NEW ORLEANS — Nearly all family physician faculty members believe intrauterine devices are safe and effective, and more than half reported insertion of one or more in the previous year, according to survey findings presented at the annual conference of the Society of Teachers of Family Medicine.
An estimated 10%–13% of women worldwide use an intrauterine device (IUD) versus less than 1% of women in the United States. Lower use in this country might be related to a lack of residency training or misconceptions about the devices. “It could be a fear of infection or liability concerns,” said Smita Arora, M.D.
Dr. Arora surveyed a random sample of 500 clinical family medicine residency faculty selected from the Society of Teachers of Family Medicine membership list. There were 221 responses, for a 44% response rate. The mean age of respondents was 44 years and 56% were male. She used an IUD survey tool adapted from the work of Nancy Stanwood, M.D. (Obstet. Gynecol. 2002;99:275–80).
More than 92% of respondents said that they believe IUDs are a safe, effective, and cost-effective means of contraception, said Dr. Arora, associate director of residency and director of obstetric and women's health at Sacred Heart Hospital in Allentown, Pa. The survey was part of work she did at a previous position.
A total of 53% of physicians said they had inserted an IUD in the previous year. “I was very surprised at this result,” Dr. Arora said. Of these physicians, 59% reported insertion of only 1–4 devices; 90% inserted copper IUDs, and 10% inserted levonorgestrel IUDs. A total of 18% said they had never inserted an IUD.
“So we have this large population of family [medicine] faculty who are open to using IUDs. So why is the rate so low?” Dr. Arora asked. “We need less restrictive and more evidence-based criteria for use of IUDs, which would be a more woman-friendly approach to contraception.”
A majority of respondents, 74%, said they believe patients are receptive to learning about IUDs. Twenty percent believe IUDs are abortifacients and 6% think the devices lead to lawsuits.
Respondents said they would not consider use of an IUD in a patient with history of pelvic inflammatory disease (71%), nulliparity (53%), or sexually transmitted disease (52%).
When asked what they believe are the three most effective methods of contraception, 28% said tubal ligation, 21% said vasectomy, and 15% said a copper IUD. Dr. Arora said, “They may have responded with IUD because this was an IUD study. I'm not sure that 15% would really say IUD otherwise.”