Patient's Query
Hello doctor,
I am a 40-year-old woman with two children, one born when I was 25 and the other at 38. Over the past six months, I have noticed what I believe may be a pelvic organ prolapse. I have also observed that my intrauterine device (IUD) appears to be at the opening of my vagina, alongside a noticeable bulge. Due to my work schedule, I have not been able to see a doctor. If I do not work, I do not get paid. However, I am now off for the summer and would like to address these health concerns. Is it safe for me to remove the IUD myself? I am concerned that it might be causing additional damage or even perforating tissue. Should I go to a primary care physician (PCP) for this, or is this situation more appropriate for an emergency department visit? I do not currently have a PCP, but I do have health insurance and can find one if needed. I am unsure how urgent this situation is.
In addition to the prolapse and IUD concerns, I have recently been experiencing a deep, aching pain under my right rib, along with back and flank pain over the past few weeks. I wonder if this might be related. The only medication I currently take is Venlafaxine.
I do not know how serious these symptoms may be and what steps I should take next to ensure proper care.
Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your detailed message. You are describing what appears to be a possible uterine prolapse or vaginal vault prolapse, along with displacement of your intrauterine device (IUD). Your concern is entirely valid, and it is good that you are seeking guidance. Below is a clear explanation of your symptoms and what steps to take next:
1. Can you remove the IUD yourself?
Do not attempt to remove the IUD yourself. If the IUD is dislodged, embedded, or protruding, removing it on your own could result in uterine or vaginal tearing, bleeding, infection, or incomplete removal, leaving part of the device inside. If the IUD is visible at the vaginal opening or has shifted, it requires removal by a healthcare professional after a proper pelvic examination.
2. Is this an emergency, a primary, or urogynecology visit?
You should visit the emergency department or urgent care if you experience severe pelvic pain, heavy bleeding, foul-smelling discharge, fever, nausea, symptoms of infection, inability to urinate or have a bowel movement, or worsening pain with visible protrusion of the IUD. If none of these urgent symptoms are present, schedule an urgent appointment with a gynecologist or urogynecologist. Since you do not currently have a primary care physician (PCP), you may contact a specialist directly through your insurance. As you are off work for the summer, this is an ideal time to seek medical attention.
3. Regarding right rib and flank pain
The pain under your right rib and in your back or flank may or may not be related to the prolapse, but it should be evaluated. Potential causes include kidney issues, gallbladder or liver problems, or referred pain from pelvic strain or nerve compression. A general medical check-up that includes blood work and imaging, such as an ultrasound or CT (computed tomography) scan, would be advisable.
4. Understanding pelvic organ prolapse
Pelvic organ prolapse is common in women who have had multiple vaginal births, especially later in life. You may be experiencing uterine prolapse or a vaginal wall prolapse such as a cystocele (bladder) or rectocele (rectum). Treatment options vary and can include a pessary device to support the organs, pelvic floor physical therapy, or surgery in more advanced cases.
To move forward, avoid trying to remove the IUD yourself, schedule a gynecology appointment as soon as possible, and monitor your symptoms, such as pain, bleeding, bladder or bowel changes, and discharge. If you are unsure how to describe the bulge to your doctor, you may take a photo for medical reference only. If your symptoms worsen, such as increased pain, fever, or visible shifting of the IUD, visit urgent care or the emergency room without delay.
I hope this information has been helpful.
Regards.
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Answered byDr. Georges Hany Kozah
Medically reviewed byiCliniq medical review team
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