Can an Intrauterine Device (IUD) be placed if a Pap test result is positive for Atypical Squamous Cells of Undetermined Significance (ASCUS)?

IUD Placement with ASCUS Pap Result

Yes, an IUD can be placed in a woman with a Pap test positive for ASCUS (Atypical Squamous Cells of Undetermined Significance), as this finding does not contraindicate IUD placement. The management of ASCUS should proceed independently of the IUD placement decision.

Management of ASCUS

The appropriate management of ASCUS depends on several factors:

For Women Over 20 Years Old:

• HPV Testing (Preferred Approach): "Reflex" HPV DNA testing is the preferred approach for women with ASCUS 1

  • If HPV negative: Follow-up with repeat cytologic testing at 12 months 1
  • If HPV positive: Refer for colposcopic evaluation 1

• Alternative Management Options:

  • Repeat cervical cytologic testing at 6-month intervals until 2 consecutive negative results 1
  • Colposcopy (though less preferred than HPV testing) 1

For Adolescents (20 years and younger):

• Follow-up with annual cytologic testing is recommended 1
• HPV DNA testing and immediate colposcopy are not recommended for adolescents with ASCUS 1

IUD Placement Considerations

There are no guidelines that contraindicate IUD placement in women with ASCUS. The 2006 consensus guidelines for management of women with abnormal cervical cancer screening tests 1 and other guidelines do not list ASCUS as a contraindication to IUD placement.

Important Points to Consider:

1. Separate Management Paths: The management of ASCUS and the decision for IUD placement can proceed independently
2. Follow-up is Essential: Ensure proper follow-up of the ASCUS result regardless of IUD placement
3. Documentation: Clearly document the abnormal Pap result and the follow-up plan 2

Follow-up After IUD Placement

• Continue with the recommended follow-up for ASCUS as outlined above
• For women who are HPV negative with ASCUS, the risk of developing CIN2+ is low, with studies showing a negative predictive value of 95.7% 3
• For women who are HPV positive with ASCUS, follow-up with colposcopy is recommended 1, 2

Common Pitfalls to Avoid

1. Delaying IUD placement unnecessarily: ASCUS is a minor cytologic abnormality and does not require postponing contraceptive care
2. Failing to follow up on ASCUS: Ensure proper follow-up according to guidelines
3. Overtreatment: Avoid unnecessary procedures for ASCUS, as most cases will resolve spontaneously
4. Poor communication: Clearly explain to the patient that ASCUS is common and often transient, but requires appropriate follow-up

In conclusion, ASCUS on a Pap test should not delay or prevent IUD placement. The management of ASCUS should proceed according to established guidelines while the patient's contraceptive needs can be addressed independently.