IUD

An IUD is an intrauterine device made of plastic and/or copper that is inserted into the womb (uterus) by way of the vaginal canal. One type releases a hormone (progesterone), and is replaced each year. The second type is made of copper and can be left in place for five years. The most common shape in current use is a plastic "T" which is wrapped with copper wire.

IUDs are used to prevent pregnancy and are considered to be 95-98% effective.It should be noted that IUDs offer no protection against the acquired immunodeficiency syndrome (AIDS) virus or other sexually transmitted diseases (STDs).

IUDs are placed in the uterus by physicians. Prior to placement the doctor will take a medical history, do a physical examination, and take a Pap test. Women who have had tubal pregnancies, an abnormal Pap smear, or abnormalvaginal bleeding are generally disqualified from using this form of contraception. Also, women who have STDs, an allergy to copper, severe pain with periods (menstruation), sex with multiple partners, or who are currently pregnant are not eligible for an IUD. There are no age restrictions.

There is continuing controversy over exactly how IUDs prevent pregnancy. Someresearchers think pregnancy is controlled by preventing conception (fertilization), while others believe that the devices prevent embryo attachment to the uterine wall (implantation).

IUDs which release a hormone may prevent pregnancy in several ways. Since onehormonal response is a thickening of the mucous at the entrance to the uterus, it is more difficult for the sperm to gain entry. This prevents the spermfrom reaching an ovum. At the same time, the lining of the uterus becomes thinner, making it more difficult for a fertilized egg to implant itself in theuterus. The copper device slowly releases copper which is believed to weakenand perhaps kill sperm. An alternate explanation is that these objects "sweep" the uterus, dislodging any fertilized egg that attempts to implant itself.In addition, both devices tend to cause a mild inflammatory reaction in the lining of the uterus which also has an adverse impact on implantation.

After the physician approves the use of an IUD, the woman's genital area is washed thoroughly with soap and water in preparation of IUD insertion. The opening into the uterus (cervix) will also be cleaned with an antiseptic such asan iodine solution. Actual IUD insertion takes about five minutes, during which a local anesthesia is used to reduce any discomfort associated with the procedure. A plastic string connected to the IUD will hang out of the uterus into the vagina. The string is used to periodically check the positionof the IUD.

The woman will be taught to watch for the signs and symptoms of potential complications and how to check the string, which should be done at least once aweek. To check the string, the woman should first wash her hands with soap and water. From a squatting position, or with one foot elevated (such as on a chair), she should gently insert her finger into the vagina until she locatesthe cervix. If she cannot feel the string, if the string feels longer than itshould, or if she can feel part of the IUD, she should notify her physicianimmediately. Additional information that needs to be reported includes painful intercourse and unusual discharge from the vagina.

Serious risks from IUDs are rare, but include heavy bleeding, pain, infection, cramps, pelvic inflammatory disease, perforation of the uterus, and ectopic pregnancy.

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