Last partial update: July 2016 - Please read disclaimer before proceeding
Intrauterine devices (IUDs)
There are two types of IUD
- The copper IUD
- The progestogen containing IUD
IUDs are a very effective, cheap and long-lasting form of contraception. It is most suitable for women in a stable long term relationship who wish a break of at least two years between children or women who wish longstanding contraception following completion of their family but who do not wish to opt for sterilisation.
They are generally not suitable for women who have not a baby as they are more difficult to insert and are also not suitable for women who are not yet in a stable relationship due to the increased risk of infection. For these reasons they are rarely prescribed for young women.
Insertion
IUDs are inserted by medical practitioners. Two appointments are required, the first to do an gynaecological examination, including a Pap smear, and take tests to exclude any current vaginal / pelvic infection and the second to insert the IUD. Period-like cramps and bleeding or spotting are common in the first few days after the IUD is inserted. Any worse symptoms should be reported to your doctor. Vaginal sex should be avoided for two to three days after insertion. The IUD should be checked by your doctor about six weeks after insertion.
Complications / side effects
There are also a couple of problems associated with their use
- Infection: The main problem is that they increase the risk of pelvic infections occurring, most commonly chlamydia. While these can be treated fairly easily, the residual scarring around the tubes can cause long-term infertility problems and thus this is a major reason that IUDs are generally not suitable for women who have not had children. Any women with an IUD who experiences symptoms of a pelvic infection, most commonly vaginal discharge and pelvic pain, needs to seek medical treatment promptly. If either partner has casual sex or if the woman with the IUD has a new partner, then condoms should be used till both partners are tested to make sure they do not have any sexually transmitted diseases. It is worth noting that some recent evidence suggests that this risk has been overestimated and that it is mostly a problem in the first few weeks after insertion.
- Ectopic pregnancy: There is a slight increase in the risk of ectopic pregnancy (that is pregnancy outside the uterus or womb, usually in the tubes) which is a serious condition. This risk is less with the progesterone IUD.
- Menstrual periods are often longer and heavier and more painful: This means that they are often not a good choice for women who already have ‘difficult’ periods
- Becoming pregnant with an IUD in place: Removal of the IUD in these circumstances is associated with a 30% risk of miscarriage. Any woman with an IUD in place who misses a menstrual period needs to see a doctor for a check up and pregnancy test.
- Dislodging or expulsion of the IUD: Occasionally the IUD can be expelled, often with periods or when straining to pass a bowel motion, and this may not be noticed by the woman. Obviously this can lead to pregnancy. (This most commonly occurs within the first few weeks after insertion.) It can dislodge higher into the uterus or rarely into the uterine wall. In this case it may not be possible to remove it and surgical removal may be required. This is usually easy but certainly a hassle. Women with IUDs should check that they are still in place after the end of each menstrual period. This can be done by inserting fingers high into the vagina to feel for the presence of the small nylon string that is attached to the end of the IUD and that protrudes through the cervix into the vagina. If it is not felt it is important to see your doctor immediately to find out whether it is still in the uterus.
IUDs are not suitable for women who
- may be pregnant
- are at increased risk of developing pelvic infections including those who
- have more than one sexual partner
- have a partner who has more than one sexual partner
- have recently changed sexual partners.
- have a current vaginal or pelvic infection (PID, infection in the tubes).
- have had more than one pelvic infection in the past.
- have a medical condition that makes it very risky to develop an internal infection, e.g. rheumatic heart disease or be treated with steroids or other drugs that stop the immune system from working properly.
- have abnormal bleeding from their vagina, the cause of which has not been diagnosed
- have fibroids or other conditions that change the shape of the uterus or cervix.
- have an abnormal Pap test which is being investigated
- have any signs of genital cancer.
IUDs are also less suitable for women who have problems with anaemia or who have had an ectopic pregnancy in the past or who, as stated above, have not had a baby.
Menstrual periods and IUDs
Copper IUDs cause menstrual periods to be heavier, longer and more painful. This means that they are often not a good choice for women who already have ‘difficult’ periods.
On the other hand, Progesteron IUDs actually decrease bleeding and pain associated with menstrual periods.
The Progesteron IUD (‘Mirena’)
This is a small ‘T’ shaped device that has a cylinder containing progesterone around its stem. It works by preventing the normal thickening in the lining of the uterus that occurs in the later half of each menstrual cycle and this prevents implantation and growth of fertilised eggs. It also causes a thickening of vaginal mucous that helps prevent sperm entering the uterus and in the first year of use can inhibit egg release.
It causes irregularity in menstrual periods in the first four to six months, which usually then settles leading to regular period bleeding that is considerably lighter than normal. (The reduction in menstrual blood loss can be as high as 90%.) This is a considerable advantage for women in their forties who often have heavier periods. Use in the United Kingdom had reduced the need for treatment of dysfunctional (heavy) bleeding by hysterectomy in this age group by about 40%.
It is also a good option for women over 35 who smoke or have other risk factors for vascular disease. Recent use has also shown that it can be considered for use in younger women and in women who have not had a baby, although it does increase the risk of pelvic infections and should not be used where a current pelvic infection is present. (Thus, in these women tests for pelvic infection should be done prior to insertion.) Women with a past history of pelvic infection should consider other contraceptive options.
Very uncommonly, the progesterone causes affects other parts of the body, causing symptoms such as vaginal dryness, flushing, headaches, nausea, acne, and mood. (The use of progestogens may be contraindicated in women with depression.)
Progesteron IUDs can be left in place for up to five years.
The copper IUD
The copper IUD is a small plastic device in the shape of a ‘7’ with a copper wire wrapped around its stem. It is inserted into the uterus by a medical practitioner and a single device can provide effective contraception for five to ten years.
No one is sure exactly how they work, although it is known that it affects sperm mobility and thus egg fertilisation.
The device has a fine nylon string attached to its base that projects through the cervix into the top of the vagina. Pulling this string enables the device to be easily removed and it can easily seen by your doctor during a gynaecological examination or felt (high in the vagina by finger examination) which provides proof that the device is in its correct position.
It is most suitable for women who wish a break of at least two years between children or women who wish longstanding contraception following completion of their family but who do not wish to opt for sterilisation.
Barrier methods of contraception
Male condoms
Male condoms are used during sexual intercourse for two reasons.
Contraception: In general condoms are not as effective as the pill and IUDs as a method of contraception, with typical use providing about 85% protection. As a contraceptive, they are most appropriately used when the woman has irregular, very infrequent sex and the woman does not wish to take another form of contraception or when an additional form of contraception is needed to that being presently used. The main problem is that it needs to be used properly to be effective and this ‘proper use’ needs to occur while intercourse is happening. This is not always a time that couples are thinking clearly, especially if alcohol has been consumed. It needs to be stressed that the woman needs to be confident that she will be able to use them properly if condoms are to be relied on as a sole form of contraception. It is important that condoms are used every time as pregnancy can occur even with sexual intercourse during menstruation.
Prevention of sexually transmitted diseases: Condoms should be used by EVERY couple having sexual intercourse when they are not in a longstanding relationship to prevent sexually transmitted diseases. They are your best protection. It is important to stress that a longstanding relationship does not mean someone who you have been having sex with for a month or two. It means a relationship that you are perhaps considering making a permanent one. Before ceasing condom use, it is wise for both partners to be tested for sexually transmitted diseases so that such disease is not later spread between partners. You may think that such disease is uncommon and your risk of infection is low. However some diseases such as Chlamydia are relatively common in both males and females (See section on Chlamydia.) and others are life-threatening, such as HIV/AIDS. It is not a matter to trifle with.
Types of male condoms
There are two types of male condoms, plastic and rubber. Both are effective as long as they are used properly although the plastic one is thinner and stronger.
Condom use
Condoms should be used only once. They are perishable and thus should be stored in a cool place and used before their expiry date.
After applying the condom to the erect penis, it is important to apply some lubricant to the outside of the condom to help make sure that it does not rupture. Water based lubricants are suitable for both types of condom but oil based lubricants, such as petroleum jelly or massage oil, should NOT be used on rubber condoms as they may cause them to rupture.
After intercourse the penis should be removed while it is still erect and the condom should then be removed and then, after tying a knot at the end, discarded in the rubbish bin; not down the toilet. If the penis becomes flaccid in the vagina then there is a risk that semen will leak out and enter the vulva / vagina.
If a male condom perforates during use, emergency contraception may be necessary and needs to be discussed the following day with your doctor.
Female condoms
There are also female condoms which also are effective as a means of contraception and in preventing sexually transmitted diseases.
It is made of soft plastic and fits into the vagina. It is approximately 17cm long and has a flexible ring at each end and tends to have a more natural feel than a male condom; something that both men and women prefer. Importantly for women, it gives them control over contraception, which is much less the case with male condoms. As the female condom covers some of the vulva, it may provide better protection against sexually transmitted infections, such as herpes simplex and human papilloma-virus infection, than male condoms.
It can take some practice to use and the woman may want to try insertion one several times before using it during intercourse.
The female condom can be inserted before having actual sex and obviously does not require an erect penis. They allow lubrication. Like male condoms, they should only be used once.
If a female condom perforates during use, emergency contraception may be necessary and needs to be discussed the following day with your doctor.
Diaphragms
Diaphragms are occasionally used as a contraceptive device but are usually not the best choice for several reasons.
Firstly, they work primarily as barrier method of contraception, unlike condoms they do not protect against sexually transmitted diseases. Thus they are not useful for women who are not in a long term relationship unless condoms are used as well.
Secondly, they do not give very good contraceptive protection, with typical use only providing about 84% protection. Thus, they are not very good for women who are having regular sex in a long term relationship.
Other sexual health information for parents and adolescents on this web site
Preventing teenage pregnancy
See section 'Preventing teenage pregnancy'Contraception for adolescents and teenagers. There is a separate section in the web site that deals in detail with contraception options for adolescents and young adult women.
See section 'Contraception for adolescents and young women - preventing unwanted pregnancy'
Unplanned pregnancy - What are the options?
See section 'Unplanned pregnancy options'
Sexually transmitted diseases and their prevention
This focuses on Chlamydia and Genital Hepres, the two most common sexually transmitted diseases in young people. Other diseases such as HIV/AIDS are also covered.
See section 'Sexually Transmitted Diseases and their prevention'
Further information
Further reading regarding teenager sexual health
Sexwise by Dr Janet Hall. Published by Random House Australia. (What every young person and parent should know about sex. Dr Hall empowers her readers by telling them the facts - and giving it to them straight.)
Unzipped by Bronwyn Donaghy. Published by Harper Collins (A book that deals frankly and sympathetically with the crucial role that love and emotions play in every aspect of adolescent sexuality.)Further titles regarding puberty and adolescent sexuality are available on the Children’s Hospital at Westmead web site. www.chw.edu.au/parents/books. (Both the above books are mentioned on this web site and are recommended by staff at this hospital.)
Further information on sexual health
Sexual health information
www.shinesa.org.au
Family Planning NSW
https://www.fpnsw.org.au
The Resource Center for Adolescent Pregnancy Prevention web site
(A good USA site that provides information and skills for both adolescents and for educators about preventing unwanted teenage pregnancies.)
www.etr.org/recapp