Inflammatory disease with use of IUD

Abstract

Drs. Edelman and Bergers' report "Contraceptive practice and tuboovarian abscess (Am. J. Obstet. Gynecol. 138:541, 1980) may produce the impression in the medical profession that the IUD does not predispose to salpingitis, salpingo-oophoritis, and tubo-ovarian abscess, as published data and clinical experience would suggest. Also, the diagnostic criteria for diagnosing 'acute pelvic inflammatory disease' stated in the report, and published studies of Jacobson and Westrom and Chaparro et al question a diagnosis of pelvic inflammatory disease that is not confirmed endoscopically or by some direct visualization obtained surgically. 35% of patients who had laparoscopy by Jacobson and Westrom and who were suspected of having salpingitis, or pelvic inflammatory disease, and 54% of laparoscoped patients suspected by Chaparoo et.al. of having pelvic inflammatory disease were found not to have either salpingitis or pelvic inflammatory disease of gynecologic etiology. As pelvic inflammation may be caused by a variety of disorders, such as appendicitis, colitis, diverticulitis, and others, the term pelvic inflammatory disease is an imprecise diagnostic term. Edelman and Berger's results can also be questioned on the ground that numerous reports (e.g., Second Report on Intrauterine Contraceptive Devices, Food and Drug Administration, 1978; Population Reports, Series B, No. 3, May 1979, the Johns Hopkins University) indicate an increased incidence of salpingitis with its attendant pelvic crippling pain and infertility that is many times more common in IUD users than in nonIUD users. Available published data therefore strongly suggest that an IUD user is at far greater risk of developing inflammatory disease of infectious etiology in her reproductive tract with its attendant pain, morbidity, infertility, and even death than nonIUD users.