Is Sounding the Uterus Prior to Intrauterine Device Placement Still Relevant?

Norman D Goldstuck Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Tygerberg Hospital Bellville, Cape Town, South AfricaCorrespondence: Norman D Goldstuck, Email [email protected]: Uterine sounds have been used in gynaecological practice for at least 200 years for various reasons. They were introduced to intrauterine device (IUD) insertion and management with the introduction of the thermoplastic devices.Methods: A literature search was performed to see whether clinical practice or manufacturers instructions had changed regarding sounding the uterus before IUD placement.Results: Despite changes in shape, size and structure, IUDs in current use still have recommendations for sounding before placement despite the lack of evidence that it provides any objective benefit. The potential benefits of all aspects of sounding appear to be outweighed by the disadvantages, especially where ultrasound imaging is available. Sounding produces measurements of dubious value and which are prone to produce errors possibly causing incorrect placement.Conclusion: Sounding the uterus prior to IUD placement appears to have originated at a time when it was being used for other procedures. Times and IUDs have changed, but there is still no evidence for supporting this practice. The insertion of IUDs is usually a minimally invasive procedure, and it is time to abandon pre-placement sounding and make it more minimally invasive. Benefits of not sounding include simplification of the insertion procedure, reduction of pain and possibly decreased introduction of bacteria into the endometrial cavity.Keywords: sound, metal, flexible, uterine length, intrauterine devices, uterine sounding, pelvic ultrasound