ENTG New Removal Guidance (SGP Article in Press)

Welcome back to the show, everyone! Today, we are diving deep into one of the most effective, set-it-and-forget-it contraceptive options available: the Nexplanon implant. With a failure rate of about 0.05%, it is a powerhouse of birth control. You pop it just under the skin of the inner upper arm, and for up to five years, you are covered. Standard removal is usually a quick, straightforward, in-office visit. But what happens when you go to feel for the implant... and it’s not palpable? That single scenario can be incredibly anxiety-provoking—both for the patient lying on the table and for the clinician trying to locate it. Did it migrate? Is it sitting deeper in the fascia or muscle? Or was it ever actually inserted in the first place? When an implant isn’t palpable, standard removal techniques won't cut it. What are the exact next steps for clinical localization? Which imaging modalities should you order first—high-resolution ultrasound, X-ray, or MRI? And here is a twist you might not expect: what on earth does a vasectomy procedure have to do with removing a difficult Nexplanon implant? Believe it or not, specialized removal techniques borrowing instruments from vasectomies are changing the game for deep implant retrievals! In today’s episode, we break down the brand-new clinical guidance from the Society of Family Planning, authored by Dr. Paula Castaño et al. and published in the journal Contraception. We’ll walk through the step-by-step algorithms for localization, safety protocols, and advanced removal techniques so you can handle non-palpable implants with complete confidence. Grab your coffee, hit subscribe, and let’s dive into the details!

1. Castaño PM, Creinin MD, Eisenberg DL, et al. Society of Family Planning Committee Statement: Management and removal of deep and nonpalpable contraceptive implants. Contraception. Published 2026. doi:10.1016/j.contraception.2026.111567

2. Society of Family Planning. News release: The Society releases clinical guidance addressing contraceptive implant removal, expands pathways to timely care. Published August 31, 2026. Accessed September 10, 2026. https://societyfp.org/about/society-statements/news-release-the-society-releases-clinical-guidance-addressing-contraceptive-implant-removal-expands-pathways-to-timely-care/