A rational approach to the IUCD

Abstract

The intra-uterine contraceptive device (IUCD) is used by about 6% of sexually active women in Britain. Although highly effective, the newest devices having pregnancy rates of less than 2 per 100 woman years,1 users remain anxious about the risk of pelvic inflammatory disease (PID) and subsequent sterility. The reputation of the IUCD began to suffer following reports of serious complications associated with the use of the Dalkon shield in America in the 1970s. The tail of this device differed substantially from those of other IUCDs in common use; its multifilament thread enclosed in a plastic sheath had an alleged wick effect allowing bacteria to reach the endometrial cavity.2 This led to septic mid-trimester abortions when accidental pregnancy occurred, as well as several deaths from septicaemia. Subsequent litigation and difficulty obtaining product liability insurance led to the withdrawal of IUCDs from the American market for purely commercial reasons.3 So how safe are these devices and how can they best be used?