Intrauterine Device Contraception in Nulliparous Women

Thesis (M.Nurs.), College of Nursing, Washington State University"Approximately half of the six million annual pregnancies (in the United States) are unintended and almost half of these are ended in abortion, for 1.3 million abortions in 2000" [22 (p. 1417)]. This statistic provides proof that the U.S. female population requires better forms of contraception and further contraceptive education. The key to preventative health care is education and therefore full education on all contraceptive methods needs to begin now. The intrauterine device (IUD) and the intrauterine system (IUS) are safe and effective long-term forms of contraception that are underutilized in the United States (U.S.) [10]. The rate of IUD/IUS use in the U.S. is low, in comparison to other developed countries, at approximately three percent [4]. The exact rate of IUD use in nulliparous women is not known, but it is thought to be much less than the rate of use in the U.S. female population as a whole. Underutilization ofthe IUD stems from multiple misconceptions held by both the medical provider and the general U.S. female population. Brockmeyer, et al. [3] states, "The fear about problems with intrauterine contraception in nullipare often lies with clinicians." (p. 253). There have been multiple studies conducted to ascertain the usefulness and safety of the IUD in the nulliparous population. These studies have found the IUD to be a reliable, safe, and cost-effective contraceptive device well suited for nulliparous women. The IUD should be considered a first-line contraceptive choice in low risk women regardless of age and parity [10]. This paper reviews the current literature regarding IUD use in the nulliparous population and dispels myths. Three primary misconceptions will be covered: increased pain with IUD use, increased risk of pelvic inflammatory disease (PID), and the increased likelihood of IUD expulsion in comparison with the parous population