Acceptability and challenges of self-removal of intrauterine devices in Campinas, Brazil

To evaluate the willingness and ability of intrauterine device (IUD) users to self-remove their device.

A cross-sectional study was conducted at the Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Brazil. We enrolled users of copper- or levonorgestrel 52 mg- IUDs who requested a device removal for any reason. Women with non-visible strings or partial IUD expulsion were excluded. Participants were instructed to insert their fingers into the vagina, with or without gloves according to their preference, to locate the IUD strings and attempt removal. If unsuccessful, removal was performed by a health care provider.

A total of 238 women were included, with a mean ± SD age of 35.4 ± 8.0 years. Regarding willingness, 174 (73.1%) declined to attempt IUD self-removal, mainly due to fear (77/174; 44.5%). Among the 64 women who attempted self-removal, 8 (12.5%) were successful. The primary reason for failure was the inability to palpate or locate the strings.

Although a low number of participants were willing to attempt self-removal, some perceived it to increase autonomy and engage in self-exploration. Nevertheless, most preferred removal by a health care provider, due to fear of pain and perceived procedural complexity. Enhancing patient education and addressing concerns may improve the feasibility and acceptability of IUD self-removal, potentially empowering more women in their reproductive health decisions.

Our study highlights that although the success rate of IUD self-removal was low, interest in the practice was notable among users. Fear and reliance on health care providers were key barriers to attempts. Our findings suggest that incorporating clear, evidence-based counseling about IUD self-removal at IUD placement may support reproductive autonomy and informed decision-making.