Risk of Bacterial Vaginosis in Users of the Intrauterine Device

Abstract

BACKGROUND Users of the intrauterine device(IUD) may be at increased risk for bacterial vaginosis (BV). Our objective was to compare the incidence of BV in women using the IUD compared to women using combined oral contraceptives (COC), the contraceptive vaginal ring, and the contraceptive patch. METHODS We prospectively recruited women negative for BV at baseline. Monthly, for six months, participants returned a self-obtained vaginal smear for Gram stain by mail. BV was diagnosed by a Nugent score ≥7. We performed Cox proportional hazards regression to investigate associations between demographic and behavioral characteristics, contraceptive method, and incident BV. RESULTS We enrolled 153 women negative for BV at baseline; 90(59%) women who chose the IUD and 63 (41%) who chose COC, ring, or patch. There were 35 women with BV at one or more time points. The incidence of BV was 37.0% among IUD users and 19.3% in COC, ring, and patch users (p=0.03). In the univariate analysis, race, IUD use, intermediate flora, and irregular vaginal bleeding were significantly associated with BV. In the adjusted model, IUD users were no more likely to acquire BV (HRadj 1.28, 95%CI 0.53–3.06)than COC, ring, and patch users. The associations between intermediate flora and irregular bleeding and BV remained significant (HRadj 3.3095% CI 1.51–7.21, and HRadj 2.54, 95% CI 1.03–6.24 respectively). CONCLUSIONS The association between IUD use and BV may be mediated by irregular vaginal bleeding. Intermediate flora is associated with an increased incidence of BV.

Prevalence and Risk Factors of Bacterial Vaginosis Among Women of Reproductive Age Attending Rural Tertiary Care Institute of Western Uttar Pradesh

“…41 and USA. 42 Our data supports the hypothesis that IUCD might change endogenous cervico-vaginal environment, which may lead to vulvovaginal infection and BV.…”

Evaluation of different diagnostic methods of bacterial vaginosis

“…This observation agrees with Lessard et al, [31], who did not find any increase in risk for acquiring BV by using IUD. But disagrees with Donders et al, [32] & Madden et al, [33] who have shown an increase in the risk of BV among IUD users. Also our finding disagrees with studies [26,34], that reported a protective effect of hormonal contraceptives against BV.…”

Influence of Contraception on Basic Vaginal States: A Prospective Study

“…However, there is still no accurate explanation of their effect on the vaginal microbiota. Tessa Madden et al showed that the incidence of bacterial vaginosis is higher in IUD users than in women using other methods and detected a positive association with two mediators: the irregular vaginal bleeding and an intermediate vaginal microbiota (BVS III) present at implantation of the device [15]. In this study, the use of male condoms, a method chosen mainly by the security offered both contraception and sexually transmitted infections, was associated with an increase in the vaginal content with VIR.…”