Hi friends! Currently in my second year of the Family NP program and also in the Women's Health Sub-specialty. I've only taken one sub-specialty class so far (Maternal-Fetal Physiology back in...Spring Semester?). Now, I'm taking the Well-Woman Gynecology course taught by the Women's Health director. She's an incredibly knowledgable, engaging, and fun professor to have teaching the course. Recently, we had an IUD insertion simulation session in the evening.
We went through a mini lecture about the different IUDs, what they are, the medical eligibility criteria (MEC), indications, contraindications, etc. And then we got to practice insertions! I don't have a picture of our simulation pelvises, but we got to take turn inserting IUDs and going through pap smears. We also got to take these IUD insertion kits home!! They're educational kits so they do NOT have hormones. Super neat right?! I was so excited taking these home haha. At the top, we have the Paragard (copper IUD), then we have the Kyleena, Mirena and Skyla (all manufactured similarly by the same company) and lastly, the Liletta.
We went through an IUD checklist:
R/o pregnancy, abnormal uterine bleeding, STI hx
Bimanual exam to determine uterine position, no gross abnormalities
Speculum insertion: lubrication, separate labia, insert at slight angle, avoid pressure on urethral meatus, follow natural curve of vagina (toward table), downward pressure (on posterior wall), open, secure, wait for cervix to come into view
Use forceps and 4x4s with antiseptic to clean cervix, vaginal walls, remove swabs (2-3x)
Consider topical or local anesthetic at tenaculum sites and at os
Apply tenaculum (also didn't take a picture... but you can google image it!) at 10:00 and 2:00 (anteverted uterus) or 5:00 and 7:00 (retroverted uterus)
Sound uterus (aka measure uterus) -- use swab as marker for uterine depth measurement
Prepare and insert IUD according to manufacturer instructions
Cut IUD strings 2-3 cms
Apply hemostatic agent prn to tenaculum sites
Excited for more simulation in Women's Health! Next, we have a contraception simulation assignment with a standardized patient!
Have a fabulous weekend, everyone!