An intrauterine device (IUD) is a highly effective, long-acting reversible contraceptive method that provides protection for several years after a single insertion. Routine self-checks of the attached strings are a standard practice for monitoring the device’s status. This regular attention helps ensure the IUD remains securely positioned within the uterus and continues to function as intended, providing reliable contraception.
The Purpose of Routine String Checks
Regularly checking the IUD strings confirms the device remains properly seated within the uterine cavity. The primary concern is detecting partial or complete IUD expulsion, which happens when the device shifts out of its intended position. An IUD that has moved cannot reliably prevent pregnancy, so monitoring its location is important. Expulsion is most likely to occur within the first few months after insertion or during a menstrual period.
The strings are also necessary for a healthcare provider to remove the device when it expires or when the user desires conception. Feeling for the strings confirms the T-shaped device is still entirely inside the uterus, where it is designed to be most effective. If the IUD has shifted, this increases the risk of an unintended pregnancy.
Step-by-Step Guide to Locating the Strings
The process of locating the IUD strings begins with meticulous attention to hygiene to avoid introducing bacteria. Wash your hands thoroughly with soap and water, paying attention to cleaning underneath the fingernails. Finding a comfortable, stable position, such as squatting, sitting on a toilet, or propping one leg up on a surface, can make the internal reach simpler.
Once positioned, gently insert your index or middle finger deep into the vagina until you feel the firm, rounded structure of the cervix. The cervix will feel distinctly different from the surrounding vaginal walls; many describe its texture as similar to the tip of a nose. The IUD strings emerge from the opening of the cervix and should be felt resting nearby.
Gently sweep your fingertip across the surface of the cervix to locate the thin threads. It is important to feel for the strings without pulling on them, as tugging could inadvertently displace the device. Healthcare providers recommend performing this check once a month, often after menstruation, since the cervix sits lower in the vagina during this time, making the strings easier to reach.
Interpreting Your Findings
A normal IUD string check involves finding one or two thin, flexible threads emerging from the cervix. These strings are typically made of plastic and feel like fine fishing line or taut dental floss. Over time, the strings may soften and curl slightly around the cervix, which is a normal change.
The threads should ideally be about the same length each time you check them, usually trimmed by the provider to be approximately 2 to 3 inches long. Consistency in length and location is the most important finding, confirming the IUD has not moved from its original placement. If the strings feel exactly as they did during the previous check, the IUD is highly likely to be correctly positioned and working effectively.
An abnormal finding includes strings that feel noticeably shorter or longer than they did before. If the strings feel longer, it may suggest the IUD has begun to slip down through the cervix, a sign of partial expulsion. If the strings feel shorter or are completely absent, they may have coiled up into the cervical canal or the IUD may have shifted higher into the uterus. Feeling the hard, plastic part of the T-shaped device itself is a definite sign of partial expulsion and requires immediate medical attention.
Action Plan: When Strings Are Missing or Change Length
If you cannot feel your IUD strings, or if they feel significantly different in length, take immediate steps to protect against unintended pregnancy. Begin using a non-hormonal barrier method, such as condoms, for every instance of sexual intercourse. This precaution is necessary because the IUD may no longer be in the correct position to provide contraception.
You should contact a healthcare provider promptly to schedule an appointment for professional evaluation. The provider will first attempt to locate the strings during a pelvic examination, potentially using a specialized instrument like a cytobrush or a magnifying colposcope. If the strings remain elusive, an ultrasound will be performed to confirm the exact location of the IUD within the uterus.
If the IUD cannot be seen on ultrasound, it is likely that the device was expelled from the body without being noticed. If the ultrasound confirms the IUD is still in the uterus but out of place, or if the strings are simply coiled, the provider will discuss removal or re-evaluation. Seek immediate medical care if a change in string length is accompanied by severe cramping, fever, chills, or unusual vaginal discharge, as these can be signs of infection or uterine perforation.