An intrauterine device as a possible cause of change in the microbial flora of the female genital system


Dr Vanja Kaliterna, Educational Public Health Institute of Split and Dalmatia County, Vukovarska 46, 21000 Split, Croatia. Email:


Aim:  An intrauterine device (IUD), used by millions of women worldwide, is one of the most efficient methods of contraception. The goal of our study was to compare a group of women using the IUD to a control group.

Material & Methods:  The survey included 236 women of fertile age from gynaecological practices in the area of Split and Dalmatia County, Croatia. The subjects were divided into two groups: IUD users and a control group (women not using any contraception methods). Sampling, transportation, sample processing in the laboratory and interpretation of results were conducted using standard microbiological procedures and methods.

Results:  Opportunistic bacteria were statistically more frequently isolated among IUD users (P < 0.001). The most frequently isolated bacteria in both groups were Escherichia coli and Ureaplasma urealyticum with significantly higher rates in IUD users (P < 0.001). Both colonization and infection had higher rates in IUD users (P < 0.001). There were no significant differences either in the frequency of bacteria isolation regarding different IUD types (P = 0.93), or in relation to duration of IUD use (P = 0.67).

Conclusions:  Based on the data in our study IUD users have an increased chance of developing a cervical infection caused by the bacteria Escherichia coli and Ureaplasma urealyticum. Therefore, before IUD insertion women should be screened and treated for asymptomatic vaginal or cervical infections to prevent possible serious IUD-associated infections.