The use of IUD as an etiological factor of acute pelvic inflammatory disease

The authors review the body of literature dealing with the association between the use of IUDs and the development of acute PID (Pelvic Inflammatory Disease); the sources, dating from 1930 to 1976, include published articles from several nations as well as proceedings of international conferences. Limitations of studies done to date include: 1) the imprecise diagnostic criteria of PID; 2) an undue emphasis on hospitalized patients; 3) missed cases in which an IUD is removed shortly before the onset of PID; 4) absence of appropriate control groups and; 5) the use of sample sizes which are too small. These methodological deficiencies make it difficult to assess the true incidence of PID which occurs in association with the use of IUDs; nevertheless, researchers agree that an increased risk does exist. In addition, IUD users have an increased risk of pain and bleeding; future sterility; and ectopic pregnancy. In consideration of these risks, especially that of subsequent sterility, the authors recommend that IUDs not be used in nulliparae. They recommend that IUDs only be inserted in the absence of any genital infection; in parts of the world where gonorrhea is prevalent, antibiotics should be administered prophylactically before insertion of the device.