An intrauterine device (IUD) is a small, T-shaped form of long-acting, reversible contraception placed inside the uterus that works by preventing sperm from fertilizing an egg or preventing implantation. The IUD has one or two thin threads that extend a short distance out of the cervix and into the upper part of the vagina. These strings serve two primary functions: they allow the user to check that the device is still properly positioned and they are used by a healthcare provider for removal.
Understanding IUD String Positioning
The strings are an intentional part of the IUD design. After insertion, a healthcare provider trims the strings to a specific length, typically about one to two inches, so they can be easily felt near the cervix. The strings are initially somewhat stiff, but they soften over the first few weeks, becoming more flexible and less noticeable.
The natural environment of the vagina causes the threads to curl and settle around the cervix or against the upper vaginal wall. This curling action is what often makes the strings difficult to feel during normal activities. The exact positioning of the strings can fluctuate slightly due to the menstrual cycle, as the cervix moves higher during ovulation and lowers during menstruation, which may make the strings feel longer or shorter at different times of the month.
Self-Management Techniques for String Discomfort
If the IUD strings feel pokey or are causing discomfort for you or a sexual partner, you can often address this through gentle self-management. The goal of “tucking” the strings is to guide them to lie flat against the curved surface of the cervix and the back wall of the vagina, moving them away from the vaginal opening. This technique is most effective when the strings are long enough to curl smoothly rather than being cut too short, which can leave them rigid and sharp.
To perform this technique, first ensure your hands are thoroughly cleaned. Find a comfortable position, such as squatting, sitting on the edge of a toilet, or lying down with your knees bent, as this can make the cervix more accessible. Insert your index or middle finger until you locate the cervix, which feels firm and round, similar to the tip of a nose.
Once you have located the strings protruding from the cervix, use the pad of your finger to gently sweep or guide the strings upward and around the curve of the cervix. The strings should be directed toward the posterior (back) wall of the vagina, where they are less likely to be disturbed. Be extremely gentle during this process, using only light pressure to redirect the threads. Never pull, tug, or attempt to adjust the strings in a forceful manner, as this could risk displacing the IUD.
Repositioning the strings helps prevent them from poking a partner during sexual activity by tucking them out of the direct path of penetration. You may find that the strings require occasional repositioning, particularly after intercourse or during times when your cervix is lower in the vaginal canal. If the strings remain a persistent source of irritation despite attempts to tuck them, you should consult your healthcare provider to discuss having them trimmed slightly shorter.
When String Changes Signal a Problem
While minor variations in string position are common, a sudden or significant change in how the strings feel can indicate that the IUD has moved. If the strings suddenly feel much longer or much shorter than they normally do, this is a primary sign that the device itself may have shifted, either partially expelling or migrating within the uterus. A check-up is warranted, as a displaced IUD may not provide effective contraception.
If you cannot feel the strings at all when you check for them, they may have retreated up into the cervical canal or the uterus, or the IUD may have been completely expelled without your notice. If you are unable to locate the strings, contact a healthcare provider immediately and use a backup method of contraception until proper placement is confirmed. Do not attempt to forcefully fish for the missing strings, as this action could inadvertently pull the IUD out of position.
String changes accompanied by new or worsening symptoms require immediate medical consultation. Warning signs include:
- Severe cramping.
- Sharp or persistent pelvic pain.
- Unusual or foul-smelling vaginal discharge.
- Fever and chills.
Seek medical advice if you or your partner can feel the hard plastic of the IUD protruding from the cervix. Only a qualified healthcare provider should make any adjustments to the length of the strings or attempt to manipulate the IUD.