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Q: Medical Question: ( Answered 3 out of 5 stars,   0 Comments )
Subject: Medical Question:
Category: Health > Conditions and Diseases
Asked by: mabelle-ga
List Price: $20.00
Posted: 03 May 2005 05:35 PDT
Expires: 02 Jun 2005 05:35 PDT
Question ID: 517173
Last week , I have found on a web page an article.  I cannot find it  today
( been searching for it for days); as i always erase my tracks on my
computer.  It is most important that I find the original article in
question; due to a family member having the same medical problem as
describved in the article in question.
Here are the words that were in the article in question:
Overdue IUD (coil) in time for changing it; causes gonorrhea and
Chlamydia infections and the sign for overdue IUD is bleeding between
I only can remember part of the website address as follows: www.a
The person in question had her IUD so overdue that it changed in color
to PURE BLACK.  If also, you can find any article about the IUD
turning black that would be a plus.
Thank you . mabelle
PS: I shall tip you good for the right answer.
Subject: Re: Medical Question:
Answered By: crabcakes-ga on 03 May 2005 19:06 PDT
Rated:3 out of 5 stars
Hello Mabelle,

   I have performed extensive searches for the website you mentioned,
but have found only a handful that start with ?a? and discuss IUDs. I
have included many articles about IUDs and STDs however. The fact that
the IUD mentioned was black, may or may not indicate infection. The
copper IUD turns black or green during use, and some may become
discolored from body fluids, medications, etc. IUDs do not help
prevent STDs as do condoms, and as such, a woman may contract an STD
as easily as having unprotected sex. The simple fact that the IUD has
been left in longer than it should will not cause chlamydia,
gonorrhea, or any other STD with exposure to the STD through
unprotected sex. Leaving the IUD in longer than recommended can make a
woman prone to bacterial and yeast infections and PID from vaginal
organisms however.

You didn?t state what kind of IUD you are asking about either, or how
excessively long the IUD had been in use. Some IUDs are intended for a
one year use while others can last as long as ten years. Studies have
shown some women have kept IUDs in place for 20-30 years with no
repercussions. Bleeding/spotting from an IUD does not always mean
there is an infection, but it does indicate the need for a check up
with a gynecologist.

?Potential side effects from using an IUD include: 
·	Mood changes
·	Acne
·	Headaches
·	Breast tenderness
·	Pelvic pain 
·	Cramping (copper IUD)
·	Increased bleeding during menstruation (copper IUD)
·	Nausea
There is an increased risk of pelvic infections, particularly for
women who have more than one sexual partner.?
?·  The Cons of an Intrauterine Device include: 
·	Available only through a prescription
·	Irregular bleeding or spotting may occur during the first three to six months
·	Copper IUD may increase cramps and bleeding during monthly periods
·	May have hormonal side effects: mood changes, acne, headache, breast
tenderness, and nausea (progesterone IUD)?

How long an IUD stays in place depends on the type of IUD inserted and
the patient?s medical condition. IUDs can also become discolored after

Here is an IUD that has been colonized with bacteria that cause PID
(Pelvic inflammatory disease)

?Any artificial implant in the human body runs the risk of developing
biofilm infections. In the United States, over 4.4 million people have
at least one artificial implant device. These devices include
artificial joints, hearts and valves, stents and contact lenses.?
**There are some graphic images on this page:

However, copper IUDs can become discolored from becoming tarnished.
?The sterilized IUD package should be opened just prior to insertion,
not in advance. If left too long in the loading tube used for
insertion, a Copper T IUD may lose its shape and become less
effective. If a copper IUD has become tarnished in its sterile package
(turns green or black), it is still safe to use and will be just as
?The protection IUDs offer can be long-term. In the absence of
complications, copper devices may be left in for 10 years or more.
Those inserted after age 40 may be left in until menopause, unless a
woman becomes pregnant. An IUD should be removed one year after menses
stop, but no ill effects have been reported among women who have not
had them removed more than a year after menopause.?

·?The copper IUD, which is good for 10 years, is a plastic device with
copper parts that interferes with sperm and egg migration,
fertilization and implantation.
·The progesterone IUD, which is good for one year, is a plastic device
that releases daily progesterone into the uterus, disrupting
·The LNG IUS, which is good for five years, has a steroid reservoir
containing LNG, a potent progestin hormone found in many oral
contraceptives. The steroid reservoir releases a small daily dose of
LNG into the uterine cavity for five years, thickening the cervical
mucus and inhibiting sperm movement and function.?,,j6ng,00.html

?In contrast to condoms, IUDs provide no protection against AIDS.
AIDS?acquired immune deficiency syndrome?is caused by the human
immunodeficiency virus (HIV). No vaccine against this virus has been
developed. HIV is found in semen as well as blood. Thus both male and
female condoms, which prevent semen from entering the vagina, and
possibly spermicides and diaphragms, can protect against HIV. Other
family planning methods cannot.?

?No protection against sexually transmitted diseases (STDs) or HIV. It
increases the chance of developing pelvic inflammatory disease (PID)
after being infected with some STDs, especially in the first months
after insertion.?

?Insertion of an IUD can introduce bacteria into your uterus. Experts
believe that most infections occurring from 3 weeks to 3 months after
placement of an IUD are caused by unsterile insertion. Infections
after that time are thought to be STDs.
The World Health Organization conducted a study recently which put to
rest the nagging suspicion that IUDs cause pelvic inflammatory
disease. In almost 23,000 IUD users studied, researchers found only 81
cases of PID. They also determined that PID risk was 6 times higher
during the 20 days after insertion; and that the risk remained low for
the next 8 years.
This study showed that PID occurred infrequently in women at low risk
of sexually transmitted disease. It also found that PID was extremely
rare in China, where more than half of all women of childbearing age
use IUDs and where there are few cases of STDs. The researchers
suggest that IUDs be left in place for as long as they are effective,
and that physicians refrain from removing them periodically to combat
potential infections, as some now do. Ironically, this routine removal
followed by reinsertion can lead to even more infections.

Scientists are also investigating the benefits of using antibiotics,
such as doxycycline, at the time of insertion to prevent infection.
While some doctors don't recommend this yet, studies with small
numbers of women have shown that preventative antibiotics can reduce
the chance of infection by about 31 percent.
Still, if you get an infection for whatever reason while using an IUD,
it can cause serious problems, including tubal infertility,
peritonitis (infection of the entire abdomen), and liver damage. If
bacteria get into your bloodstream, it can prove fatal.

Doctors can treat early infections successfully with antibiotics. If
the infection isn't severe, your physician may opt to leave your IUD
in place for a few days to see if the infection goes away. You will
probably get a shot of Cefoxitin (Mefoxin) plus an oral dose of
probenecid (1 gram), or a shot of Ceftriaxone (Rocephin) and a 2week
prescription for oral doxycycline (Doryx).
If your infection is severe, your doctor will almost certainly remove
the IUD. If you require hospitalization, you may need intravenous
injections of Cefoxitin or Ceftriaxone, plus oral doxycycline over a
two week period?

?Although IUD users are more likely to develop PID than nonusers, it
is still an uncommon complication. A WHO study of multiparous women,
mostly in developing countries, who were using copper IUDs reported a
cumulative rate of removal for PID of less than one per 100 women
after six years of use (307). Another international multicenter study
reported 3.4 removals of copper IUDs per 100 women after seven years
of use (549). In a European study involving many young, unmarried
women, who are at higher risk for PID, the 5-year removal rate was
seven per 100 women?

?The organisms associated with IUDs were predominantly composed of
Staphylococcus aureus (16%), Staphylococcus epidermidis (18%),
Pseudomonas aeruginosa (5%), Escherichia coli (27%), Neisseria
gonorrhoeae (2%), Candida albicans (20%) and Candida dubliniesis
(12%). SEM studies indicated that these organisms were organized into
biofilms. Studies on the in vitro adherence pattern by crystal violet
staining on 96 well microtitre plates revealed that the biofilms were
stably established after 60 hours. These biofilms are resistant to an
array of antibiotics tested. CONCLUSION: Biofilm formation may be one
of the major causes for persistent infection and antibiotic resistance
in IUD users.?;year=2003;volume=21;issue=3;spage=161;epage=165;aulast=Pruthi

?It can stay in the uterus for 1-3 years (depending on the type of
IUD), and is removed when pregnancy is wanted or if problems occur.
The main criticism of using an IUD has been that it increases the risk
of developing pelvic inflammatory disease (PID), which can lead to
fertility problems. PID is caused by STD, most commonly chlamydia and

?STIs and PID:  PID in IUD users is related to poor insertion
techniques and the presence of an STI at the time of insertion. PID is
usually caused by a pathogen ascending from the vagina or cervix into
the upper reproductive tract (uterus, fallopian tubes, ovaries), which
can be facilitated by insertion of an IUD. The risk of PID is
significantly increased in the first month after IUD insertion, but
after the first three months of use, the risk in IUD users is
comparable to that in nonusers.

Another recent study (Shelton, 2001) modeled the risk of PID based on
the assumption that PID among IUD users results from insertion in the
presence of cervical gonorrhea or chlamydia and occurs within the
first few months after insertion. Fully symptomatic PID attributable
to IUD use was uncommon, even in populations with a high prevalence of
STI. The author estimated that the risk of clinical PID due to IUD use
was 0.15 percent, or less than one in 600 women. With a high overall
prevalence of gonorrhea or chlamydia of 30 percent, the PID risk
increased to 0.3 percent.?

?Risk factors for trichomoniasis include use of an IUD, cigarette
smoking and multiple sexual partners.16,17,42 From 20 to 50 percent of
women with trichomoniasis are asymptomatic.?

?PELVIC INFLAMATORY DISEASE (PID): PID is an infection in the uterus,
fallopian tubes and sometimes ovaries. This is a major complication
associated with IUD usage. PID is 3-9 times more likely to occur in
women using this method of birth control. The risk is significantly
lower if you are in a long term, monogamous relationship. The string
at the end of your IUD is your link to the continued presence of you
IUD. It is also a ladder that may provide a potential route for
vaginal and cervical bacteria to travel into the uterus. If you
contract gonorrhea or any sexually transmitted disease (STI) while
using an IUD, have the device removed immediately and get treatment.
Since infections travel fast in this area of the body it is important
to be tested on first suspicion of an STI. Watch for: pelvic pain or
tenderness, fever, sever cramping and/or foul smelling discharge. A
pelvic infection can cause scarring of the fallopian tubes which can
then result in future sterility. If a pelvic infection goes untreated
it can lead to death.
·  PERFORATION: The uterine wall can be perforated upon insertion.
Occasionally the IUD will escape through the perforated wall and pass
into the abdominal cavity, from which it needs to be removed. A
shorter or missing string could be an indication of a perforation.
There are often no other physical symptoms. After removal of the IUD
the perforation usually heals over in time.
·  EMBEDDING: Embedding occurs when the lining of the uterus starts to
grow around the IUD. If only partially embedded, it will usually still
be effective. It may or may not cause excessive pain. Check your
string carefully each month as a shorter string may indicate this
condition. An embedded IUD can be difficult and painful to remove, but
removal is recommended.
·  EXPULSION: Our bodies have a natural tendency to expel anything
foreign. IUD expulsion can be partial or complete and usually occurs
during the first 3 months of usage, most often during a period. 5-20%
of IUD users spontaneously expel their IUD in the first year. The
symptoms of expulsion may include vaginal discharge, cramping or pain,
intermenstrual spotting, lengthening of the string, ability to feel
the hard part of the IUD at the cervical opening or in the vagina, or
passage of the IUD itself from the vagina. While expulsion carriers no
directly harmful effect, if left unnoticed by the user it can result
in an accidental pregnancy. Approximately 1/3 of IUD related
pregnancies result from undetected partial or complete expulsion.

Some IUDs come with black strings too:
Lippes Loop
Description: Polyethylene with barium sulfate added for visibility on
x-rays. Available in four sizes, designated A (left) through D
Developer: Jack Lippes (US).
Date first marketed: 1962.
Major distributor: P.T. Kimia Farma, Indonesia (in-country distribution only).
Length: A?26.2 mm; B?25.2 mm; C?27.5 mm; D?27.5 mm.
Width: A?22.2 mm; B?27.4 mm; C?30.0 mm; D?30.0 mm.
Strings: Two; A?blue, B?black, C?yellow, D?white.

?PID develops when bacteria (germs) get into a woman?s internal
reproductive organs. There are a number of ways this can happen. The
internal organs are usually protected by the cervix, which blocks
bacteria in the vagina from moving up into the womb. But when the
cervix is open (e.g. during menstruation or at ovulation), or if the
cervix itself becomes infected, bacteria have a greater chance of
getting through and causing infection. Bacteria may also get into the
reproductive organs during pelvic surgery or invasive procedures that
disrupt the cervix, such as abortion, childbirth or insertion of an
IUD (intra-uterine device). Bacteria from severe appendicitis can lead
to PID if it spreads to the pelvic tissues, but this is uncommon.

Chlamydia and Gonorrhoea
PID can be caused by many types of bacteria, but most cases are caused
by the bacteria from Chlamydia trachomatis and Neisseria gonorrhoea,
two sexually transmitted infections (STIs). Both infect a woman?s
cervix and can damage its surface, making it easier for bacteria to
get to the internal reproductive organs.
Chlamydia ? Chlamydia is one of the most common sexually transmitted
infections in the world, and in the UK, it is the number one cause of
PID. It is estimated that as many as one in ten sexually active women
under the age of 25 may be infected with chlamydia, and while it is
less common in older age groups, the number of cases in people over 25
is on the rise. Chlamydia can live in the body without causing any
symptoms for months or years. Up to 70% of women and 50% of men with
chlamydia have no noticeable symptoms, but when symptoms are present,
in women they are:
·	pain or burning when urinating
·	abnormal vaginal discharge
·	bleeding between periods
It is estimated that 40% of women who have chlamydia will develop PID.
PID caused by chlamydia often produces very mild symptoms, if any at
all (called silent or subclinical PID). This does not mean the
infection is less serious than other forms of PID, but does mean that
the infection may go undetected until permanent damage has been done.
Gonorrhoea ? Like chlamydia, gonorrhoea is found most commonly among
teenagers and those in their 20s, but recent public health figures
show an increase in gonorrhoea among 35 to 44 year-olds. Up to 50% of
women (and 10% of men) who become infected with gonorrhoea have no
symptoms. But when symptoms do occur, in women they are:
·	yellow or greenish vaginal discharge
·	pain or burning when urinating?
·	PID caused by bacteria from gonorrhoea tends to cause sudden and
severe symptoms, including high fever and abdominal pain (called acute
Other sources of infection
Other bacteria commonly found in the vagina can lead to PID if they
get past the cervix and into the internal reproductive organs. This is
most likely to happen if your cervix has been damaged, if you have had
PID before, or if your cervix is opened during a surgical procedure.
IUD (intra-uterine device) ? When the cervix is opened to insert an
IUD, bacteria from the vagina have an opportunity to get into the
womb. Studies show that the risk of developing PID is increased for
about one month following IUD insertion.?
?Sexually active women under the age of 25 have the highest risk of
developing PID, with most cases occurring in teenagers. This may be
because young women are more likely than older women to have multiple
sexual partners and practice unsafe sex ? two high risk behaviours for
getting PID (see below). Another age-related factor that may influence
the development of PID is cervical mucus. Thick cervical mucus can
protect the cervix from some forms of bacteria (such as gonorrhoea),
but young women in their teens tend to have thin mucus that is less
Sexual activity ? Having multiple sexual partners is one of the main
risk factors for developing PID. The more partners you have
penetrative sex with, the more likely you are to be exposed to
bacteria that can lead to PID, particularly if you are not using
barrier contraception ? a condom, femidom, diaphragm or cervical cap
with spermicide. The rate of PID is lower among lesbians than
heterosexual women, and this is probably related to a lower incidence
of the STIs that can lead to PID. Some studies suggest that having sex
during your period may increase your chances of developing PID. This
is believed to be because the cervix is open during menstruation and
the presence of blood may help some bacteria to multiply.
IUD ? The IUD was once thought to increase a woman?s risk of PID
significantly, but recent research suggests it may be the process of
inserting the IUD that increases risk, not the IUD itself. Current
studies show that risk is increased mainly during the month following
insertion, and after that, risk is related more to sexual activity and
exposure to STIs than to the use of an IUD.
The Pill ? There is conflicting information about whether the Pill
increases or decreases a woman?s risk of PID. The Pill does not
protect against sexually transmitted infections, but it does have a
thickening effect on cervical mucus that may prevent some bacteria
from getting through the cervix.
Other risk factors ? Once you?ve had PID, you have an increased risk
of getting it again. Smoking, douching and cocaine-use also have been
linked to an increased risk of PID, but more research is needed to
investigate these links.?

?"Among women who have an IUD inserted, women with cervical infections
appear more likely to develop PID than are women who do not have a
cervical infection," Dr. Morrison says. What accounts for this small
increase in PID risk? It is thought that the process of IUD insertion
can introduce STD-causing bacteria from the cervix into the uterus and
fallopian tubes, which can later cause PID. WHO studies involving
nearly 23,000 IUD insertions demonstrated that IUD users rarely
develop PID after the first 20 days following insertion. The rate of
PID immediately after insertion was 9.7 per 1,000 woman-years.
Thereafter, for up to eight years later, PID risk among IUD users was
1.4 per 1,000 woman-years.6 PID risk among non-IUD users varies,
largely depending upon the STD prevalence in an area.?

?Pain and bleeding are the leading reasons for removal. An FHI study
involving 10,000 women using the Copper T found 5 percent had the
device removed because of pain or bleeding.6
·	While significantly better than earlier IUDs that are no longer
widely used, copper-bearing IUDs cause an increase in menstrual
bleeding. This usually is not a medical problem. Typically, bleeding
declines after several cycles. The LNg intrauterine system, which
releases levonorgestrel, reduces the amount of bleeding.
·	Prolonged and excessive bleeding is rare. Because prolonged and
excessive bleeding increases the risk of anemia, women who experience
these side effects should use iron tablets. Nonsteroidal
anti-inflammatory drugs, such as ibuprofen, may reduce pain and
?Though a copper IUD can be left in place for up to 8 years with
minimal attention, the initial insertion can be a minor ordeal. Done
in the doctor's office or clinic, the procedure can be painful; and
cramping can continue for up to a day. To insert the device, the
doctor will pass a special applicator through the cervix into the
lower end of the uterus. As it is pushed upwards with a plunger, the
device unfolds to form a ?T.? A string is left protruding from the
cervix to permit later removal.?

?An IUD can be removed at any time, but should be removed in the
presence of pelvic infection, pregnancy, abdominal pain of uncertain
cause or if the IUD is already partially extruded. Never push a
partially extruded IUD back inside the uterus as you will introduce
significant bacterial contamination into either the uterus or the
abdominal cavity, whichever area you penetrate.?

?If actinomyces found on routine swab culture IUD should be removed
with penicillin prophylaxis. Can be reinserted 2-3/12 later if swabs
Antibiotic therapy (high dose penicillin) is only indicated if patient
is symptomatic suggestive of upper tract infection eg. PID.
Actinomyces like organisms (ALO) reported in Pap smear should be
confirmed on culture before IUD removal in asymptomatic woman as smear
results have a high false positive rates for ALO. If culture is
negative no action is required.?

These are the only pages I found that began with an ?a? and pertained to IUDs.

More on IUDs and PID and STDs
  Although I have not found your exact page, I am hoping one of the
sites above answers your question. If you can think of any more
?clues? about the site, or have other questions, please request an
Answer Clarification, before rating. This will allow me to assist you
further, if possible.


Search Terms
side effects + IUD
IUD + black
Discolored IUDs
Infected IUDs
?pure black? + IUD
STDs + IUDs + PIDs

Request for Answer Clarification by mabelle-ga on 06 May 2005 03:29 PDT
Hello Crabecakes:
Please kindly do some more research for me; as I still need the
original article in question.  For further clues; I tried to remember
and I was first searching in:
 the health< STD's < Chlamydia section of different health websites,
 also, then I went to , and in the search
box: " ask the physician" different websites too

 One thing I can say that "assup or askup" rings a bell to my
attention. I mit be wrong; but please check for me ;_ in the Chlamydia

Kindly do you best to find the original article; I would be very grateful.
Thank you again and I await your reply with good news.

Clarification of Answer by crabcakes-ga on 06 May 2005 20:14 PDT
Hi mabelle,

  I have searched this afternoon to no avail. I'll continue searching
and post tomorrow. Keep in mind though, that many websites change
content and update often. Websites such as medical sites, with
constantly changing news and comments may change even more frequently.

  Regards, Crabcakes

Clarification of Answer by crabcakes-ga on 07 May 2005 20:47 PDT
Hi mabelle, 

Thank you for your patience. Please give me a bit more time, as I'm
still seeking the exact article you want. Was it something posted by
someone, or was it an article written by medical personnel?

Regards, Crabcakes

Request for Answer Clarification by mabelle-ga on 07 May 2005 23:34 PDT
Hello crabecakes:  It was written by medical personnel. Thank you to
keep searching, I will wait for you to find it hopefully.

Clarification of Answer by crabcakes-ga on 08 May 2005 23:04 PDT
Hi mabelle, I have not forgotten you! I have some other matters to
take care of, but I WILL post when I have something more for you.
Please continue being patient and allow me a few more days. I
appreciate it!

Regards, Crabcakes

Request for Answer Clarification by mabelle-ga on 08 May 2005 23:46 PDT
Hi crabecakes:  Yes, I shall wait for the exact article from you. 
Take _ How many days you need for the search. I shall be waiting and
hoping that you do get the original article in question.  As I
promised, I shall be grateful ( tipping you) .  Hoping that you can
find it soon.

Clarification of Answer by crabcakes-ga on 10 May 2005 14:12 PDT
Hi Mabelle,

   After many extensive searches, I have been unable to come up with
the exact page you mentioned. It is possible it is no longer online.
It sounds to me that you are requesting this information because
someone you know has an IUD that should have been removed some time in
the past. If this is true, she should make an appointment to be seen
by her doctor. As I posted in the original answer, some women have
left their IUDs inserted, problem-free for years. Each IUD
manufacturer recommends how long it's IUDs should remain in place, and
the patient should follow the recommended guidelines.

   As to the IUD turning black, I can only imagine that if the IUD was
not black when manufactured, as some are, it may have become
discolored due to oxidation, body fluids, or a bacterial infection.
Regardless of the reason, if the IUD is overdue for removal, your
family member should go for a removal as soon as possible. If
infection is present, the doctor can have the IUD and/or the cervix
cultured to identify the organism involved, and appropriate antibiotic
therapy begun, if indicated.

  With the exception of the sites I posted in the original answer, I
was unable to find any reference to an IUD turning black.

  Here is more information on IUD and STDs:


     ?The intrauterine device, or IUD, is a small plastic device
that is inserted into the uterus by a health care provider.  It
prevents pregnancy as long as it remains in place.  The length of
time an IUD should be left in the uterus is debatable, possibly
as long as five years.  Use of an IUD is severely limited.  For
instance, women with STDs, abnormal uterine bleeding, anemia,
pelvic infection, multiple sex partners, and a desire to have
children in the future may be advised not to use an IUD. [9]

     No human studies with HIV-positive women using IUDs exist.
However, most health care providers do not consider an IUD a good
choice for HIV-positive women because of an increased risk of
infection during insertion.  Also, insertion may increase the
chance of developing pelvic inflammatory disease (PID).  HIV-
positive women who have IUDs already in place, and who have not
had problems with it, should work with their provider to decide
whether or not to remove the device.  Considerations involved in
this decision include sexual activity, risk of PID, history of
sexually transmitted diseases, and willingness to use a condom.
It is important to note that IUDs do not prevent the transmission
of HIV and must be supplemented with condom use by male sex

?ANALYSIS:  The cases and controls were compared to determine
differences in the primary exposure of use or non-use of a copper IUD.
 Other data, including presence of chlamydia trachomatis antibodies,
detailed sexual history, history of prior STD?s and age at diagnosis
of infertility was collected.  Adjusted odds ratios were calculated
for the association of copper IUD use and tubal occlusion or
infertility.  The power to detect a doubling of the risk of tubal
occlusion or infertility with copper IUD use was 90% (infertile
controls) and 87% (pregnant    controls).
RESULTS:  No significant difference was demonstrated between the cases
and both sets of controls. ?

?Warnings that Something Is Wrong with Your IUD
Tell your clinician immediately if you
find that the string length is shorter or longer
are not able to feel the string
feel the hard plastic bottom of the "T" of the IUD against the cervix
think you might be pregnant
have periods that are much heavier or last much longer than usual
severe abdominal cramping, pain, or tenderness in the abdomen
pain or bleeding during sex
unexplained fever and/or chills
flu-like symptoms ? muscle aches, feeling tired
unusual vaginal discharge
a missed, late, or unusually light period
unexplained vaginal bleeding
passed blood clots or clumps of tissue

Having an IUD removed or replaced is usually a simple matter. The
clinician carefully tugs on the string ends at a certain angle, the
IUD "arms" fold up, and the IUD slides through the opening of the
cervix. Replacing the IUD with a new one can be done immediately after
removal in most circumstances. Women should never try to remove IUDs
themselves or ask nonprofessionals to do it for them. Serious damage
could result.

In rare cases, IUDs become embedded in the uterus and cannot be easily
pulled free. In these cases, the cervix may have to be dilated and a
surgical tool ? forceps ? may be used to free the IUD. A local
anesthetic is used for such removals.

In very rare cases, surgery becomes necessary. Women may have to be
hospitalized for removals that require incision.

?The greatest concern with IUDs is the potential for infection. This
risk was overestimated in the 1970s. Reevaluation of data from that
time shows considerably lower risk estimates of infection with IUD
use.1,6 The overestimation was probably secondary to several factors,
including poor choice of control groups (such as users of oral and
barrier contraceptives, both of which decrease the risk of infection),
overdiagnosis of PID in IUD users and inclusion of data from Dalkon
Shield users in the risk assessment figures.
Many factors have been suggested as contributing to the development of
PID in IUD users.

There has been concern that the presence of a tail provides an avenue
by which vaginal pathogens can ascend into the upper genital tract.
Electron microscopy has shown that a coating builds on the tail during
12 to 14 months of use.25 This coating is usually thin and contains
mostly mucus, and cellular and bacterial debris. The intrauterine
portion of the IUD rarely contains any live bacteria. However, as the
coating becomes thicker, bacteria can be found on the tail within the
uterus and on the device itself.

 Some have theorized that, compared with the earlier multifilament
tail, the monofilament tail is associated with far less risk of
ascending infection because the total surface of the tail is exposed
to the cervical mucus, which is believed to have protective properties
against ascending infection.25 This theory is consistent with studies
showing that the Dalkon Shield presented a greater risk of ascending
infection because its multifilament tail had far less exposure to the
cervical mucus.5 Recent studies conclude that the overall contributing
factors in the development of ascending genital infection in IUD users
are the number of sexual partners and the increased incidence of STDs.

 Several investigations have shown that the peak in PID risk among IUD
users occurs during the first 20 days after insertion.26 The risk
following this initial period appears to be low and, in the case of
copper-bearing IUDs, the risk is negligible in women in mutually
monogamous relationships.4,6,26 A recent study found that patients in
mutually monogamous relationships and at low risk for STDs appear to
have little, if any, risk of PID with IUD use.?

The treatment of actinomyces discovered on a routine Pap smear is one
of the most controversial areas on IUD use in the literature. This
rare finding on cervical cytologic specimens is more prevalent in IUD
users than in other women.30 There was concern that actinomyces was
linked to IUD-associated PID, but a study found that the presence of
actinomyces on a routine Pap smear did not correlate with an increased
risk of PID or the development of actinomycotic disease.30 Observation
of the asymptomatic patient and active management of the symptomatic
patient by removing the IUD and administering penicillin or
tetracycline is recommended.12,30 The use of antibiotics in
asymptomatic patients has not been reviewed thoroughly and cannot be
recommended at this time.? 

?Plastic inert IUDs are associated with a greater prevalence of
Actinomyces infection than are copper-bearing IUDs. Pap smear can
detect the presence of Actinomyces organisms, which are seen as
branching filaments, sulfa granules or irregular islands of amorphous
material which stain blue to brown or black. The organism may either
be pathogenic or commensal, depending on the presence of leukocytes.
Overall prevalence of Actinomyces showing up on Pap smears of IUD
users is estimated at 80% to 90% of IUD users. Treatment suggestions
depend on whether the patient has symptoms or is asymptomatic, and
whether the presence of the organism represents an infection or a
colonization. IUD removal, antibiotic treatment, and if necessary,
surgical excision are recommended. Monitoring programs for IUD users
are briefly discussed.?

?Pelvic actinomycosis associated with the use of IUDs can mimic pelvic
malignancy; for that reason, it is often treated surgically. However,
if the diagnosis of actinomycosis can be obtained preoperatively,
antibiotic treatment may lead to complete resolution. The Papanicolaou
smear may be useful in evaluating such patients.?

Some IUDs are made of black materials.

?Overall, women using IUDs are about twice as likely to develop pelvic
inflammatory disease (PID) as women using no contraception, according
to most studies. These studies have involved women with both high and
low risk of sexually transmitted diseases (STDs), which cause PID (41,
78, 81, 209, 265, 421). This increased risk of PID is largely
concentrated in the first few weeks after insertion and is due to poor
infection prevention during insertion. Thereafter, the risk is among
women exposed to STDs. Thus, for women in mutually faithful sexual
relationships, IUDs pose little ongoing risk of PID (208, 227, 507).

?Pelvic inflammatory disease is a broad term for any infection
ascending from the cervix into the uterus, fallopian tubes, and
ovaries (422). PID is fairly common in developed countries. About 1%
to 2% of all women of reproductive age develop PID each year (30, 421,
532). In developing countries the incidence is unknown but may be
higher in some areas (244, 302). In addition to STDs, postpartum and
postabortion infections are major causes of PID.

The complications of PID sometimes are severe. Even a single infection
can permanently damage the lining of the fallopian tubes. This may
partially or totally block one or both tubes, substantially increasing
the chances of ectopic pregnancy and infertility (136, 369, 421, 424).
With each episode of PID the chances of tubal blockage and infertility
increase (422). A woman who has had PID is more likely to have chronic
pelvic pain than other women and is more susceptible to repeated
infections (422). All these complications are most likely if PID is
not treated promptly and appropriately?

Please be aware that the IUD itself does not increase the chances of
chlamydia or any other STD without EXPOSURE to the infective organisms
through sexual contact. It is true that exposure, though sexual
contact, is more likely to turn into an STD in a woman with an IUD
than one without. However, if the woman is not exposed to the
chlaymidia bacteria, she will not contract the infection, with or
without an IUD in place.

?Your experience has been negative on several counts. Cramping
mid-cycle and during the period often accompanied by heavier bleeding
is pretty common with the IUD. As well, the "tail" or the strings can
sometimes be felt by the male at the ultrasensitive tip of the penis.
Some doctors attempt to trim the tail, others will remove the IUD to
avoid difficult removal. When the strings are accessible, removal is
relatively easy with brief and very manageable discomfort felt by the

I should say here though, for others who are reading, the IUD is a
very effective method of birth control (typical failure rate is 3% -
this means that if 100 couples were using the method for a year 3 of
them would get pregnant), and for many women, provokes few side
effects. If partners are monogamous and hence the risk for sexually
transmitted infection is nil, the method may be a good choice.
However, it provides no protection from infection and even increases
the risk if either individual in the couple has more than one partner.
If there is any question that monogamy is not being practised, a
condom should be used and the female should consider using a different
method of birth control.?

Additional reading on IUDs and STDs

I'm sorry I was unable to locate the exact site for you, and I
apreciate your patience while I searched. If you are unhappy with this
answer, you may request that the editors remove the answer, whereby
your question can be reposted.(The address can be found at the bottom
of this page) Another researcher may have more sucess than I.

Sincerely, Crabcakes
mabelle-ga rated this answer:3 out of 5 stars and gave an additional tip of: $5.00
ThankYou Crabecakes for your help.  I 'm sorry that you could not find
the article in question that I was looking for; but I am grateful for
your efforts. Mabelle

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