Insertion recommendations

This ultrasound picture shows a fundal thickness of 12.8 mm. It is very safe to insert the anchor if the thickness in the midline is more than 10 mm.

GyneFix^® is a frameless, flexible IUD, which is fixed at the fundus of the uterus. The following are some pertinent recommendations:

• Measure the thickness of the uterine fundus. The thickness of the fundus should be at least 10 mm.
• Use of a forceps with 18 or 19 cm in length. Allis or Pozzi forceps, is recommended as this facilitates insertion and aligning the utero-cervical axis.
• Use a short speculum to have close access to the cervix of the uterus.
• Perform the “cotton swab test”: This test with a cotton swab soaked in antiseptic solution can be done to test the tightness of the internal cervical os and to obtain information on pain sensation. If the test provokes severe pain, local anesthesia can be provided prior to sounding the uterus. Additional instrumentation (eg, os finder, cervical dilator), except for a sound to measure the length and flexion of the uterus, is rarely necessary if the test shows that that cavity can be entered easily.
• Attention to comfort during insertion is very important. If necessary, perform cervical priming by, for example, Cytotec^®: 2 tablets of 200mg orally, 3 hours before the insertion. In addition, you can also use intra-cervical anesthesia, preferably with a dental syringe.
• Following birth, especially in breastfeeding mothers, the insertion should be postponed until three months after birth.
• Women using the 3-monthly injectable should not use GyneFix^® as long as the uterus is atrophic.
• After insertion, the woman should not have intercourse and not use tampons nor Mooncup within 7 days.

Midline insertion is easily accomplished if traction on the cervix is exerted throughout the insertion procedure.