WOMENS-HEALTH Messages for April, 1999: Re: IUDs

Re: IUDs

From: William D. McIntosh, MD (anonymous@obgyn.net)
Thu, 22 Apr 1999 10:16:44 -0500 (CDT)

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At Wed, 21 Apr 1999, Raquel wrote: >
>I am a 31 year old woman who's never had children (or been pregnant). I
>am considering going off the pill because I have frequent migraines, as
>well as some other considerations. A doctor has suggested an IUD as an
>option (my husband is allergic to spermicides of all types, so using a
>diaphragm etc. is not an option). I have been reading about IUDs but
>have a question I have not found the answer to.
>Why is the IUD contraindicated for women who have never had children?
>There seems to be debate about this, but I can find nothing that
>explains why it's contraindicated. I want to keep the option of having
>children open, and thus don't want to do anything to jeopardize that
>possibility.
> I appreciate your thoughts.

Not having any children is a relative contraindication, meaning that there is a concern, but in an individual patient that fully understands the risks, it can still be used. There are two concerns with the IUD in the nulligravida woman. The first is technical. The uterus of a woman that has never been pregnant is usually a bit smaller than her uterus would be if she had had a baby. There are only 2 IUDs available in the US, and neither one is designed for use in small uteri. Your doctor has no doubt taken that into account, and apparently feels that you are still a candidate.

The other concern is the risk of infection and resultant infertility. The IUD provides no protection from sexually transmitted diseases. In fact, if you were to acquire chlamydia or gonorrhea, the IUD would act as a foreign body that could interfere with clearance of that infection, and could even lead to tubal disease, and sterility. The real question here is not the IUD so much as your personal risk of an STD of this type. If you have significant risk, the IUD is probably a bad idea for you. If your risk is very low to non-existant (strict mutual monogamy), then the IUD may be the answer to your problem.

I think the IUD is a wonderful form of contraception in the properly chosen patient. You and your doctor should evaluate your personal risks to help with your choice.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

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