The intrauterine device (IUD) is a highly effective, small, T-shaped form of contraception placed inside the uterus by a healthcare provider. The purpose of the thin, plastic strings attached to the IUD is twofold: they allow the user to perform a monthly self-check to confirm the device is in place, and they provide the medical professional with a means to safely remove the IUD when the time comes. These strings extend a short distance from the cervix into the upper vaginal canal.
Understanding IUD Strings and Comfort
IUD strings are typically cut to a length of about one to two inches, which is long enough for checking but should ideally be unnoticed during daily activities. The strings are made of a fine, flexible material, often resembling fishing line. However, immediately following insertion, the strings can be somewhat stiff and may protrude straight out from the cervical opening.
This stiffness can sometimes lead to mild irritation for the user or a partner, particularly during deep penetrative intercourse. A partner may report a sensation of being poked or tickled by the ends of the strings. The motivation for repositioning the strings is to encourage them to soften and curl naturally around the cervix, or to gently nudge them into a position where they are less exposed.
The cervix is located at the top of the vaginal canal and feels firm. The goal is to move the strings so they rest in the small space behind the cervix, away from the path of penetration. The strings naturally tend to soften and curl over time, which often resolves the issue without any manual intervention.
Step-by-Step Guide to String Repositioning
Before attempting any self-manipulation, thoroughly wash your hands with soap and water, ensuring you clean beneath your nails to minimize the risk of introducing bacteria. Assuming a comfortable position, such as squatting or sitting on the edge of a toilet, can help bring the cervix lower and make it easier to reach. This is the same posture recommended for a regular IUD string check.
Gently insert your index or middle finger into the vaginal canal until you locate the cervix. Once you feel the strings emerging from the cervical opening, pause to confirm you can feel both strings and that they feel the same length as your last check. This pre-check is important to ensure the IUD has not shifted before proceeding.
With the tip of your finger, very gently sweep the strings backward, aiming to tuck them into the posterior fornix. The strings should be nudged, not pushed forcefully, to encourage them to coil or lay flat against the back curve of the cervix. Think of this motion as a light caress or draping rather than a deep adjustment.
If the strings are the correct length, a light nudging motion should be enough to temporarily reposition them and help them settle into a less exposed spot. Never tug on the strings in any direction, as this carries a significant risk of dislodging the IUD. If the strings resist this gentle redirection, stop immediately and do not attempt to force them.
Important Safety Considerations and Red Flags
Self-manipulation of IUD strings, even gentle repositioning, should be done with extreme caution. If the IUD moves out of its correct position, its effectiveness as contraception is compromised, and it may cause pain. Inadvertently pulling the strings can lead to partial or complete expulsion of the IUD from the uterus.
There are several red flags that indicate a serious problem requiring immediate consultation with a healthcare provider. If you or your partner can feel the hard, plastic part of the IUD itself, this is a clear sign that the device has partially expelled and is no longer providing reliable birth control. Severe abdominal pain, cramping that is not relieved by over-the-counter medication, or a sudden fever or chills are also signs of a potential complication like infection or perforation.
You must also contact your provider if the strings feel significantly longer or shorter than they did during a previous check, or if you cannot feel them at all. While strings can sometimes curl up into the cervical canal naturally, a change in string length can signal IUD dislodgement. Until a professional confirms the IUD is correctly seated, a backup method of contraception should be used. If bothersome strings persist, a professional check-up may include the option of having them trimmed shorter.