Intrauterine devices in nulliparous women.

The majority of studies on the clinical events following the insertion of an intrauterine device for contraception have observed a higher frequency of adverse effects in nulliparous women. In this review, the significance of nulliparity on the occurrence of medical removal for bleeding and pain, expulsion and pelvic inflammatory disease is estimated. The possible role of the anatomy of the pregravid uterus is discussed, and results obtained through a selective measurement of the endometrial cavity in a population of nulligravidas is presented. It is concluded that IUDs should not be the first choice of contraception in nulliparous women because of an increased risk of long-term adverse effects. The relationship between the length of the intrauterine device and the length of the endometrial cavity does not seem to be of clinical significance for the performance of IUDs in nulliparous women.