The IUD, or intrauterine device, is a small plastic object that is inserted into the uterus through the vagina and cervix and then continuously kept in place. There are many different models of IUDs, which vary in shape, size, and composition. For example, some contain copper filaments (the Copper 7 and the Copper T) and some contain a hormone (the Progestasert T slowly releases a synthetic form of progesterone into the uterus).
While IUDs became popular in this country only in the last twenty years, they are a modern application of an ancient concept. For centuries, Arab and Turkish camel drivers put a large pebble into the camel's uterus for contraceptive purposes, since a pregnant camel on a long desert trek would not be very helpful. The first IUD designed for humans, a ring made of silkworm gut, did not gain much attention when introduced in 1909. In the late 1920s a ring of gut and silver wire was developed by Grafenberg, a German physician, and enjoyed some popularity. Early models of the IUD, however, were condemned because of the risk of pelvic infection and fell into disrepute.
By 1978 about 6 percent of married women of reproductive age in America used the IUD, while about 20 percent did in Scandinavia and approximately half of all women using
contraceptives adopted it in China. On a worldwide basis, approximately 60 million women use the IUD.
The exact way the IUD works is not known. The most plausible explanation is that it interferes with implantation of the fertilized egg in the lining of the uterus. This outcome may result from a local inflammatory reaction or from interference with chemical reactions inside the uterus that affect implantation. IUDs containing progesterone also alter the development of the lining of the uterus so that implantation is unlikely.
The IUD must be inserted into the uterus by a trained health care professional after determining that the woman is not pregnant and does not have gonorrhea or other pelvic infections. Inserting an IUD can cause abortion in a pregnant woman and can push bacteria from an infection into the uterus or Fallopian tubes. Insertion is usually done during a menstrual period, since it is a fairly reliable sign that the woman is not pregnant, but it can be done at other times.
Inserting an IUD usually causes only brief discomfort, but some women prefer to be given a short-acting painkiller. Taking two or three aspirin tablets about an hour before insertion
provides some pain relief and may theoretically decrease cramping because it blocks release of prostaglandins. The woman must be shown how to check the plastic thread that comes through the mouth of the cervix to be sure the IUD is in place. If this thread cannot be located, or if it seems longer than it was before, the woman must return for a checkup.
IUDs are sometimes expelled from the uterus so that they no longer provide contraceptive protection. Expulsion rates are lower in women who use copper-or progesterone-containing devices (about six or seven per 100 women during a year) compared to a rate of approximately fifteen per 100 women during a year for other IUDs. Expulsion rates are higher in younger women, in women who have had no children, and during menstruation. One-fifth of expulsions go unnoticed, and this accounts for one-third of the pregnancies among IUD users.
Even though they may be expelled, IUDs are highly effective, with only one to six pregnancies occurring in 100 women using IUDs for one year. One study showed that women using IUDs to prevent pregnancy had a failure rate of 2.9 percent, whereas women using IUDs to delay or space pregnancy had a failure rate of 5.6 percent.
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Men's Health Erectyle Dysfunction
