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Maryna insertion and removal replacement preparation for insertion examine the patient to establish the size and position of the uterus and in order to detect any signs of acute genital infections or other contraindications for the insertion of Mirena and to exclude pregnancy insert a speculum visualize the cervix and then cleanse the cervix and vagina with a suitable antiseptic solution grasp the anterior lip of the cervix with the tenaculum to stabilize a uterus if the uterus is ret reverted it may be more appropriate to grasp the posterior lip of the cervix gentle traction on the forceps can be applied to straighten the cervical canal the forceps should remain in position and gentle counter traction on the cervix should be maintained throughout the insertion procedure advance uterine sound through the cervical canal to the fundus to measure the depth and confirm the direction of the uterine cavity if difficulties encountered consider dilatation of the canal insertion first open ster
