It’s understandable to be concerned that anything you put in your vagina — from period products to sex toys — could potentially pull an IUD out.

After all, an IUD, which is put through the vagina and cervix into the uterus, is in pretty close proximity to anything else that’s inserted in your vagina. And if you can feel the two little strings that stick out just outside the cervix — there so your doctor can remove the IUD later or check that it’s still in place — can you accidentally pull on them too hard?

To find out if there are any real risks to using certain period products with IUDs, we called Dr. Kelly Culwell, an OB-GYN and former medical officer at the World Health Organization. Here’s what she told us.

Which period products are safe to be used with IUDs?
“For the most part, women with IUDs can use any kind of period protection. If your IUD string is a little on the long side, there would be the risk that you could pull out your IUD while you’re removing a tampon or a menstrual cup. There’s not really an infection concern or anything like that — it’s really more [that] if you’re putting something in your vagina that you’re then reaching up and pulling out, there is a chance that you could pull your IUD out, because the strings of the IUD stick out just a little past the cervix.”

Is it common that someone would pull their own IUD out?
“I have seen patients have an IUD pulled out. So it can happen — it’s just very rare, and it shouldn’t prevent women from either using IUDs or using the period protection that they want to use. If you just pull it out a little bit and didn’t remove the whole thing, you could have what we call a partial expulsion of the IUD. A lot of times the IUD will still work, as long as it’s at least partly in the uterus. But if there was ever a concern, like if you felt your strings and they felt longer than they felt before, that could be a sign of a partial expulsion and that should be something that you go in and see your healthcare provider about. Really, it’s all about how effective the IUD will be. But it is not going to hurt you.”

What should you do if you are nervous you might have pulled your IUD out?
“Women can check their IUD strings after each period, which is usually a good time just to confirm that they still feel them and that they’re about the same length. That’s not a requirement, but it can be done to reassure women who are using tampons or menstrual cups.”

What should you do if you are the sort of person who worries about these things?

“You can go in to your healthcare provider and ask them to cut your strings really short. The only downside to cutting your strings short is that it sometimes can make the IUD a little bit more difficult to remove when the time comes, but they can be removed even if there are no strings. A healthcare provider, or at least an OB-GYN, or people who are skilled at IUD removal, can get the IUD out. Just as an example, I have an IUD in. I use tampons. I’m not concerned at all, and I do not tell my patients that they can’t use tampons.”

Which is to say, that although there is always some risk that you could accidentally remove your IUD, the risk is actually very low. And if that did happen, it is unlikely to cause any pain or injury, the only concern is that your IUD could be less effective. If you’re concerned that you might have pulled out or displaced your IUD, you should contact your physician immediately.

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