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Author Topic: IUD question
eryn_smiles
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Please could you comment on how common is 'cervical shock' when IUDs are inserted in women who have never been pregnant before?

I know this can be a life-threatening complication at worst and I've heard that at least 1/5 nulligravid women experience some shock with insertion, although not usually so serious. Is the rate only this high where I live?

(I've read the IUD article, only one of the links mentions it- http://www.managingcontraception.com/qa/questions.php?questionid=1334)

Thanks!

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Heather
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I haven't actually heard that term before, eryn.

But I work with a provider a couple times a month who puts a lot of IUDs in younger women. Many of them have been pregnant (since this is at an abortion clinic), but I still expect her to know about this, so let me drop her a line.

I'll post when I hear back.

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Heather Corinna, Executive Director & Founder, Scarleteen
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Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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So, the provider hasn't heard that term before, either.

Can you perhaps toss me some other medical references to it?

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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eryn_smiles
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Sure.

So, Emedicine describes Cervical shock as "Vasovagal syncope produced by stimulation of the cervical canal during dilatation may occur. Rapid recovery usually follows." But, I found this definition under "Abortion complications"-
http://emedicine.medscape.com/article/795001-overview

I couldn't really find other official references except-
http://www.plymouthpct.nhs.uk/CorporateInformation/policiesprocedures/Documents/Clinical%20Guidance/Cervical%20Shock%20Assoc%20Insertion%20IUCD%20v2.1.pdf

I know that WHO and NICE guidelines don't mention it at all. The person who told me about it is one of my teachers who inserts IUDs often in family planning clinics. She thinks it is more common than stated in literature. Use of lubrication jelly or cervical nerve blocks prior to insertion, I think, reduce the incidence of shock.

--------------------
"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Heather
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Okay, here's what I have back for you:

"Vasovagal reactions upon insertion of IUDs, even in nulliparous women, are very rare. The more skilled the provider, the less frequently it happens.

The number of 1/5th of nulliparous woman quoted in the first email is grossly inflated by my experience. I cant remember the last time this happened to me and I put in hundreds a year.

To call this a life threatening complication is also grossly inflated. And to use the term cervical shock does it a disservice as well.

Shock has a very definite meaning in medicine, and a vasovagal reaction is not equivalent.
IUDs are very safe in nulliparous women. The insertion is virtually always without incident."

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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eryn_smiles
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Thanks, that's reassuring. I'm thinking maybe our providers are still gaining adequate insertion experience due to low uptake numbers of IUD and Mirenas?

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"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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Heather
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How many years have they been doing them for?

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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eryn_smiles
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Well, they have been doing copper IUDs for many years, and Mirena I think for 5-10 years now.

(I feel a little bad about starting this topic now as the person who described this is a skilled experienced provider who teaches other providers.)

--------------------
"Caring for myself is not self-indulgence, it is self-preservation and that is an act of political warfare."

Audre Lorde

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