When an intrauterine device (IUD) is placed in the uterus, the healthcare provider leaves one or two thin, plastic threads, known as strings, dangling through the cervix into the upper part of the vagina. These strings allow the user to confirm the device remains in place and are used by a professional to remove the IUD when it is no longer wanted or needs replacement. Finding that these strings are suddenly absent can be unsettling, though the device is often still correctly positioned and functioning. Understanding the immediate steps for self-examination and the reasons behind the disappearance can help manage this situation effectively.
Immediate Steps for Self-Examination
Before contacting a healthcare provider, you can perform a careful self-check to try and locate the strings. Begin by thoroughly washing your hands with soap and water, ensuring you clean beneath your fingernails to prevent introducing bacteria into the vagina. Finding a comfortable position, such as squatting or sitting on the edge of a toilet, can make reaching the cervix easier, as these positions shorten the vaginal canal.
Gently insert your index or middle finger into your vagina until you feel the cervix, which is firm and rubbery, often compared to the tip of your nose. The IUD strings, which feel like fine fishing line, should be felt emerging from the center of the cervix. It is often beneficial to check for the strings immediately following menstruation, because the cervix tends to sit lower in the vagina during this part of the cycle, making the strings more accessible.
Take note not only of the presence of the strings but also their length compared to previous checks. If the strings feel significantly shorter or longer than usual, or if you can feel the hard plastic or copper part of the IUD itself, this suggests the device may have shifted. If you cannot feel the strings after several attempts, or if you detect a change in length, it is time to seek professional guidance.
Understanding Why Strings May Be Absent
The inability to feel the IUD strings does not automatically mean the device has failed; the cause is often related to natural anatomical movement. The most common reason is that the strings have curled up and retracted into the cervical canal, resting close against the cervix. This retraction may be due to the natural softening of the threads over time or the normal movement of the cervix.
More serious possibilities involve the device moving out of its correct position. The IUD may have partially or completely moved out of the uterus, a process called expulsion, which is most likely to occur in the first few months after insertion or during a menstrual period. If expulsion has occurred, the IUD’s effectiveness is compromised, and you may notice symptoms like severe cramping, heavy or unusual bleeding, or a change in vaginal discharge.
In rare instances, the strings may be absent because the IUD has migrated through the uterine wall, known as perforation. This complication occurs in about 1 to 2 out of every 1,000 insertions and is sometimes associated with pain, fever, or chills. Finally, the strings may have been cut too short during the initial insertion procedure, making them consistently unreachable during self-checks.
Professional Consultation and Management
If self-examination fails to locate the IUD strings, contacting a healthcare provider is the necessary next step. Until a medical professional confirms the IUD’s correct placement, it is prudent to use a backup method of contraception, such as condoms, to prevent unintended pregnancy. This precaution is needed because an IUD that has shifted may no longer be fully effective.
The medical workup usually begins with a pelvic examination, where the provider will use a speculum to visually inspect the cervix. If the strings are not immediately visible, the provider may use a small, sterile brush, like a cytobrush, to gently sweep the cervical canal in an attempt to pull down retracted strings. If this initial step is unsuccessful, the next diagnostic procedure is typically a transvaginal ultrasound.
The ultrasound can confirm whether the IUD is still located within the uterine cavity and whether it is correctly positioned. If the IUD cannot be visualized within the uterus on the ultrasound, a plain abdominal X-ray may be ordered to check if the device has perforated the uterine wall and migrated into the pelvic or abdominal cavity. Depending on the findings, the IUD may be left in place if it is correctly seated, or it may be removed using specialized instruments or, in rare cases of perforation, require surgical intervention.