Response to "The intrauterine device and pelvic inflammatory disease: the Women's Health Study reanalyzed"

Pelvic inflammatory disease: risk factors and microbial etiologies

OBJECTIVE

To review the risk factors and microbial etiologies of pelvic inflammatory disease (PID).

DATA SOURCES

Include 77 current and historical references on PID, PID risk factors, and sexually transmitted diseases.

STUDY SELECTION

34 studies that address specific research questions.

DATA EXTRACTION

Data were used from studies whose methodologies are discussed.

DATA SYNTHESIS

This review identifies research problems regarding the definition, diagnosis, and identification of microbial profiles and risk factors of PID.

CONCLUSIONS

More reliable diagnostic criteria for the varied clinical presentations of this polymicrobial infection are needed. PID is a disease with multiple, interrelated risks. Education is an important nursing intervention.

Is users' knowledge about contraceptives adequate? A case study of Finnish IUD users

Intrauterine contraceptive devices (IUDs) are popular: in Finland, in 1987, about 25% of women of childbearing age used them. We studied Finnish women's knowledge about contraindications for and side-effects of IUD use, with emphasis on current users. In December 1987-January 1988, a postal questionnaire was sent to a random sample of 1000 women of childbearing age, in Uusimaa province, which includes the capital, Helsinki. After three reminders, the response rate was 84%. We compared the answers of current and past users and nonusers of IUDs, and analyzed the associations between IUD use, education, age, and knowledge about side-effects. In contrast to the recommendations for use and information to be given to the contraceptive users, a substantial proportion of current IUD users assumed there are few limitations for IUD use. Some side-effects possibly leading to severe consequences were not considered to be connected with IUD use, not even by users. Although risk of infection was a quite well known fact, infertility was seldom associated with IUD use, and 22% of current IUD users did not associate ectopic pregnancy with IUDs. The results thus suggest that contraceptive counseling is not fully adequate and should receive more attention.