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Can a woman have sex the same day her IUD is inserted? #1017/8
I am going to have my Minera IUD put in two days from now. Can I have sex that same day?  What am I to expect in the following days?

I have had a tubal ligation already there is no chance of pregnancy, but it is to help with the menstraul pain. Do you recommend Minera to help the pain?


Many people recommend waiting 24-48 hours after insertion of an IUD to have intercourse, however 4 important text books make no mention of delaying intercourse:

 

Family Planning a Global Handbook for Providers

A Clinical Guide for Contraception; 4th edition

Managing Contraception 2007-2008

Contraceptive Technology 2008        

 

The 3 big issues that arise at and shortly after Mirena insertion are outlined below:

Cramping and Pain

Discomfort may be felt at the time of IUD insertion and may be followed by cramping pain over the next 10 to 15 minutes. One approach is preventive therapy with oral non-steroidal anti-inflammatory drugs, local anesthesia, or both. Prophylactic administration of a non-steroidal anti-inflammatory drug around the time of insertion has not been found to be helpful. The most common analgesia approach used for insertion in the United Kingdom is intrauterine anesthesia with a solution of 2% lidocaine (Instillagel), which is not commercially available in the United States.  For paracervical anesthesia, use of a long-acting local anesthetic, such as bupivacaine, may be preferable to shorter-acting drugs, such as lidocaine. Should a woman have pain or vasovagal symptoms immediately after insertion, a paracervical block can be placed at that time. Rarely, the IUD needs to be removed at the insertion visit. Pain that develops later may reflect threatened or partial expulsion, dislodgment, infection, or a complicated pregnancy.

 

Pain after insertion may benefit from Motrin and other prostaglandin inhibitors.

 

Menstrual Problems

Bleeding problems constitute one of the more common IUD complications. Altered bleeding patterns may be a normal side-effect of intrauterine contraception or may signal pregnancy, infection, or partial expulsion. Irregular bleeding is common in the early months of intrauterine contraception with either device. Women using the TCu 380A usually have heavier menses, and irregular bleeding can occur during early use. Irregular but light bleeding or spotting is the norm in the early months of the levonorgestrel intrauterine system, since endometrial suppression takes several months to achieve. Thereafter, a marked decrease in bleeding occurs. Women should be thoroughly counseled about these effects, which tend to be self-limiting.

 

Excessive bleeding with the TCu 380A can be treated with non-steroidal anti-inflammatory drugs; trials have not demonstrated the superiority of one product over another. Since local prostaglandin production is involved with excessive bleeding, any prostaglandin synthetase inhibitor should help; in contrast, aspirin and acetaminophen do not. Starting in advance of menses does not give better results than starting with the onset of flow. If hemoglobin levels drop, oral iron supplementation can be started.

 

Not all nuisance bleeding can be attributed to the contraceptive. For example, other gynecologic disorders, such as endometrial polyps, may be responsible. Alternatively, an accidental pregnancy (including an ectopic pregnancy) can present with bleeding. In addition, bleeding may accompany endometritis. Of note, with the use of small catheters, the endometrium can be biopsied with the device remaining in place. Persistent abnormal bleeding requires clinical evaluation. If no explanation is found and if the woman’s threshold for tolerance is passed, the device can be removed.

 

 

1.    If a woman has a Mirena IUD inserted at any time within the first 7 days after the start of menstrual bleeding, no additional contraception is needed.

 

2.    If insertion is at any other time in the cycle she will need to avoid vaginal intercourse or use additional contraceptive protection for the next 7 days.

 

THIS COMES FROM THE WORLD HEALTH ORGANIZATION 2005 Selected Practice Recommendations for Contraceptive Use (Second Edition).

Insertion Timing

No scientific reason supports the common practice of inserting the IUD only during menstrual bleeding. The inconvenience and cost to the woman caused by such a policy can be substantial. Allowing insertion during the entire menstrual cycle gives the woman and her provider more flexible appointment times. An IUD can be inserted at any time during the menstrual cycle, provided reasonable assurance exists that the woman is not pregnant. Sensitive pregnancy tests can assist here.

 

Good luck! You will be using a great contraceptive that provides 7 to 10 years of contraception (not just 5)

 

  

Key Words:  Mirena IUD, inserted, sex, tubaligation, pregnancy, menstrual pain, cramping, discomfort, menstrual problems, excessive bleeding, intrauterine contraceptive, endometrial polyps, ectopic pregnancies, cycle, additional protection, World Health Organization Selected Practice Recommendations, timing

 

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2008-10-27


Managing Contraception for Your Pocket 2013-2014
  


Managing Contraception for Your Pocket 2013-2014
  

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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