Abstract
Based on data collected from 20,000 IUD users in Britain, it is suggested that the device not be the 1st choice of nulliparous women. Rekindled concern with long-term consequences of IUD use, raised incidence of pregnancy, expulsion of the device, bleeding or pain in nulliparous vs. parous users, and raised incidence of pelvic disease are discussed. The link between IUD use and pelvic inflammatory disease is bolstered by data showing a 3-fold increase in salpingitis in IUD users compared with women in general. When controlled for parity, a 7-fold increase in pelvic inflammation exists in nulliparous IUD users vs. nulliparous nonusers. Subsequent miscarriage and ectopic pregnancy in users vs. nonusers are special problems in women using the device as a means of delaying 1st pregnancy. A controlled prospective study is called for, since pelvic infection may affect subsequent fertility.
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