Colposcopic and Cytological changes in intrauterine contraceptive device users: A Prospective study

Shanmugavadivu, L (2006) Colposcopic and Cytological changes in intrauterine contraceptive device users: A Prospective study. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Intrauterine Contraceptive Device (IUD) is a safe, convenient and inexpensive method of contraception involving neither repetition nor interference with sexual activity. In India, IUD is the second most commonly used family planning method after voluntary female sterilization. IUD has its own merits and demerits. The various complications related to IUD use are, Immediate: Difficulty in insertion, Vasovagal attack, Uterine Cramps, Early: Expulsion, Perforation, Spotting, Menorrhagia, Dysmenorrhea, Vaginal Infection, Actinomyces. Late: Pelvic Inflammatory disease, Pregnancy, Ectopic Pregnancy. Various studies have been conducted since 1980 to study the long-term effect of IUD and its role in predisposition to cervical or endometrial pathology. The studies involve clinical examination, Cytology, Colposcopy and histopathology for detection of cervical pathology. Colposcopic examination involves the systematic evaluation of the lower genital tract with special emphasis on the superficial epithelium and blood vessels of the underlying connective tissue stroma. Cytological study is by means of papsmear. Presently exfoliative cytology and colposcopy are considered to be complementary to each other in the detection of early neoplastic changes. These procedures have contributed to the lowering of incidence of invasive cancer of the cervix in the developed world. AIM OF THE STUDY: To compare the colposcopic changes and cytological changes found in intrauterine contraceptive device users. To create awareness among the IUD users for regular follow up. SUBJECTS AND METHODS: This was a prospective study conducted at Government Kasturbha Gandhi Hospital, Chennai at the department of obstetrics and gynecology from November 2003 to March 2006. This study comprised of study subject [n=298] using intrauterine contraceptive device for more than 6 months and attended family planning clinic for follow up. INCLUSION CRITERIA: 1.Subjects using intrauterine contraceptive device for more than 6 months. 2.The subjects were chosen irrespective of their socio-demographic profile. 3.Never on any other contraceptive method. 4.In active sexual life. EXCLUSION CRITERIA: 1.Subjects with IUD using less than 6 months. 2.Subject with missing IUD 3.Subjects with pregnancy with IUD in situ. METHODS: The subjects were explained about the study and consent was obtained. Detailed history including any complaints, menstrual history, obstetric history and duration of IUD use was obtained. Each subject underwent general physical, systemic, abdominal examination. Then the acceptors was subjected to colposcopic examination. SUMMARY: 1. In this study the mean duration of IUD use is 17.5 months 2. 76 % of the study subjects had inflammatory changes in cytology 3. The incidence of inflammatory change is associated with the duration of the intra uterine contraceptive device use. 4. There is no significant increase in incidence of low grade intraepithelial neoplasia and high grade intraepithelial neoplasia in IUD users. CONCLUSION: The present study indicates that there is a definite change in the cervical architecture in IUD users and the change is also dependent on the duration of use. A simple technique like colposcope is highly useful in diagnosing these changes and combating them by early interference wherever necessary. However the present study and some of the earlier studies does not reveal any increased risk of dysplasia in IUD users over their non using sisters. However the need for regular and periodical follow up cannot be over emphasized particularly those who wish to use the IUD as a long term contraception.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Colposcopic ; cytological changes ; intrauterine contraceptive device users ; Prospective study.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 09:42
Last Modified: 05 Dec 2017 01:23

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