The clinical diagnosis of a pelvic inflammatory disease (PID) is notoriously difficult. The incidence rate of PIDs among intrauterine device (IUD) users as reported from different studies depends heavily on the definition used and the means available for diagnosing PIDs. It varies by almost 10-fold from 1 per 100 to 1 per 1000 woman-years in different publications. PID risk has been found to be 6-fold higher in the first month after IUD insertion than it is thereafter. It is not known if the overall PID risk in IUD users beyond the first month of IUD insertion is higher than that in nonusers; however, if it is higher, the additional risk is small. The PID risk in IUD users is modified by the number of sexual partners of the IUD user and that of her partner(s), community prevalence of STDs and age of the IUD user. Bacterial vaginosis appears not to be associated with IUD use. Overall, bacterial vaginosis is not associated with PIDs, but specific subgroups of patients with BV that may be difficult to identify clinically are at an increased risk for PIDs. Because of the long duration of use of current copper IUDs, replacement of the IUD is infrequent and insertion-associated PIDs should consequently also be less frequent. IUD use has become safer with respect to PIDs through more effective screening and counseling procedures described in current guidelines for the initiation of IUD use. Current guidance must be followed to preserve the IUD as a safe contraceptive method.
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