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Relationship Between Use of the Intrauterine Device and Pelvic Inflammatory Disease
Why does the article1 state it is imperative that a woman receiving an intrauterine device (IUD) is in a mutually monogamous relationship during IUD use? The authors state earlier that no relationship between IUD and pelvic inflammatory disease (PID) exists except in the immediate postinsertion period.
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For years investigators were concerned about the possibility of an increased risk of PID in women using the IUD. During the 1970s, there was a massive increase in sexually transmitted diseases, largely due to gonococcal and chlamydial infections.2 At the same time, there was a general increase in the use of IUDs and, not surprisingly, the increase in the rates of PID was linked to IUD use. However, the largest database for the IUD (collected by the World Health Organization) and reanalysis of the data by Farley et al3 found that married and cohabiting women had little appreciable increased PID risk associated with IUD use compared with previously married and never married women using IUDs. These results suggest that women at low risk of acquiring sexually transmitted infections have little increase in the risk of PID. However, those who acquire gonococcal or chlamydial infection do have an increased risk of developing PID while using the IUD. An article by Lee et al4 states, "Perhaps IUDs facilitate the ascension of lower tract infections due to organisms such as Neisseria gonorrhoea or Chlamydia trichomatis."
It is now well recognized that the major contributing factors in the development of PID with IUDs are the number of sex partners and exposure to sexually transmitted diseases.5 Because PID can lead to significant morbidity in terms of infertility, ectopic pregnancy, and chronic pelvic pain, every attempt should be made to prevent PID in these patients. Hence, these patients should be counseled about mutual monogamy during IUD use.
Seshu Sarma, MD
Atlanta, Ga
1. Sarma SP, Garafolo K, Graves WL. Use of the intrauterine device by inner-city women. Arch Fam Med. 1998;7:130-133.
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2. Kessesl E. PID and IUD use: a reassessment. Fertil Steril. 1989;51:1-11.
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3. Farley TM, Rosenberg MJ, Rowe PJ, Chen JH, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet. 1992;339:785-788.
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4. Lee NC, Rubin GL, Borucki R. The intrauterine device and pelvic inflammatory disease revisited: new results from the Women's Health Study. Obstet Gynecol. 1988;72:1-6.
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5. Grimes DA. Whither the intrauterine devise? Clin Obstet Gynecol. 1980;32:369-376.
Arch Fam Med. 1999;8:197.
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