TO THE EDITOR: Dr Johnson's article (1) forward the intrauterine device (IUD) corrects a certain number of common misconceptions about IUD use.

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TO THE EDITOR: Dr Johnson's article (1) forward the intrauterine device (IUD) corrects a certain number of common misconceptions about IUD use. For instance, many physicians insert IUDs and nothing else during menses, despite evidence that insertion can offer safely at any point in the menstrual round of years however, the article (1) advises that "a lifestyle placing the woman at risk for sexually transmitted diseases" is a contraindication to IUD use. the article1 also intimates that the ideal candidate for the IUD is a parous woman. these points require clarification. Although general infection with Neisseria gonorrhoeae, Chlamydia, or other organisms causing suppurating cervicitis is indeed an absolute contraindication to IUD insertion, infections that appear after IUD insertion can be treated safely without removing the IUD and do not artificial position a substantially increased risk of pelvic inflammatory disease. thus, the World health organization (2) and the United States Agency of international development's office of Population and reproductive health (3) advise that increased risk for sexually transmitted diseases (STDs) should be considered a caution, not a contraindication, for IUD use. Because studies fail to link IUD use to infertility, neither organization glance ats restricting IUD use to parous women smooth nulliparous women with multiple sex partners can use IUDs safely, provided that these women save themselves from STDs by using condoms. Given the high rates of unintended pregnancy and STD in the United States, all physicians should encourage women to cover themselves against both problems. We should avoid inappropriately restricting women's access to high-efficacy contraceptive methods

compassion LESNEWSKI, M.D.

LINDA PRINE, MD

Beth Israel Residency in Urban Family Practice

16 E 16th St

novel York, NY 10003

MARJI GOLD Md

Albert Einstein body of Medicine of Yeshiva University

Department of Family and Social Medicine

3544 Jerome Ave.

Bronx NY 10467

REFERENCES

(1) Johnson BA. Insertion and removal of intrauterine devices. Am Fam Physician 2005;71:95-102

(2) World Health Organization. Medical eligibility criteria for contraceptive use. 3d ed: 2004 Accessed online June 23 2005 at: http://www.who.int/reproductivehealth/ publications/mec.

(3) IUDs: aged thinking versus new thinking. Accessed June 23 2005 at: http://www.maqweb.org/maqtools/ iudsoldvsnew.shtml.

EDITOR'S NOTE: this literal sense was sent to the author of "insertion and removal of intrauterine devices," who declined to reply

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