reports new focal severe pain immediately after insertion and the IUD strings are not visible, suspect perforation. Arrange same-day ultrasound and surgical consult if ultrasound suggests extrauterine location. ## If you suspect an IUD was inserted without your consent: immediate actions Unauthorized insertion is a medical, ethical and legal violation. Patient safety and rights come first. Here are concrete steps to take if you suspect an IUD was placed without your authorization. - Seek immediate medical assessment - Arrange an urgent gynecologic consult to confirm whether an IUD is present and to evaluate placement using a speculum examination and transvaginal ultrasound. - If you are pregnant or have heavy bleeding, seek emergency care. - Document and preserve evidence - Ask for copies of your medical records, including the procedure note, consent forms, nursing notes, and any imaging. If denied, request them in writing. - Take photographs of any visible signs (e.g., inflammation at cervix if present), noting date and time. - Request removal if desired - If the IUD was placed without your permission, you have the right to request removal. Removal is often straightforward if the strings are accessible; if not, removal under ultrasound or hysteroscopy may be necessary. - Discuss timing: if you are pregnant, the decision to remove should be individualized — removing a visible IUD in early pregnancy reduces infection risk but has a small increased risk of miscarriage; a specialist should counsel you. - Get a second opinion and expert evaluation - If you distrust the original clinician, seek a gynecology colleague or reproductive health clinic. Many hospitals have patient advocates or ethics committees to assist. - Report the incident - File a complaint with the facility, local health authority, or licensing board. Ask for a copy of the complaint and follow up. - If you prefer, contact a reproductive rights organization for legal advice and support. Practical example: A 35-year-old patient came to my clinic reporting she had never consented to contraception but discovered an LNG-IUD during a routine exam. We performed a transvaginal ultrasound to confirm placement, removed the device in clinic with ring forceps after local anesthetic, provided counseling, documented everything in her chart, and referred her to a patient advocate. She later filed a complaint with the hospital. ## Correct clinical process for IUD placement: step-by-step (for clinicians and what patients should expect) Below I describe a correct, evidence-based insertion workflow. This is both a checklist clinicians should follow and a list patients can use to verify they received proper care. - Pre-insertion counseling and consent (mandatory) - Discuss full options, risks, benefits, side effects, and alternatives (copper IUD vs levonorgestrel IUS vs other contraceptives). - Review STI risk and offer testing if clinically indicated. - Obtain documented informed consent — verbal counseling is not sufficient without documentation. - Pre-procedure checklist - Confirm pregnancy status if patient reports missed periods or other risk factors (urine pregnancy test within 1 week or same day if indicated). - Screen for current pelvic infection; do not insert an IUD in active PID. - Offer analgesia: oral NSAID (ibuprofen) pre-procedure reduces pain; local cervical block is optional. - Ensure sterile instruments and trained assistant. - Procedure steps (practical, clinic-level) - Position patient in dorsal lithotomy. Perform a bimanual exam to assess uterine size, position, and mobility. - Use a sterile speculum and cleanse cervix with antiseptic. - Grasp the cervix with a single atraumatic tenaculum to steady it. - Measure uterine depth with a uterine sound if used — many clinicians use a sound to avoid perforation; manufacturer’s guidance should be followed. - Load the IUD according to manufacturer instructions and advance to the fundus. Release the arms and withdraw the inserter to the cervix, then trim strings to 3–4 cm. - Document insertion depth, difficulty, analgesia used, and patient tolerance. - Post-insertion care and follow-up - Observe for 10–15 minutes for bleeding or vasovagal symptoms. - Provide written instructions on how to check strings and warning signs that require immediate care. - Schedule a follow-up appointment at 4–8 weeks (earlier if problems) to check strings and symptoms. If postpartum immediate insertion was performed, counsel on slightly higher expulsion risk and plan follow-up sooner (4 weeks). Expert note: Routine prophylactic antibiotics are not recommended for IUD placement in low-risk patients. Use antibiotics if there's a specific indication (e.g., current STD or high risk). ## Signs of misplacement, complications and how they are managed Understanding the range of complications helps you act quickly. Below are common and rare problems and clear steps for evaluation and management. - Partial expulsion - Presentation: strings shorter than before, increased bleeding or pain, or sensing the device in the vagina. - Action: If partially expelled but strings visible, remove and replace in clinic once infection is ruled out or switch method. If patient wants another IUD, re-insert after counseling. - Complete expulsion - Presentation: patient reports device fell out; pregnancy risk possible. - Action: Confirm with speculum and ultrasound. Offer emergency contraception if within window and pregnancy test if indicated. - Perforation and migration (rare but serious) - Presentation: sudden severe pain during insertion or persistent pain after, inability to visualize IUD in cavity on ultrasound, or extrauterine location on imaging. - Action: Obtain pelvic x-ray if ultrasound unclear. If device is in peritoneal cavity, laparoscopic removal is usually required. - Pregnancy with IUD in place - Presentation: positive pregnancy test, sometimes spotting or abdominal pain. - Action: Arrange urgent ultrasound. If IUD strings are visible, removal reduces risk of infection and adverse pregnancy outcomes; if strings are not seen, weigh risks, monitor closely, and consult maternal-fetal medicine if needed. Real case: A 26-year-old nulliparous patient had a copper IUD inserted 2 weeks postpartum at a primary clinic. She presented with cramping and heavy bleeding. Ultrasound showed the IUD in the lower uterine segment (malposition). The device was removed and replaced after counseling and confirming no infection. She chose a levonorgestrel IUS for lighter bleeding. ## How to self-check and when to seek care — patient-focused, practical instructions - Self-check method (monthly for first 3 months, then periodically) - Wash your hands. - Sit or squat and insert your index finger into the vagina until you touch the cervix. - Feel for two thin, flexible threads. Do not pull on the strings. - If you feel hard plastic at the cervix, that suggests the device may be low or partially expelled — contact your clinician. - When to seek immediate care - Severe abdominal pain not responding to analgesics - Fever >38°C (100.4°F) with pelvic pain (possible infection) - Unusual, heavy bleeding (soaking >1 pad/hour) - Pregnancy symptoms or a positive pregnancy test - Strings suddenly shorter or longer, or you find the device in your underwear Practical product note: Supplies like menstrual cups or speculum kits are available for clinic use and patient education — see our [shop](/shop) for recommended clinician-grade items and patient educational models. ## Legal and ethical considerations — protecting reproductive autonomy Unauthorized insertion is both a violation of autonomy and a safety issue. Clinicians must adhere to consent laws and institutional policies. If you are a clinician: - Always obtain and document informed consent. Use interpreter services if language is a barrier. - Document alternatives discussed, risks/benefits, and the patient’s decision. - If a patient lacks capacity, follow local laws regarding consent from legal guardians and document thoroughly. - Report suspected misconduct via institutional channels and cooperate with investigations. If you are a patient and suspect rights were violated: - Request a written explanation and copies of your records. - Contact patient advocacy groups and legal counsel if needed. Many reproductive health organizations offer support and guidance. - Consider reporting to your local health authority or licensing board. For more background on rights-based reproductive care, read our [related topic](/blog) that covers informed consent and contraception ethics. ## Practical scenarios and examples — what I do in clinic Example 1 — Missing strings: A 34-year-old presented for a 6-week check and could not feel strings. On speculum exam the strings were not visible. I ordered a transvaginal ultrasound which showed the IUD low in the cavity but intrauterine. I removed the device and re-inserted a new LNG-IUS after counseling; she tolerated it well. Example 2 — Suspected unauthorized insertion: A patient reported being told she had a contraceptive inserted without her knowledge at a previous facility. She was anxious and reluctant to be examined. I first established rapport, explained all steps of the physical exam, and offered a chaperone. We confirmed the device with ultrasound and removed it on request. I documented the patient’s statements and referred her to patient advocacy. Example 3 — Perforation requiring surgery: During a difficult insertion, a patient experienced sharp pain. The IUD strings were not visible afterwards. Ultrasound suggested the device was not in the uterine cavity; pelvic x-ray confirmed extrauterine location. She underwent laparoscopic removal and recovered uneventfully. We documented the event, notified the hospital quality team, and provided counseling. ## How to choose between Copper IUD and Levonorgestrel IUS (clinical pointers) - Copper IUD (Cu-IUD) - Mechanism: spermicidal effect of copper - Ideal for: women who prefer hormone-free contraception, emergency contraception option if inserted within 5 days of unprotected sex (some guidelines extend timing) - Side effects: heavier, longer menses and increased cramping - Levonorgestrel intrauterine system (LNG-IUS) - Mechanism: local progestin effect causing cervical mucus thickening and endometrial changes - Ideal for: women who want reduced bleeding or amenorrhea potential, effective treatment for heavy menstrual bleeding - Side effects: irregular bleeding initially, possible systemic progestin side effects (rare) Decision-making: offer patient-centered counseling, covering contraception goals, bleeding preferences, medical contraindications (e.g., active pelvic infection), and plans for future fertility. ## When removal is needed and how it’s performed - Indications for removal - Patient requests removal (always honored) - Device is malpositioned, expelled, or causing severe symptoms - Confirmed pregnancy (individualized decision) - Intrauterine infection unresponsive to antibiotics - Removal technique - If strings visible: gentle traction on strings with forceps in clinic with local anesthesia as needed. - If strings not visible: ultrasound-guided removal or hysteroscopic removal in an outpatient or operating room setting. - If perforated and migrated: laparoscopic retrieval often required. Practical tip: If removal is expected to be difficult (e.g., pregnancy, embedded device), arrange for removal with hysteroscopic capability and counseling regarding risks. ## Follow-up and long-term care - Schedule a routine check at 4–8 weeks post-insertion to assess strings and symptoms. - After the initial period, annual wellness checks are sufficient for most women unless symptoms arise. - Discuss ongoing pregnancy plans — most IUDs are removed when pregnancy is desired; fertility typically returns quickly after removal (cycles may resume within weeks). ## Resources and support If you need further patient-facing information or products, consult our clinic resources and patient education materials in our [shop](/shop). For broader reading on informed consent and reproductive rights, see our [related topic](/blog). ## FAQ ### What should I do if I think an IUD was inserted without my permission? If you suspect an unauthorized insertion, seek clinical assessment immediately to confirm whether an IUD is present and assess placement (speculum exam and transvaginal ultrasound). Document everything: request copies of your medical records and any consent forms. Ask for removal if you wish — this can often be done in clinic. File a complaint with the facility and consider contacting a patient advocate or legal counsel. If you are in immediate pain or have signs of infection or pregnancy, go to emergency care. ### How can I tell if my IUD is in the right place at home? You can check your IUD strings by washing your hands, inserting a finger into the vagina, and feeling for the thin strings at the cervix. Do not pull on the strings. If you cannot feel strings, feel hard plastic, or notice the device protruding, contact your clinician. Monthly checks for the first 3 months and then periodically are recommended. ### Can I get pregnant with an IUD in place? Pregnancy can occur with an IUD, though it is uncommon. If you have a positive pregnancy test with an IUD in situ, contact your clinician immediately. If the strings are visible, removal in early pregnancy reduces the risk of miscarriage and infection compared with leaving the device in place. If the strings are not visible, management must be individualized with ultrasound monitoring and specialist consultation. ### What are the signs of a misplaced or perforated IUD? Signs include severe pain during insertion, persistent pelvic pain, missing strings, abnormal bleeding, or inability to visualize the IUD in the uterine cavity on ultrasound. If perforation is suspected, obtain pelvic x-ray to locate the device; most migrated IUDs require laparoscopic retrieval. ### What is the proper consent process before IUD insertion? Proper informed consent includes a documented discussion of all contraception options, the risks and benefits of the IUD type being proposed (copper vs levonorgestrel), potential side effects, alternatives, and the right to refuse. Consent should be given voluntarily, with language interpretation if required, and documented in the medical record. No one should be fitted with an IUD without their informed consent. --- If you have specific concerns about an IUD insertion you experienced, bring any documents you have to your appointment and ask for an ultrasound and full counseling. For education on related reproductive health topics, visit [related topic](/blog). For clinician supplies and patient models you can use in counseling, see our [shop](/shop).