Effects of intrauterine device and oral contraceptive on vaginal flora and epithelium

OBJECTIVE: To investigate the microbial and cytopathological changes and genital symptoms in oral contraceptive pill (OCP) and intrauterine contraceptive device (IUCD) users.

METHODS: Included in the study were 34 women using OCP and 34 women using IUCD for 24 to 36 months period and 34 women as control group. We conducted the study between March to September 2005 in Antakya Maternity Hospital, Turkey. Vaginal discharge was subjected to wet mount examination, gram staining, and culture. Cervical smears were examined and reported using the Bethesda system as reference.

RESULTS: In the IUCD group, women with intermediate score was 20.6%, while those with bacterial vaginosis was 11.7%. In the OCP group however, women with intermediate score was 8.8%, while those with bacterial vaginosis was 5.9%. Compared to the control group, these rates were 2.9% for those with intermediate score and 2.9% for those with bacterial vaginosis. Escherichia coli vaginal colonization increased by 5-fold in the IUCD users (p<0.05). Cervical erosion was found in 14.7% of the women using IUCD as compared to the other groups (p<0.05). Actinomyces like organisms was detected in 11.7% of the IUCD users (p<0.05).

CONCLUSION: The use of IUCD clearly alter the normal vaginal flora, although OCP appears to have minimal effects on the vaginal microbial flora. The data support the hypothesis that IUCD might change cervico vaginal environment, and suggests that women with IUCD may be at a higher risk for vulvovaginal infection.