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PERFORATION OF THE UTERUS-IS THE MOST SERIOUS RISK OF USING AN IUD

Perforation of the uterus (puncturing the wall of the uterus) is the most serious risk of using an IUD. If it occurs, it is almost always at the time of insertion. This problem, which occurs in about one in 1,000 insertions, can cause sudden pain and bleeding or, more rarely, may be without immediate symptoms. Perforation usually requires surgery to prevent damage to the intestines, since the IUD usually perforates through the uterus into the abdomen. Recently, it has been found that inserting an IUD while a woman is breast-feeding causes a tenfold increase in the risk of perforation of the uterus, so it seems advisable to choose a different method of birth control during this time.

The most common side effects of the IUD are increased bleeding from the uterus and cramping pain. Menstrual periods are typically heavier and longer (except in women using IUDs with progesterone, which decreases menstrual flow), and there is more likely to be spotting between periods. This increased blood loss can cause anemia. Cramps and bleeding can be serious enough to have the IUD removed (about 10 percent of women find this necessary) but usually lessen after the first three months.

IUD users have about a four times higher risk of pelvic infection than other women. This risk is present not only at the time of insertion but also with continued use of the device. Bacteria, viruses, or fungus infections may enter the uterus by "climbing" the tail of the IUD, and there is a chance that the infection will spread to the Fallopian tubes and ovaries, which can cause

permanent scarring and infertility.

If a pregnancy occurs in a woman with an IUD, there is about a 5 percent chance that the pregnancy is ectopic or misplaced. This poses a major threat to the woman's health if not properly detected. Uterine pregnancies in IUD users have a 30 percent risk of spontaneous abortion if the IUD is removed, compared to a 50 percent abortion risk if the device is left in place. IUDs, however, do not cause any birth defects.

The IUD is well suited to women who want, a highly effective contraceptive method that requires no active participation on their part and is easily and promptly reversible. It may be particularly appropriate for women who cannot use birth control pills for medical reasons and for the mentally retarded, who may not be able to remember to take a pill or use a mechanical method of birth control. IUDs should not be used by women who are pregnant or who have active pelvic infection, bleeding disorders, anatomical abnormalities of the uterus or cervix, or abnormal pelvic bleeding. Women who have had an ectopic pregnancy, severe menstrual disorders, or any disease that suppresses normal immunity to infection should not use IUDs.

Like birth control pills, the IUD is effective in preventing pregnancy and does not interfere with sexual spontaneity or mood. Yet the IUD can cause pain during intercourse. The woman may experience pain if the IUD is not in the right position or if there is pelvic infection or inflammation; the man may have pain at the tip of the penis or along the shaft because of irritation from the tail of the IUD in the vagina. Both abdominal cramping and persistent bleeding can lessen a woman's interred in sexual activity, but these side effects occur in only about percent of users. Infrequently, women who use IUDs find orgasm may cause intense, unpleasant cramping because of uterine contractions around the IUD.

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Men's Health Erectyle Dysfunction