Intrauterine Device Research Articles

Efficacy of intrauterine device procedural analgesics.

Nearly half of all pregnancies worldwide are unintended. Intrauterine devices are an effective, long-acting form of pregnancy prevention that require minimal maintenance, and also can be used in patients with menorrhagia. However, they are underused because of pain associated with their insertion. Topical and local anesthesia are good options for reducing procedural pain in select patients. IUD placement falls within the scope of practice for physician associates/assistants (PAs) practicing in family medicine, internal medicine, and women's health. PAs should be aware of these additional analgesia options available to patients in order to increase use of effective contraception.

Outcomes of Mechanical Resection of Endometrial Polyps and Submucosal Fibroids Through TruClear™ Hysteroscopy.

To assess the efficacy of mechanical resection through TruClear™ hysteroscopy in patients with endometrial polyps and submucosal fibroids. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Shifa International Hospital, Islamabad, Pakistan, from June 2018 to 2022. Patients diagnosed with endometrial polyps and submucosal fibroids confirmed by abdominal or transvaginal ultrasonography were included. Patients having a history of congestive cardiac failure, chronic kidney disease, and bleeding diathesis were excluded from the study. Data about the complete removal of pathology (endometrial polyps and submucosal fibroids), mean operating time, and postoperative complications such as bleeding and perforation were extracted. The follow-up was set up to 6 months after the procedure. The average age of the 45 patients was 35.62 ± 7.46 years. Heavy menstrual bleeding was the most prevalent symptom, seen in 73.3% of cases, followed by irregular vaginal bleeding (IVB) in 11.1% of cases. The most frequent disease identified by sonography was a polyp in 21 (47%) instances, followed by submucosal fibroids in 12 (27%) cases, mixed pathology in 10 (22%), and malignancy in 2 (4%) cases. The overall average operative time was 36.46 ± 24.94 minutes. A hundred percent removal of lesions was observed in this study. Persistent symptoms were observed in 13% of patients after the surgery so they were treated with other interventions. The most common intervention was an intrauterine hormonal device. Intraoperative bleeding was observed in only one patient and was managed by intraoperative intrauterine balloon insertion. The recurrence rate was 8.9% (4/45). TruClear™ hysteroscopy showed a major advantage in the successful and complete removal of the pathology, low operation time, and complications. Fibroids, Hysteroscopy, Polyps, Endometrial resection, Menstrual bleeding.

Minimally Invasive Treatment of Abdominal Pregnancy Implanted on the Ileocecal Junction

We report a case of a 32-year-old gravida 1 para 0 with a copper intrauterine device in place and a newly diagnosed pregnancy at 5 weeks gestation. Serum human chorionic gonadotropin (hCG) was 23,940 mIU/mL and transvaginal ultrasound demonstrated a presumed right adnexal ectopic pregnancy with fetal cardiac activity. Upon laparoscopic entry, a 3 cm vascular mass consistent with ectopic pregnancy was noted densely adherent to the cecum, adjacent to the ileocecal junction. Given difficult tissue plane dissection and bleeding, a 4 cm mini-laparotomy was made and the mass was bluntly dissected away from the bowel implantation site. The bowel was oversewn. The patient's postoperative course was uncomplicated.

Prevalence, Determinants, and Management Options of Scar Site Pregnancy in Women With Previous Cesarean Section: A Study From the Al-Qassim Region.

Pregnancy located outside the uterine cavity following a cesarean section has become more prevalent in recent years due to the increase in cesarean section delivery. This study sought to investigate the prevalence, determinants, and treatment options of scar site pregnancy among women who sought maternal and child health services in a hospital in Buraydah, Al-Qassim region, Saudi Arabia. Utilizing a quantitative retrospective case-control design, 50 women were recruited and assigned to the two groups evenly. Demographic data and risk factors were assessed using a questionnaire, and data were analyzed using SPSS version 27 at a 95% confidence interval and presented intables and figures. Fifty-eight percent of the participants were aged 35 years and above, with 38% reporting a parity of 1-3. Logistic regression revealed that parity (odds ratio (OR) = 10.975, 95% confidence interval (CI) = 0.887-135.861, and p-value = 0.062), the interval between the last and present pregnancies (OR = 0.056, 95% CI = 0.005-0.668, p-value = 0.023), intrauterine contraceptive device (IUCD) use in the last year(OR = 0.070, 95% CI = 0.006 -0.780, p-value = 0.031) were statistically significant in predicting cesarean scar pregnancy. Combined methotrexate and aspiration were the most prevalent treatment options for scar site pregnancy in this study. Scar site pregnancy is a maternal health complication that affects women across all healthcare settings, and its prevalence is not clear due to underdiagnosis and underreporting. The risk of scar site pregnancy increased with an increase in the number of childbirths (parity) and the interval between the last and current pregnancies.

A small-loop double-coil decoupling TEM device for high sensitivity near surface detection

Small loop transient electromagnetic (TEM) devices, several meters in size, are increasingly applied to near-surface geophysical exploration in space-limited environment. But the transmitter (TX) coil significantly affects the early time data acquisition of the receiver (RX) coil during current turn-off, resulting in the loss of shallow signals and creating a significant blind zone problem. We report a double-coil decoupling TEM (DCDTEM) device to solve this problem. The novel DCDTEM device ensures a weak primary magnetic flux region between the two coplanar transmitter (TX) coils with the same current direction and different radii. Simulation results indicate that the transmitting field of the DCDTEM device is more focused compared to the traditional central loop device, ensuring a stronger coupling with the target. 3-D TEM forward modeling results show that the DCDTEM device has the highest detection sensitivity, together with a relatively high lateral resolution compared to other small-loop TEM devices. We further carry out several physical experiments to test the response characteristics of the DCDTEM device with reference to both the offset and the ratio of turns between the TX and RX coils. The experimental results ensure that the position of the zero magnetic flux point can be accurately calibrated and mitigate interference from TX coils. The proposed DCDTEM device is also applied in a field test on water pipe detection, demonstrating its practicality in near-surface detection.

Prospective Evaluation of Ease and Difficulties of 869 Cases of Intrauterine Devices Removals

ObjectivesThe objective was to describe the ease and difficulty of removing intrauterine devices (IUDs). MethodsWe conducted a prospective study at the University of Campinas (UNICAMP), Faculty of Medical Sciences, UNICAMP. We included women who requested IUD removal. We excluded women with partial IUD expulsion in which the IUD was protruded at the external os. We identified difficult IUD removal when the removal was challenging, including the inability to visualize IUD strings extending from the cervical os. ResultsA total of 869 women participated. Women were aged 29.4 ± 8.0 years (mean ± SD; range 14–51) and the duration of IUD use at the time of removal was 4.3 ± 4.2 years. We found that 702 (80.8%) women had visible strings at the external os and the removals were performed at the first attempt without difficulty in 692 (79.6%) participants. The pain was more intense (>4) in cases of difficult removals. After multivariate logistic analysis, difficult removals were associated with users of IUD ≥3 years (3 times higher risk); for each previous cesarean delivery, the risk increased by 1.5 times. ConclusionsOur study showed that IUD removal is an easy and safe procedure, with only a small proportion of women reporting significant pain with IUD removal.

Hubungan Sikap, Sosial Budaya, Dan KIE (Komunikasi, Informasi, Edukasi) Terhadap Keikutsertaan Ibu Dalam Mengikuti Program KB IUD Di Wilayah Puskesmas Jatirahayu Bekasi Jawa Barat

Introduction: An Intra-Uterine Device (IUD) is a long-term non-hormonal contraceptive that is inserted in the uterus and is made of a plastic/copper-like material and has various shapes. Participation in IUD KB is the behavior of women in following all procedures for using IUD contraception, such as the initial examination before installation, the installation procedure, and the examination after installation. This study aims to determine the relationship between attitude, socio-culture, and KIE on the participation of mothers in the IUD family planning program in the Jatirahayu Health Center area. Methods: Using descriptive analytics with a cross-sectional approach. The sampling technique used was total sampling with a total of 33 respondents. Results: The results showed that there was a relationship between attitudes towards participation in the IUD family planning program, which obtained a p-value of 0,039; but there was no relationship between socio-culture and participation in the IUD family planning program p-value of 0,425; and KIE towards participation in the IUD family planning program p-value 1,000. Discussion: This study concludes that there is a relationship between attitudes towards participation in the IUD family planning program and no relationship between socio-culture and KIE towards participation in the IUD family planning program for mothers in the working area of the Jatirahayu Health Center in 2023. Suggestions for prospective family planning acceptors are expected to increase knowledge of the benefits and effectiveness of IUD family planning to foster trust and motivation to participate in the IUD family planning program.

How is age at menopause and reproductive lifespan associated with chronic pain outcomes in postmenopausal women?

Female sex is a prominent risk factor for chronic pain, although the underlying mechanisms are not fully understood. This cross-sectional study aimed to investigate the relationship between age at menopause, reproductive lifespan, and chronic pain in a sample of postmenopausal women aged 40 to 93 years. Data were collected from the Tromsø study conducted in Norway between 2015 and 2016 (Tromsø7). Chronic pain was assessed using a single question, which formed a sample size of 5741 participants. Chronic widespread pain was evaluated using the more comprehensive Graphical Index of Pain, resulting in a sample size of 5920 women. Premenopausal women and those who experienced menstrual cessation due to chemotherapy/radiation or hormonal intrauterine devices were excluded from the analysis. Adjusted relative risk ratios with 95% confidence intervals were calculated to determine associations. The results showed that early menopause was associated with a 1% increase in the prevalence of chronic pain for each year of earlier onset at menopause (0.992, CI 95% 0.985-0.998). This association was also observed in women who experienced natural menopause only. However, the association between menopause and chronic widespread pain did not reach statistical significance in the fully adjusted analysis (0.996, CI 95% 0.975-1.017). There were no significant associations found between reproductive lifespan and either outcome. In conclusion, the findings suggest that early menopause in postmenopausal women is linked to a higher prevalence of chronic pain. However, reproductive lifespan does not appear to have a significant impact on chronic pain or chronic widespread pain.

Intrauterine device (IUD) migration to the fallopian tube: a rare location for a translocated IUD with no visceral injury

BackgroundLoss of Intra Uterine Device (IUD) following silent perforation of the uterus either during or after IUD insertion is an uncommon finding due to a lack of immediate follow-up. We report a rare case in which uterine perforation following the migration of IUD to the right fallopian tube without visceral injury. The patient presented with lower abdominal pain and pain during sex for one year since IUD insertion. On examination, we noted tenderness on the right suprapubic region and on speculum examination, no IUD thread was seen. A radiological pelvic examination showed an empty uterus without an IUD. Laparotomy and retrieval of migrated IUD was done followed by repair of perforated uterus.ConclusionMigrated IUD with silent uterine perforation without visceral injury is a distressing clinical condition both to the patient and the clinician. This case is reported to increase awareness in doing immediate vaginal examination and pelvic ultrasound post-IUD insertion.

Intravesical Migration of Intrauterine Contraceptive Devices with Calculus Formation: Two Cases and Review of Literature

Intravesical Migration of Intrauterine Contraceptive Devices with Calculus Formation: Two Cases and Review of Literature

Contraceptive use in the Gaza Strip: A systematic review

Background: Between 2017-2019, the average total fertility rate in Gaza was 3.9 births per woman, which is significantly higher than the average global total fertility rate at 2.4 births per woman in 2018. Reliable family planning methods allow women and men to avoid unintended pregnancies and reduce maternal mortality. The purpose of this systematic review was to examine what is known about contraceptive use in the Gaza Strip, including: 1) common contraceptive methods used, 2) access to contraceptive services, and 3) barriers impacting family planning services.Methods: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles published in the English language within the last 10 years (2013 to 2023) were screened from the following databases: CINAHL, PubMed, and Google Scholar.Results: Seven articles were included in the final analysis. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was found to be the main family planning service provider in the Gaza Strip (61%). Intrauterine devices (35.4%) were found to be the main method of contraception. Factors identified that impact contraceptive use included: 1) access to contraceptives, 2) cultural beliefs, 3) demographic characteristics (e.g., occupation and education), and 4) healthcare provider (HCP) and system influence. The restriction of goods into the Gaza Strip continues to impact contraceptive accessibility. Educational interventions should focus on addressing contraceptive misconceptions among Gazan women and HCPs while giving special attention to cultural beliefs (e.g., desire for several children) and demographic characteristics, specifically relating to occupation and education status.Conclusion: Unintended pregnancies are preventable through the effective use of contraceptives. Future studies should prioritize interventions aimed at overcoming barriers to contraceptive use in the Gaza Strip, thereby promoting and safeguarding Gazan individuals' ability to exercise their reproductive health rights freely.

Contraceptive Use Measured in a National Population-Based Approach: Cross-Sectional Study of Administrative Versus Survey Data.

Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for the study of specific population subgroups such as people with low income. Health administrative data could be an innovative and less costly source to study contraceptive use. We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data. We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population-based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age. There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women. Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health.

Social Determinants of Health and Patient-Reported Difficult Discontinuation of Long-Acting Reversible Contraception.

Background: Some individuals who receive long-acting reversible contraception (LARC) face barriers to discontinuation. The inability to discontinue a contraceptive method when desired negatively impacts a person's reproductive autonomy. Persons impacted by social determinants of health (SDH) may be disproportionately affected. The objective of this study is to evaluate the association of SDH with patient-reported difficult LARC discontinuation. Methods: A retrospective cross-sectional analysis of data from the 2017-2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal. Results: A total of 754 respondents reported wanting to have their LARC removed, and 105 (11%) reported difficulty discontinuing LARC methods. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). After adjusting for age, race, education, geographic location, parity, and body mass index (BMI), persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficultly discontinuing LARCs compared with respondents without any SDH (2.11; 95% confidence interval [CI]: 1.21, 3.69). Transportation barriers demonstrated the largest aOR of 2.90 (95% CI: 1.07, 7.87). Conclusions: SDH are associated with challenges to LARC discontinuation. SDH are unique risk factors that can impact one's entire contraceptive experience. A nuanced discussion of SDH at the time of contraceptive counseling may be a critical step in addressing the intersectionality of method selection and reproductive agency.

Perceptions of Women in Opioid Recovery Regarding Policies and Laws on Sexual and Reproductive Health

ObjectiveTo explore perceptions of policies and laws on sexual and reproductive health among women in recovery from opioid use disorder (OUD). DesignQualitative descriptive. SettingTelephone interviews conducted in a midsized urban area in the midwestern region of the United States. ParticipantsTwenty-two women ages 18 to 49 years who self-identified as being in recovery from OUD. MethodsWe conducted individual, semistructured telephone interviews and analyzed the data using reflexive thematic analysis. ResultsWe identified three themes: Barriers to OUD Treatment and Recovery, Pregnancy as a Gateway to Treatment and Recovery, and The Dobbs Effect. Participants described OUD treatment barriers such as inadequate recovery resources for women and the criminalization of drug use. Many participants described pregnancy as a gateway to recovery because of improved access to treatment services and enhanced motivation for engaging in recovery. Participants described unintended pregnancy as a threat to recovery that made them seek woman-controlled contraceptive methods they could use without negotiating with a partner (e.g., intrauterine devices) after the Supreme Court overturned constitutionally protected access to abortion. ConclusionOpioid use disorder is a public and mental health crisis in the United States that affects reproductive-age women. Participants in our study closely connected recovery from OUD with sexual and reproductive health policy and laws. There is a need for regulation to support the unique needs of women in OUD treatment. The recent Supreme Court decision that overturned constitutionally protected abortion creates challenges for women in recovery from OUD. Nurses are ideally positioned to advocate for recovery and sexual and reproductive health policies and laws that improve the physical and mental health of women in recovery.

Contraceptive access and use before and during the COVID-19 pandemic: a mixed-methods study in South Africa and Zambia

Background The COVID-19 pandemic affected global access to health services, including contraception We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users’ desire and ability to obtain removal. Methods Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported that they tried to access FP since the start of the pandemic. The vast majority of those seeking services were using short-acting methods and 95% were able to obtain their preferred method. The proportion of women not using a method before and after the start of the pandemic did not change in Zambia (31%), and increased from 8% to 10% in South Africa. Less than 7% of implant or IUD users in either country reported wanting removal. Among the 22 who sought removal, 10 in Zambia and 6 in South Africa successfully obtained removal. In qualitative interviews, those reporting challenges to service access specifically mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions We did not find a substantial impact of COVID-19 on contraceptive access and use among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people’s ability to access their preferred contraceptive methods.

An in-vivo study of the safety of copper-containing intrauterine devices in 3.0 Tesla magnetic resonance imaging

PurposeThe aim of this study is to prospectively evaluate whether women with copper-containing intrauterine devices (Cu-IUD), currently listed as MR conditional, can safely undergo 3.0 Tesla (3 T) magnetic resonance imaging (MRI).Methods73 women, age 18–54 years old, with a Cu-IUD who were undergoing MRI for any reason were included consecutively. Pre- and post-MRI standard pelvic ultrasound examinations were completed to determine the appropriate pre- and post-MRI positioning of the Cu-IUD. Displaced IUDs were defined by IUD crossbars not in the fundal portion of the endometrial cavity, a visualized tip in the mid or lower uterus, any part of the device located in the cervical canal or outside of the endometrial canal, a fractured device, or a non-visualized IUD. Additionally, a questionnaire was completed by participants to determine the level of pre- and post-MRI pelvic pain.ResultsThere were zero observed displaced Cu-IUDs on post-MRI pelvic ultrasounds (p = 0/70, 95% CI 0, .043). Three participants were dropped from the study due to malpositioned IUDs on pre-MRI pelvic ultrasound. Six patients reported new or worsening pelvic pain/discomfort during or after their MRI examination.ConclusionOur results suggest that performing 3 T MRI using a low SAR setting does not cause displacement of Cu-IUDs, with zero out of 70 patients demonstrating IUD displacement.Graphical

Chronic pelvic pain among transgender men and gender diverse adults assigned female at birth.

There are limited data on pelvic pain among transgender men and gender diverse people, and the impact of testosterone on pelvic pain is poorly understood. Characterize the prevalence and correlates of chronic pelvic pain (CPP) among transgender men and gender diverse people and examine the association between testosterone use and CPP. We used 2020-2022 data from The Population Research in Identity and Disparities for Equality (PRIDE) Study, an online prospective cohort study of sexual and gender minority adults in the United States, to conduct complementary cross-sectional and longitudinal analyses. Our primary outcome was self-reported CPP lasting 3 months or longer measured using the Michigan Body Map. Among 2579 transgender men and gender diverse people assigned female at birth included in our sample, 457 (18%) reported CPP. CPP correlates included: inflammatory bowel disease, irritable bowel syndrome (IBS), kidney stones, pelvic inflammatory disease, polycystic ovary syndrome (PCOS), uterine fibroids, current hormonal intrauterine device use, prior pregnancy, vaginal delivery, hysterectomy, and oophorectomy. Individuals with CPP reported a high prevalence of IBS (37%), PCOS (20%), uterine fibroids (9%), post-traumatic stress disorder (51%), and severe depression and anxiety symptoms (42% and 25%, respectively). Current testosterone use was associated with a 21% lower prevalence of CPP (adjusted prevalence ratio (aPR) 0.79, 95% confidence interval [CI]: 0.65-0.96). In longitudinal analyses (N=79), 15 (19%) participants reported any CPP after initiating testosterone: eight (56%) of whom reported CPP prior to testosterone initiation, and seven (47%) who reported new-onset CPP. The relationship between CPP and testosterone is complex. Although testosterone use was associated with a lower prevalence of CPP, some transgender and gender diverse individuals experienced new-onset pelvic pain after testosterone initiation. Given the significant impact that CPP can have on mental health and quality of life, future research must examine the role of testosterone in specific underlying etiologies of CPP and identify potential therapies.

Effect of progestin-based contraceptives on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls.

Adolescent girls bear a disproportionate burden of both the HIV epidemic and unintended pregnancies; yet important questions remain unanswered regarding the effects of hormonal contraceptives on the vaginal immune microenvironment, which can impact HIV susceptibility in this group. Multiple studies report genital immune alterations associated with the progestin-based contraceptive Depot medroxyprogesterone acetate (DMPA) in adult women, but there is little available data in adolescents. The objective of this longitudinal cohort study was to evaluate the effects of short-term use of three progestin-based contraceptives, levonorgestrel intrauterine device (LNG-IUD), subdermal etonogestrel (ETNG), and injectable DMPA, on HIV-associated vaginal immune biomarkers and microbiome in adolescent girls. Fifty-nine sexually active, HIV-uninfected girls aged 15-19, were recruited from the Washington DC metro area and self-selected into Control (condoms only), combined oral contraceptive pills, LNG-IUD, ETNG and DMPA groups. Vaginal swabs were collected at baseline prior to contraceptive use and at 3-month follow-up visit. Vaginal secretions were tested for pro-inflammatory (IL-1α, IL-1β, TNF-α, IL-6, IL-8, MIP-3α, IP-10, RANTES, MIP-1α, MIP-1β) and anti-inflammatory/anti-HIV (Serpin-A1, Elafin, Beta-Defensin-2, SLPI) immune biomarkers using ELISA and for anti-HIV activity using TZM-bl assay. Vaginal microbiome was evaluated using 16S rRNA gene sequencing. Data were analyzed using SAS Version 9. Among the 34 participants who completed both visits, no significant changes in median biomarker concentrations, HIV inhibition and microbiome composition were observed between baseline and follow-up visits for any of the contraceptive groups. IL-8 (p<0.01), MIP-3α (0.02), Elafin (p = 0.03) and RANTES (p<0.01) differed significantly by race whereas IL-6 was significantly different by age (p = 0.03). We conclude that 3-month use of LNG-IUD, ETNG and DMPA have minimal effects on adolescent vaginal immune microenvironment, and therefore unlikely to impact HIV risk. Future studies with larger sample size and longer follow-up are recommended to continue to evaluate effects of contraceptives on the lower genital tract immunity and susceptibility to sexually transmitted infections.

Colonoscopic removal of an intrauterine device with rectal perforation: A case report.

The intrauterine device is one of the effective, safe, convenient, economical, and reversible contraceptive methods. Although its contraceptive effect is definite, some female patients may experience complications such as expulsion, bleeding, and pregnancy with the device in place. Rectal perforation is one of the rare and serious complications, which can lead to complications such as abdominal infection and intestinal adhesions, severely affecting the quality of life of patients. A 34-year-old female was sent to the Department of Gastroenterology with noticeable left lower quadrant abdominal pain. She had presented with abdominal discomfort and anal tenesmus 1 year earlier. Two months ago, her abdominal pain had gradually worsened and she was presented to our hospital. Investigations, including colonoscopy and computed tomography scan, had revealed an intrauterine device migrated and perforated into the rectum. The patient underwent successful colonoscopic removal of the intrauterine device. She recovered well after the treatment. This case proves that endoscopic therapy can be considered the preferred method for removing intrauterine devices displaced into the digestive tract lumen.

Utilisation of immediate and early postpartum intrauterine contraceptive devices among adolescents in Mbale City, Eastern Uganda

Utilisation of immediate and early postpartum intrauterine contraceptive devices among adolescents in Mbale City, Eastern Uganda