Iuds:hidden infections

The Lancet 's study (28 March 1992), from the World Health Organization's examination of nearly 23,000 women, showed that the device did not increase a woman's chances of pelvic inflammatory disease. PID was more likely to be caused by sexually transmissible disease or a poor insertion. WHO concluded that because of the increased risk of insertion, IUDs should be left in place as long as is safe an estimated eight years.

That same month, in its case records section, the new England Journal of Medicine (5 March) described the nightmare story of a woman who arrived at the hospital with a pelvic mass so large that it filled the pelvis, compressed the bladder and obstructed the rectum.

Eventually she was found to be a victim of actinomycosis, a fungi like bacterial infection characterized by the appearance of lumpy abscesses which exude pus through long "rays". During surgical investigation the surgeon in charge could not remove the IUD, which was firmly imbedded in the vaginal wall in fact, he found it difficult to find the uterus in the middle of this mass.

The patient was given a three month course of antibiotics and will eventually undergo "at least" a hysterectomy. In several similar instances, patients have had to have all reproductive organs removed as well as abdominoperineal "resection" to clear up the pelvic confusion.

In the article, the doctors cite one study showing the risk of colonization of actinomycosis is about 12.6 per cent, with the risk increasing the longer the IUD is in place. (Those who'd had theirs for less than two years rarely had infection.)

Another doctor who'd treated the woman believes that up to 25 per cent of IUDs eventually become colonized by actinomyces, and 2 to 4 per cent of those will go on to have serious infections.