to the editor: Dr. Johnson’s article1 on the intrauterine device (IUD) corrects some common misconceptions about IUD use. For instance, many physicians insert IUDs only during menses, despite evidence that insertion can occur safely at any point in the menstrual cycle. However, the article1 advises that “a lifestyle placing the woman at risk for sexually transmitted diseases” is a contraindication to IUD use. The article1 also suggests that the ideal candidate for the IUD is a parous woman. These points require clarification. Although current infection with Neisseria gonorrhoeae, Chlamydia, or other organisms causing purulent cervicitis is indeed an absolute contraindication to IUD insertion, infections that occur after IUD insertion can be treated safely without removing the IUD and do not pose a substantially increased risk of pelvic inflammatory disease. Thus, the World Health Organization2 and the United States Agency of International Development’s Office of Population and Reproductive Health3 advise that increased risk for sexually transmitted diseases (STDs) should be considered a caution, not a contraindication, for IUD use. Because studies fail to link IUD use to infertility, neither organization suggests restricting IUD use to parous women. Even nulliparous women with multiple sex partners can use IUDs safely, provided that these women protect themselves from STDs by using condoms. Given the high rates of unintended pregnancy and STDs in the United States, all physicians should encourage women to protect themselves against both problems. We should avoid inappropriately restricting women’s access to high-efficacy contraceptive methods.
editor’s note: This letter was sent to the author of “Insertion and Removal of Intrauterine Devices,” who declined to reply.