Intrauterine device perforation symptomatic after nine years

Intrauterine device (iud) is a cost effective, long acting and reversible method of contraception. we present a patient who had an iud inserted nine years prior to attending our clinic; complaining of vaginal discharge and hematuria. the threads of the device were observed at the external cervical os however the transvaginal ultrasonography we performed as part of a routine work-up revealed that the device had perforated the entire body of the myometrium. we suspected bladder injury and for further diagnostic information mri was utilized. mri showed bladder serosa involvement. we were able to retrieve the iud with the aid of a hysteroscopic forceps. cystoscopy was performed after the procedure and there was no intraluminal bladder pathology. we cannot verify the cause of the uterine perforation; however we believe that iud’s should be adminestered by experienced providers without prior blunt sounding instrumentation in order to decrease uterine perforations. we suggest that transvaginal ultrasound should routinely be performed on women who present for their gynecological visit. this is especialy important for patients who chose to use a iud for contraception.