Intrauterine devices have been around for roughly a century, with the earliest documented clinical uses dating to the 1900s and 1920s. That long history is marked by genuine innovation but also by scandal, injury, and decades of distrust that still shape how people think about IUDs today. The Dalkon Shield disaster of the 1970s is the most famous chapter, but it was hardly the only time an IUD design caused serious harm. Understanding how these devices evolved, and how badly some of them failed, helps explain why a method used by hundreds of millions of people worldwide still carries a complicated reputation.
The Earliest Experiments
The idea of placing something inside the uterus to prevent pregnancy is old enough that its exact origin is debated. By the early 1900s, European physicians were experimenting with rings and stems made from materials like silkworm gut and precious metals. The German physician Ernst Gräfenberg developed a silver ring in the 1920s that is often cited as the first true IUD designed for widespread contraceptive use. Gräfenberg later incorporated other metals, and his ring saw use through the 1930s and beyond, though it was controversial from the start. The medical establishment in many countries viewed any intrauterine device with suspicion, partly because infection control was still primitive and partly because contraception itself was politically charged.
Gold and silver stem pessaries were another early approach. These rigid metal devices were inserted through the cervix and left in place, but they carried real dangers. A 1933 report in JAMA described a case of a gold stem pessary perforating the uterus, warning explicitly about “the danger to life and health” from these devices.1JAMA. Penetration of the Uterus by Gold Stem Pessary Perforation, infection, and embedding were recurring problems with these early metal designs, and they gave intrauterine contraception a dangerous reputation that took decades to shake.
The Plastic Revolution of the 1960s
IUD development stalled for years, partly because of World War II and partly because the medical profession remained wary. The field reopened in the late 1950s and early 1960s when researchers began experimenting with plastic, which was flexible, inert, and far less likely to cause the kind of traumatic perforation that rigid metal devices did. The result was a wave of new designs, often with evocative names and wildly varying shapes.
The Lippes Loop, introduced in 1962, was one of the most successful. It was a plastic double-S loop shaped like a trapezoid to fit snugly inside the uterine cavity, which reduced the chance of expulsion. It became one of the most widely used IUDs from the 1960s through the 1980s.2BMC Women’s Health. Lippes Loop intrauterine device left in the uterus for 50 years: case report The Lippes Loop was a genuine step forward: it was cheap, it worked, and it could stay in place for years. But it was far from the only design on the market, and not every new IUD was as carefully considered.
The Majzlin Spring, a stainless steel coil used by roughly 100,000 women between 1967 and 1973, illustrates the darker side of this era. It was eventually pulled from the market due to serious complications including bleeding, infection, perforation, and difficult removal. Even after withdrawal, some women still had the device in place years later, and many physicians had little familiarity with its risks.3PubMed. The Majzlin spring revisited The Majzlin Spring was one of several designs from this period that were rushed to market with inadequate safety data, treating women’s bodies as proving grounds for untested devices.
The Dalkon Shield Disaster
No IUD failure had consequences as far-reaching as the Dalkon Shield. Introduced in 1971 by the A.H. Robins Company, the Dalkon Shield was a small plastic device with a distinctive crab-like shape and a multifilament tail string. It was marketed aggressively, with the manufacturer claiming pregnancy rates far lower than what independent studies would later confirm. Within a few years, reports of serious pelvic infections, septic abortions, and deaths began accumulating.
The core problem was the string. Unlike monofilament strings used on other IUDs, the Dalkon Shield’s tail was made of multiple smaller filaments enclosed in a nylon sheath. Electron microscopy of removed devices showed that this sheath deteriorated in every case examined, particularly at the attachment knot that sat inside the uterus. The deterioration exposed the inner filaments, which could wick bacteria from the vagina up into the uterine cavity by capillary action.4PubMed. Scanning electron microscopy of the multifilament IUD string The result was a direct pathway for infection that other IUD designs did not share.
The Dalkon Shield was pulled from the U.S. market in 1974, but the company did not issue a recall, meaning devices already in place often stayed there. Thousands of women filed lawsuits. The eventual litigation drove A.H. Robins into bankruptcy and resulted in one of the largest product-liability settlements in American history at the time. The fallout went far beyond one product: IUD use in the United States collapsed. Manufacturers withdrew other, safer devices from the market rather than face potential lawsuits, and both doctors and patients developed a deep wariness of intrauterine contraception that persisted for a generation.
Adding Copper Changed the Game
Even before the Dalkon Shield crisis, researchers were looking for ways to make IUDs more effective without making them larger or more rigid. In the late 1960s, a team led by Howard Tatum and Jaime Zipper discovered that adding a small amount of metallic copper to a T-shaped plastic frame dramatically improved contraceptive performance. When copper was added to the T device, pregnancy rates dropped significantly compared to the unmedicated version.5PubMed. Metallic copper as an intrauterine contraceptic adjunct to the “T” device
Copper ions released by the device create an environment hostile to sperm, impairing their motility and viability before they can reach an egg. This meant the device itself could be smaller and simpler, reducing side effects like cramping and bleeding that had plagued larger plastic-only designs. The copper T became the template for modern copper IUDs, and the ParaGard (TCu-380A), which carries copper on both its arms and stem, remains in use today. Copper IUDs also turned out to be effective as emergency contraception when inserted within five days of unprotected sex, reducing pregnancy risk by over 99 percent.6PubMed Central. Copper Intrauterine Device for Emergency Contraception: Clinical Practice Among Contraceptive Providers
The Hormonal IUD Arrives
The next major leap came from Finland. Dr. Jouri Luukkainen, a gynecologist who directed the Steroid Research Laboratory at the University of Helsinki, led the development of a levonorgestrel-releasing IUD that would eventually be marketed as Mirena.7European Journal of Obstetrics & Gynecology and Reproductive Biology. Intrauterine contraception: from silver ring to intrauterine contraceptive implant Rather than relying on copper, this device slowly released a progestin hormone directly into the uterus. The hormone thickened cervical mucus to the point where sperm could not penetrate it effectively, while also thinning the uterine lining.8PubMed. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability
Mirena was approved in Finland in 1990 and in the United States in 2000. Its arrival shifted the conversation around IUDs in important ways. For one, the hormonal IUD dramatically reduced menstrual bleeding, which made it attractive not just for contraception but also for managing heavy periods. For another, because it delivered hormones locally rather than systemically, the dose reaching the bloodstream was far lower than with oral contraceptives. Several smaller hormonal IUDs (Kyleena, Liletta, Skyla) followed in later years, each with slightly different hormone loads and durations, giving clinicians and patients more options than ever before.
Who Was Told They Could Not Use One
For decades, a persistent and largely unfounded belief held that IUDs were inappropriate for women who had never given birth. When the ParaGard copper IUD was first marketed in the United States in 1988, its product label included language recommending it only for women who had “had at least one child.” This label language, combined with restrictive practices by clinicians, effectively locked nulliparous women out of intrauterine contraception in the U.S. and elsewhere for years.9ScienceDirect. Copper intrauterine device use by nulliparous women: review of side effects
The restriction was rooted partly in the Dalkon Shield era. Some of the women most severely harmed by that device had been young and nulliparous, and the general anxiety about IUDs solidified into specific clinical gatekeeping. But the evidence did not actually support a blanket restriction. In 2005, the FDA approved a new label for the ParaGard that removed the discouraging language entirely. Professional organizations including the American College of Obstetricians and Gynecologists now endorse IUD use for adolescents and nulliparous women. The old restriction lingered in clinical culture long after the evidence changed, and some providers still hesitate to offer IUDs to younger patients or those without children, a legacy of fear rather than data.
Perforation and the Risks That Remain
Modern IUDs are vastly safer than their predecessors, but they are not risk-free. Uterine perforation, where the device pushes partially or fully through the uterine wall, still occurs. A large population-based study found an overall perforation rate of about 0.4 per 1,000 devices sold, with the rate consistent between copper and hormonal IUDs. Certain factors raised the risk: breastfeeding at the time of insertion was common among perforation cases, and more than half of perforations occurred when the device was placed within six months of delivery.10PubMed. Intrauterine contraception: incidence and factors associated with uterine perforation–a population-based study
That rate is low in absolute terms. For context, roughly four out of every ten thousand insertions result in perforation. But it is not zero, and the consequences of an undetected perforation, where a device migrates into the abdominal cavity, can require surgical retrieval. The postpartum and breastfeeding connection is worth knowing about: the uterus is softer and thinner during that period, and the hormonal environment of lactation may contribute. Providers are generally trained to account for this, but the finding underscores that timing of insertion matters.
Pain During Insertion
One of the most common complaints about IUDs, past and present, is that insertion hurts. For years, the standard recommendation was simply to take 800 mg of ibuprofen an hour beforehand. Research has consistently shown this approach is inadequate for many women, particularly those who have never been pregnant. A scoping review of pain management during insertion in nulliparous women found that while ibuprofen remains the only broadly recommended option, women continue to experience significant pain during the procedure. Additional strategies being studied include cervical nerve blocks and cervical softening agents.11PubMed Central. Pain Management During Intrauterine Device Insertion in Nulliparous Women: A Scoping Review
The pain question is arguably one of the biggest unresolved issues in IUD care. Stories of agonizing insertions circulate widely online, and they are not exaggerations for many people. The medical profession has been slow to take this seriously, in part because the procedure is brief and because historical norms treated gynecological pain as something women should simply tolerate. There has been a visible shift in recent years, with more providers offering lidocaine injections or other interventions, but practice varies enormously depending on where you go and who your clinician is. If you are considering an IUD and worried about pain, it is worth asking specifically what pain management your provider offers beyond ibuprofen.
Frameless Designs and the Push to Improve
Even the best modern IUDs are imperfect. The rigid T-shaped frame that most copper and hormonal devices share does not perfectly match every uterine cavity, and size mismatch can contribute to expulsion, cramping, and abnormal bleeding. This has driven interest in frameless IUDs, which dispense with the plastic frame entirely. The GyneFix, the best-known frameless design, consists of copper sleeves threaded on a nylon string that is anchored directly into the muscular wall at the top of the uterus.12PubMed Central. Frameless versus classical intrauterine device for contraception
The rationale is straightforward: a flexible, frameless device should cause less cramping and bleeding than a rigid frame, and it should be less likely to be expelled because it is anchored in place rather than relying on its shape to stay put. A frameless levonorgestrel-releasing system called FibroPlant has also been developed along similar principles.13Contraception. New frameless and framed intrauterine devices and systems — An overview These devices are available in parts of Europe and Asia but have not gained widespread adoption in the United States, partly because the anchoring technique requires specific training and partly because the regulatory pathway for new IUD designs is lengthy. They represent a genuinely different approach to the fundamental engineering problem of keeping a contraceptive device in a cavity that varies in size and shape from person to person.
Global Access and Policy Restrictions
The IUD’s troubled history has not played out the same way everywhere. While use plummeted in the United States after the Dalkon Shield, it remained high in many other parts of the world, particularly in China and parts of Europe. Today, the picture is mixed. A survey of low- and middle-income countries found that 87 percent had policies addressing IUD use, and 84 percent reported that hormonal IUDs were available in some form. However, only 42 percent had hormonal IUDs available through public-sector health systems, and free IUDs in the public sector were offered in 75 percent of surveyed countries.14BMC Public Health. Expanding choice and access in contraception: an assessment of intrauterine contraception policies in low and middle-income countries
Policy restrictions also persist. Fifteen countries in the survey maintained rules beyond what the World Health Organization recommends, including barring IUD use for women who are unmarried, nulliparous, adolescent, or have multiple sexual partners. These restrictions echo the same paternalistic gatekeeping that limited IUD access in the United States for decades, and they often reflect moral judgments about who deserves contraception rather than medical evidence about who can safely use it. The legacy of historical IUD failures has given governments and health systems a convenient justification for restrictions that serve social control more than patient safety.
How the Dalkon Shield Still Echoes
It has been fifty years since the Dalkon Shield was pulled from sale, but its shadow is remarkably long. The device is responsible for much of the regulatory framework that now governs medical devices in the United States. Before the Dalkon Shield, IUDs could reach the market without the kind of rigorous premarket testing that drugs required. The Medical Device Amendments of 1976, passed in part because of the Dalkon Shield and similar scandals, created the classification system the FDA still uses today, requiring higher-risk devices to demonstrate safety and effectiveness before approval.
The cultural impact may be even more durable than the regulatory one. Surveys have repeatedly found that American women and their providers hold more negative attitudes toward IUDs than their counterparts in many European and Asian countries. Some of this gap reflects genuine differences in healthcare systems and training, but much of it traces directly to collective memory of the Dalkon Shield. When a patient says “I’ve heard IUDs are dangerous,” they are often channeling a fear that was shaped by a specific product failure half a century ago, applied broadly to a category of devices that have changed dramatically since. The irony is that modern IUDs are among the most effective and well-studied contraceptives available, with failure rates well under one percent per year. The troubled history is real, but the devices that emerged from it bear little resemblance to the ones that caused the trouble.