Intrauterine devices (IUDs) are widely used long-term contraceptive methods. Bacterial vaginosis (BV) is a common vaginal infection. This article explores the potential relationship between IUDs and the risk of developing BV.
Understanding Bacterial Vaginosis
Bacterial vaginosis is a common vaginal infection resulting from an imbalance in the natural vaginal bacteria. Normally, “good” bacteria, primarily lactobacilli, outnumber other types. BV occurs when certain “bad” bacteria overgrow, disrupting this delicate balance.
Symptoms can vary, with some individuals experiencing no symptoms. When present, they may include an off-white, gray, or greenish vaginal discharge, often with a “fishy” odor that can become stronger after sex. Vaginal itching or irritation and a burning sensation during urination may also occur. Factors such as douching, having new or multiple sexual partners, and a natural lack of lactobacilli bacteria can increase the risk of developing BV.
IUDs and BV Risk
Scientific findings offer insights into whether IUDs increase the risk of bacterial vaginosis. Research indicates that copper IUDs have been more frequently associated with an increased risk of BV compared to hormonal IUDs. For instance, one study found that copper IUD users experienced a 1.28-fold higher BV risk compared to women using no contraception or other non-hormonal methods. This elevated risk can persist for up to 18 months.
While the overall risk of BV with any IUD type remains relatively low, a temporary increase in risk can occur immediately after insertion. Hormonal IUDs, such as those releasing levonorgestrel, generally have less impact on BV risk. Some research suggests hormonal contraception might even offer protection against BV development. However, other studies indicate hormonal IUD users may still have a greater presence of BV-associated bacteria compared to those using oral contraceptives.
How IUDs Might Influence Vaginal Health
Several factors may explain how IUDs influence the vaginal microbiome and potentially increase BV risk. The insertion process itself can introduce bacteria from the cervix or skin into the upper reproductive tract, affecting the vaginal environment. The presence of any foreign body, like an IUD, within the uterus may also alter the local environment, favoring the growth of certain bacteria.
For copper IUDs, theories suggest that the release of ionic copper may selectively reduce the growth of beneficial bacteria, allowing inflammatory bacteria to proliferate. Copper IUDs can also lead to increased menstrual bleeding, and menstrual blood has a higher pH that can disrupt the vaginal environment, making it more susceptible to BV. While hormonal IUDs release progestin, which can affect vaginal pH, their impact on the vaginal flora regarding BV risk is less significant than that of copper IUDs.
Addressing BV with an IUD
If bacterial vaginosis develops while an IUD is in place, seeking medical diagnosis and treatment is important. BV is treated with antibiotics, available as oral tablets or vaginal creams. IUD removal is usually not necessary unless the infection is recurrent or persistent.
For individuals experiencing recurrent BV with a copper IUD, healthcare providers might consider alternative contraceptive methods. Maintaining good vaginal health practices can also help reduce the risk of recurrence. This includes avoiding douching, which disrupts the natural balance of vaginal bacteria, and practicing safe sex with barrier methods, especially with new partners.