Category: Bladder/Urologic

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IUD-etails

Intrauterine Device (IUD) Situated Within Uterus
 

The intrauterine device (IUD, or coil) has become a highly popular form of reversible contraception.  By 2007, it had more than 180 million users worldwide.  It is a ‘T’-shaped device that is inserted into the uterus, and it comes in three varieties:

  1. Copper IUD (ex. ParaGard): This version operates in a manner similar to spermicide, and the increased levels of copper ions, prostaglandins, and white blood cells interfere with sperm motility and function. Advantages of the copper IUD include that it can prevent unwanted pregnancy for up to five days post unprotected sex, it is resistant to corrosion, it is safe to use while breastfeeding, and fertility is restored shortly after removal of the device.  However, it is associated with increased menstrual cramping and bleeding, and it has a failure rate of 0.8%.  In addition, it has 2-5% rate of involuntary expulsion and 0.7% rate of uterine perforation.
  2. Hormonal IUD (ex. Mirena and Skyla): This IUD releases a small amount of levonorgestrel, which thickens cervical mucus thereby interfering with the ability of sperm to travel into the uterus. It may decrease or even terminate menstrual bleeding, and it has a failure rate of 0.2% during the first year of usage.  Mirena is approved for safe usage for up to five years and Skyla is approved for up to three years.
  3. Inert IUD: These forms of contraception use inert materials, such as a stainless steel ring or plastic, as opposed to the bioactive components of the previously mentioned IUDs. The device is perceived by the uterus as a foreign body, and it results in the uterus becoming a hostile environment to sperm that does not support fertilization and pregnancy.  This version is not approved by the FDA.

IUDs have become extremely popular, and it is important to be aware of best and safe practice guidelines to minimize the risk of developing an infection during usage:

  1. It is worth noting that anyone using an IUD slightly increases her risk of developing pelvic inflammatory disease (PID) during the first twenty days post insertion. Should one notice significant pain or any major changes, she should consult her gynecologist.
  2. Screening for sexually transmitted infections should be performed prior to IUD insertion.
  3. Prophylactic antibiotic usage is generally discouraged prior to IUD insertion.
  4. Only sterilized instruments should be utilized during IUD insertion.
  5. Should one experience mild PID while using an IUD, it is not necessary to remove the device. If one is experiencing severe PID, she should consult with her gynecologist.
  6. IUDs are a safe and effective form of contraception for adolescents and women who are HIV-positive.

If you are considering an IUD, please consult with your physician regarding the best choice for you.  Furthermore, it is safe to participate in pelvic floor physical therapy while using an IUD.

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A St-APP in the Right Direction

Smartphone Technology Meets Women’s Health
 

While many of us in the United States of America take advantage of our smartphone apps for conveniences which include online banking, social networking, and reading our favorite blogs, women in Uganda have recently started utilizing their smartphones for more basic healthcare related functions- testing for vaginal infections.  Thanks to Vaginosis Her Health/BVkit, women who cannot easily afford or who do not have easy access to gynecologists can perform an at home urine test which measures the pH level of their urine.  If the pH measured is too high or too low, the Vaginosis App will advise the individual to seek medical attention and provide physician recommendations.

This app enhances the women’s health progress that has already been made in Uganda in recent years.  In 2006, Dr. Ian Jacobs, Dean and Head of the School of Medicine at the University of Manchester, established the Uganda Women’s Health Initiative (UWHI), a collaborative project between Britain and Uganda with the goal of improving screening and treatment for women in Uganda.  Poor detection of infection, such as bacterial vaginosis, may result in pelvic inflammatory disease, miscarriages, and cervical cancer.  Cervical cancer is the leading cause of cancer related deaths amongst women in Uganda.  Prior to UWHI, approximately 2,464 of the 3,577 women diagnosed with cervical cancer annually in Uganda died from the disease.  Thanks to the efforts of Dr. Jacobs, improved screening techniques have enabled earlier detection and treatment of cancer.  In addition, postpartum hemorrhage (PPH), defined as loss of more than 500 ml of blood within the first 24 hours following childbirth, is a common and often fatal condition in Uganda.  PPH is often treated with oxytocic medications, and UWHI has increased the availability of misoprostol, a similar drug that can be self-administered.  Finally, UWHI has helped reduce brain damage in newborns through innovative brain cooling techniques, and it has empowered more women to seek medical attention in general.

While progress has clearly been made, nevertheless we still have a ways to go.  For starters, the entire premise of the BVkit app involves owning a smartphone, and at present only approximately 5% of women in Uganda own smartphones.  The apps designers hope and expect that these numbers will increase in the near future.  In the meantime, they are trying to share their app with women in other countries such as Nigeria and South Africa, where approximately 30% of women own smartphones.  Who knows what creative concepts are in technological store for women in the future?  I encourage you to share your ideas and suggestions…and if you end up winning a Nobel Prize someday, feel free to give me a shout out.