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a) Yes. However, IUDs should not be the first choice of contraception in nulliparous women. To receive IUDs, all women, especially young women, should not be at risk of sexually transmitted diseases (STDs). Counseling should focus on the increased risk of pelvic inflammatory disease (PID) and possible infertility in IUD users who have or adopt a sexual behavior that poses them at an increased risk of STDs. It is appropriate to warn women that the IUD has an increased risk of STD-associated PID and infertility.
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a-b) Young women statistically have a higher risk of PID. IUDs, in comparison to all other modern contraceptive methods, increase the risk of PID when a woman is infected with an STD. PID is a major risk factor for tubal infertility and ectopic pregnancy. Because young women may have patterns of sexual activity that lead to STD risk, the relative risk of PID in young IUD users may be high. Additionally, nulliparous women receiving IUDs may be at higher risk for expulsion.
The degree to which a client values future fertility is an important factor in the choice of a contraceptive method. Studies have shown that the risk of PID and subsequent tubal-factor infertility is directly proportional to the risk of exposure to STDs. IUDs do not protect women against PID or other STDs.
Nevertheless, women should be allowed to make their own choice.
- World Health Organization Task Force of Intrauterine Devises, Special Programme of Research, Development and Research Training in Human Reproduction. PID associated with fertility regulating agents. Contraception 1984;30(1):1-21.
- Petersen KR, Brooks L, Jacobsen B, Skouky SO. Intrauterine devices in nulliparous women. Advances in Contraception 1991;7(4):333-8.
- Angle MA, Brown LA, Buekens P. IUD protocols for international training. Studies in Family Planning 1993;24(2):125-31.
- Luukkainen T, Nielson NC, Nygren KG, Pyorala T. Nulliparous women, IUD and pelvic infection. Annals of Clinical Research 1979;11:121-4.
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