No matter how understanding your ob/gyn is, you still might be hesitant to bring up certain questions at your appointments. In an ideal world, you’d feel free to ask your ob/gyn anything under the sun, but some matters just seem too personal. Yes, even with the person whose job it is to dive deep into your vagina. As a prime example, you might be wondering if an especially rough bout of sex could dislodge your IUD, but you also may not want to broach the subject with your doctor. Luckily enough, we’re willing to take one for the team. Here, ob/gyns share whether or not rough sex can do a number on your IUD.
To understand if it’s really possible for your IUD to fall out during rough sex, you have to get familiar with the way IUDs work.
IUDs are little T-shaped devices placed inside of your uterus to prevent pregnancy. They come in two main categories: hormonal and non-hormonal.
Hormonal IUDs (sold under the brand names Mirena, Kyleena, Liletta, and Skyla) contain progestin, a synthetic hormone that thins your uterine lining (which a fertilized egg would latch to in order to receive nutrients and grow), thickens your cervical mucus so it’s harder for sperm to move through, and even sometimes suppresses ovulation so your ovaries don’t release any eggs to be fertilized, according to the Mayo Clinic. The one non-hormonal IUD on the market, ParaGard, uses copper to induce an inflammatory reaction in your uterus that’s toxic to sperm, according to the Mayo Clinic.
No matter which kind of IUD you choose, you can be confident that you’re receiving excellent protection against pregnancy. The available research on IUDs’ efficacy shows that hormonal IUDs only fail to do their jobs 0.2 percent of the time, and copper IUDs fail 0.8 percent of the time. Translation: Fewer than one out of 100 women will wind up pregnant each year when using an IUD.
A hormonal IUD can also be a great choice if you have raging period problems, like extremely heavy or painful menstruation. This is because the progestin in hormonal IUDs thins your uterine lining, so there’s not as much for your body to get rid of during your period, possibly resulting in lighter flows. This can have the added effect of reducing period pain, as prostaglandins, which are hormone-like chemicals that make your uterus cramp up, come from cells in your uterine lining, Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. Having less uterine lining build-up can result in fewer prostaglandins to bowl you over with period pain.
IUDs make all this magic happen from right inside your uterus. The insertion process, which can range from feeling like a slight twinge to being surprisingly painful, involves your doctor pushing the folded up IUD past your cervix and into your uterus via a slim applicator tube, according to the Mayo Clinic. Once free from the tube, the IUD’s wings will expand so it assumes its proper T shape and remains firmly lodged in place, with strings hanging down into your vagina for easy removal when you’re ready to move on from an IUD (or to get another one once time is up on yours, which may take anywhere from three to 10 years depending on the type).
So…is it actually possible for an IUD to fall out? And how?!
Yes, it’s possible, but it’s also not that common, according to the most reputable numbers experts have. This is what’s known as IUD expulsion, which is essentially when your uterus pushes out the IUD.
Since there’s a pretty major dearth of research in this area, experts don’t have an exact number regarding how common IUD expulsion is. However, the American College of Obstetricians and Gynecologists (ACOG) estimates that it occurs in 2 to 10 percent of all people with IUDs. If this happens to you, you might experience heavy bleeding and cramping, or even see that the IUD has come out, Dr. Minkin says. But sometimes the IUD doesn’t come out all the way, so it’s not like seeing the device plop into your underwear or the toilet after expulsion is a guarantee—instead, you might feel something hard extending from your cervix if the IUD is only partially expelled.
Though IUD expulsion numbers aren’t set in stone, the chances of this happening because of sex are honestly infinitesimal, according to experts. “No IUD is coming out because of intercourse,” Jacques Moritz, M.D., an ob/gyn at Weill Cornell Medicine in New York, tells SELF. Dr. Minkin agrees, adding, “I’ve heard lots of strange things in my life, but that’s not one.” Could your IUD theoretically already be on its way out, only for you to realize during sex? Sure. But it’s not going to actually happen due to penetration, the experts say.
Of course, there are plenty of different types of sex. It’s not like a penis can yank on your IUD strings and dislodge the device—but what about fingers? “That would be really hard to do,” Dr. Moritz says, explaining that IUD strings are thin and essentially the same thing as fishing wire. “If you try to grab [the strings], you would probably find them to be slippery, especially with vaginal secretions,” he says.
Even ob/gyns, who have much more expertise in IUD removal than the average person, don’t use their fingers to remove these devices. Instead, they use a tool to clamp down on the strings and pull out the IUD, Dr. Moritz explains. (This process is typically much less painful than insertion, for what it’s worth.) Also, IUD strings often curl up around your cervix, so that makes your partner even less likely to come into contact with them, Dr. Minkin says.
In reality, one of the biggest risk factors for IUD expulsion seems to be having had the device inserted recently. In those cases, it’s possible that the medical provider didn’t place it correctly during insertion or that your uterus is simply like, “WTF is this foreign object, I want it out, please.” “The further out you get from IUD insertion, the less likely expulsion is,” Dr. Minkin explains.
Placement right after you’ve given birth is another major risk factor, since your cervix is more dilated than usual, Dr. Moritz says, potentially allowing for an IUD to slip from your uterus into your vagina more easily. More risk factors include a history of heavy or prolonged periods, severe menstrual pain, and having expelled an IUD already, among others.
The point: Sex is not a known risk factor for IUD expulsion.
There is another IUD complication called perforation, or when your IUD pokes through your uterine wall. Don’t worry, rough sex probably isn’t going to cause this, either.
ACOG estimates that perforation only happens in 1 out of every 1,000 people with IUDs (again, these aren’t hard-and-fast numbers, but they’re the ones experts have based on the best research available). It’s most common during placement, typically due to issues with how the IUD is inserted. Someone banging against your cervix during sex, no matter how fervently, isn’t going to do the trick and push your IUD into a place it shouldn’t go, Dr. Minkin says, explaining that your cervix is too thick for vaginal activity to move the contents of your uterus.
If you did have a problem with IUD perforation, you would potentially experience pelvic pain, but you also might not, Dr. Minkin says. Many people only realize they’re dealing with perforation if they get an examination after going into the doctor because they’re not able to feel their IUD strings, Dr. Minkin says. If the doctor also can’t find the strings, they can do an ultrasound, which may reveal perforation.
If you’re at all worried something is up with your IUD, first check to see if you can feel the strings. Even if you can’t, don’t panic—it doesn’t necessarily mean anything’s wrong. Make an appointment with your doctor if you’re nervous or experiencing strange symptoms.
Dr. Minkin often encourages people to check their IUD strings periodically after placement, around every month or so until they feel comfortable that the device is not going anywhere. Imagine placing a few thin threads on top of the tip of your nose and rubbing them; that’s how it’ll feel to touch your cervix with the strings protruding , Dr. Minkin says.
But, as noted earlier, sometimes the strings curl up around your cervix, so you may not be able to feel them even if your IUD is exactly where it’s supposed to be. If you’re concerned, go in to see your ob/gyn. Given how much time they devote to examining vaginas, they’re your best bet for figuring out what’s up with your IUD. You don’t, however, need to run to the doctor just because you can’t feel your IUD strings after bed-breaking sex. What you do with your vagina during sex won’t affect your uterus (unless, you know, it results in a pregnancy), so go forth and get as rough as you like—no IUD worries necessary.