Cervical Cleaning Prior to IUD Removal
Cervical cleaning with antiseptic solution is standard practice and should be performed prior to IUD removal to minimize infection risk, though the evidence base for this specific step is limited. 1
Standard Procedural Approach
The available guidelines establish that standard practice includes cleansing the cervix and sterilizing any instruments that will be used prior to and during IUD procedures 1. While this recommendation specifically addresses IUD insertion in the 2014 Canadian guideline, the same infection prevention principles apply to removal procedures in routine clinical practice.
Key Procedural Steps
Visualize the cervix using a speculum and identify the IUD strings 2
Cleanse the cervix with an antiseptic solution (typically povidone-iodine or chlorhexidine) before grasping the strings 1
Remove the IUD by pulling gently on the strings once the cervix has been prepared 2
Rationale and Evidence Considerations
Infection Risk Context
The theoretical concern about bacterial spread during IUD removal is acknowledged in guidelines, particularly in the context of pelvic inflammatory disease where removal should occur after antibiotics have been started to avoid the potential risk for bacterial spread resulting from the removal procedure 2. This suggests that the removal process itself can potentially introduce or spread bacteria.
Bacterial Colonization Data
Research demonstrates that most IUDs are heavily contaminated by bacteria at the time of removal, with 94.5% of removed IUDs showing positive cultures in one study 3. Common organisms include Staphylococcus coagulase negative, Escherichia coli, and Enterococcus faecalis 3. Another study found that IUD users have significantly higher rates of opportunistic bacteria, particularly E. coli and Ureaplasma urealyticum 4.
Clinical Significance
Despite high bacterial colonization rates on IUDs, no cases of PID were recorded during a 36-month follow-up study of 200 IUD users, and the bacterial flora consisted of common organisms that do not typically account for PID in asymptomatic women 3. This suggests that while bacteria are present, routine removal in asymptomatic patients carries minimal infection risk when proper technique is used.
Important Caveats
In cases of active PID, the timing of removal is more critical than the cleaning procedure itself—removal should occur after antibiotics are initiated 2
Cervical cleaning does not require delay of the removal procedure and should be performed as part of the standard sterile technique 1
Post-removal counseling should include advising the patient to return promptly for heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 2