1.  Vagal reactions  Mild: diaphoresis, nausea  Moderate: dizzy, lightheaded, low HR +/- BP  Severe: loss of consciousness, seizure  Perforation at time of insertion  By sound or IUD  Infection  Greatest in first 20 days (consider prophylaxis)  Expulsion  2-5% in first year of use

2.  No need to do anything – they resolve without sequelae  Atropine 0.6mg IV works like magic

3.  If you take the IUD out, expect rapid healing without sequelae  Copper IUDs in the abdominal cavity cause scarring and should be removed laparoscopically

4.  Consider prophylaxis in high risk women (metronidazole 2 g or doxycycline 300 mg)  Consider treatment does (one week of doxycycline) in very high risk women