Table 2.

Provider and patient misconceptions about intrauterine devices (IUDs)

Patient and Provider Misconceptions	Evidence
IUDs cause STIs/PID	The increased risk of PID is within the first 20 days after insertion. Infection with Neisseria gonorrhoeae or Chlamydia trachomatis infection at the time of IUD placement increases the risk. After the peri-insertional period, there is no increased risk of infection compared to women without an IUD.29,30,33
IUDs cause infertility	IUD users do not appear to have an increased risk of tubal infertility. The risk of tubal-factor infertility is instead due to upper genital tract infection.31
IUDs are abortifacients	The primary mechanism of action of all IUDs is the prevention of fertilization. This is achieved with the LNG-IUS by thickening of the cervical mucus & inhibition of sperm motility & function. The copper IUD causes damage to sperm & oocytes, thereby preventing the formation of viable embryos.27,28
IUDs increase the risk for ectopic pregnancy	IUD use significantly lowers the risk of the ectopic pregnancy because it lowers the risk of pregnancy. However, if a woman with an IUD does become pregnant, there is a higher chance of an ectopic location than if she were not using an IUD, but the absolute risk is still very low.32
IUDs are not recommended for nulliparous women	No studies have shown increased risks associated with IUD insertion in nulliparous women. Some studies have found decreased rates of expulsion.66
IUDs are not recommended for young women	Women less than 20 years old have similar IUD satisfaction & continuation rates (>80% at 12-months) as older women.67
IUD insertion is difficult	Available evidence from a primary care setting shows that successful insertion occurs in 95% of attempted procedures. Additionally, 90% of all insertions and 80% of insertions in nulliparous women are rated by providers as “easy.”68
IUD expulsion is common	Expulsion rates are between 2 and 10%. Risk factors for expulsion are age 14-19, parity, obesity, heavy periods, & immediate postpartum or postabortion insertion.66
Many women request early removal of IUDs due to side effects	IUD users have the highest satisfaction and continuation rates compared to users of other methods. At 12-months, over 80% of IUD users are still using the method, compared with 57% of DMPA* users and 49-55% of pill, patch, or ring users.22
IUD insertion is painful	The largest study available used a scale of 0 (no pain) to 10 (severe pain) & showed that 48% of women rated IUD insertion as less than 1, 15% rated it 1-2, 11% rated it ≥5, and 4% rated it ≥7. Older age, nulliparity, non-breastfeeding status, and >3 months since last delivery were related to greater pain rating.69 Some lidocaine formulations, naproxen, and tramadol have been found to be moderately effective in preventing pain.70
You need to have testing done before getting an IUD	The only requirements prior to placing an IUD is to have a normal gynecologic exam and that the provider be reasonably sure a woman is not currently pregnant. The copper IUD can also be used for emergency contraception.46
Your partner will feel the IUD	When IUD strings are cut long enough, they become soft & curl up. If they are cut too short, they may stick out of the cervix & be felt as sharp by a woman's partner.

^*DMPA=depot-medroxyprogesterone acetate