Sexually Transmitted Infections, Pelvic Inflammatory Disease, and the Role from Intrauterine Devices: Myth or Fact?

Abstract

Connections among Intra Uterine Devices (IUD), Sexually Transmitted Diseases (STDs) and Pelvic inflammatory disease (PID) still bring doubts for health professionals; Our goal is to understand better these associations. We searched the PubMed database for articles including evidence about these topics. A common outcome found is the superiority of levonorgestrel (LNG) IUD over NOVA T (copper) device regarding clinical performance and PID rates. The modern IUDs do not elevate the risk of getting PID; however this risk is higher when a patient has a STI at the time she gets an IUD. It is wise requiring a STI test, principally for cervicitis, before placing an IUD. The epidemiologic data suggests this management mainly for woman with a new sexual partner, or with multiple sexual partners, and under age 25. It is also correct inserting an IUD and test for STI at the same day: if positive results come, antibiotics can be used. Old papers usually show a higher risk for PID in IUD users, an outcome not found in recent researches that have improved methodology and therefore are more reliable. However, the investigation concerning the STI and cervicitis remain as an important point to investigate before decision to IUD use.

Indications and reasons for discontinuing the levonorgestrel-releasing intrauterine system (LNG-IUS)

“…1,11,25 In the present study, the nulliparous tended to experience greater difficulty with the insertion of the LNG-IUS. One explanation for this could be because for many years, the insertion of a copper IUD in nulliparous was contraindicated, 11 which has led to a lower ability of the professionals for inserting the LNG-IUS in this group of women.…”

“…The LNG-IUS expanded the indications for intrauterine devices, including contraception for nulliparous and this indication became more frequently and supported by scientific evidence. 9,11,25 Parity has also been considered a factor that may be related to the difficulty in insertion of the LNG-IUS 9,10 although some studies reported no difficulty in the insertion in nulliparous. 1,11,25 In the present study, the nulliparous tended to experience greater difficulty with the insertion of the LNG-IUS.…”

“…9,11,25 Parity has also been considered a factor that may be related to the difficulty in insertion of the LNG-IUS 9,10 although some studies reported no difficulty in the insertion in nulliparous. 1,11,25 In the present study, the nulliparous tended to experience greater difficulty with the insertion of the LNG-IUS. One explanation for this could be because for many years, the insertion of a copper IUD in nulliparous was contraindicated, 11 which has led to a lower ability of the professionals for inserting the LNG-IUS in this group of women.…”

“…It is known that the area of scar tissue changes in the isthmus region after cesarean section may hinder the passage of the device during insertions. Although a history of cesarean section is not contraindicated for the LNG-IUS insertion, 11 a study compared the difficulty of insertion among women with and without a previous cesarean section found that most of the women who presented difficulty in insertion had a history of cesarean delivery. 9 It is important to consider the limitations of the present study.…”

“…10 The reasons for the removal of the LNG-IUS include changes related to menstrual bleeding pattern, and although less frequent, hormonal changes causing such as weight gain, acne and mastalgia. 11,12 Expulsion is another reason for discontinuation of the use of the LNG-IUS. 13 In addition to expanding the contraceptive options available to women seeking effective, reversible, and safe methods, the LNG-IUS has been very cost-effective method.…”