A reader sent me a question about using the copper IUD as an emergency contraceptive (PDF) option for sexual assault patients. While I think Plan B and Ella are the more appropriate option for EC in most circumstances, I wouldn’t rule out using IUDs, and I certainly think we should be discussing its use as part of baseline clinician education.
Part of the reader’s question was a request for some type of online education on the subject, and I was able to find this: New York State’s Center of Excellence for Family Planning featured a webinar on the use of the copper IUD as EC this past spring, and it’s still available in their archive for viewing. The slide deck and a hard copy of the Q&A are also available for download. While this presentation is specific to the experience of a rural NY county implementing a program in their family planning clinic, they discuss the procedural issues of same-day IUD insertion, including follow-up concerns (such as if they check placement in every patient–the short answer is no). It’s an interesting webinar for those of you who have questions about whether IUD placement might be a consideration in your practice. If you are operating out of a campus clinic, community health clinic, on a military installation or anywhere where you might have a greater opportunity to see patients for follow-up care (based either on billing or physical plant capabilities), the answer might be yes. There are obviously specific issues related to who can place IUDs, the necessary education and competency requirements, etc. Still, it presents some interesting possibilities, and for patients who don’t have ready access to healthcare (or contraception, for that matter), or who may exceed the weight limits of oral EC, this may be the much more patient-centered option where available.
Something to ponder…
5 replies on “Copper IUD as Emergency Contraception Post-Assault”
Also Jen like to add other resources such as list serve for ICEC (International Consortium Emergency Contraception) and ASEC (American Society for Emergency Contraception) have great info on the use of EC when and what is appropriate.
I just want to add onto your discussion of competencies. Also Cooper IUD is mentioned the preferred method for EC I do want to reiterate that folks that put these have extensive experience (such as women’s health NP, OB-Gyn, etc)not everyone can insert these. In our state an RN cannot insert an IUD so again this would be a limited service in most institutions unless there is a prior arrangement of calling in a qualified provider to perform IUD insertion post assault. (Just my less than .02 cents worth)
Regards,
Barb Bachmeier
Barb,
I don’t think RNs can place IUDs in any state, so agreed that this is a limiting factor, as I also mentioned (albeit briefly) in my post. This is one of the issues that would definitely need to be addressed in considering the possibility of IUD as EC, without question.
Thanks for your comment and the resources.
Jen
The other issue that I have not seen addressed that is of huge concern to me after sexual assault is the infection risk- if inserting an IUD in the immediate aftermath. For that reason, there should be serious consideration of the risk vs benefit of this form of contraception as “emergency” contraception.
So existing research suggests infection, while a concern, is not nearly the issue we believe it might be. See for example:
http://www.ncbi.nlm.nih.gov/pubmed/25445666
http://www.ncbi.nlm.nih.gov/pubmed/25222531
http://www.ncbi.nlm.nih.gov/pubmed/23168755
Agreed, it needs to be part of the calculus, though.
While overall, an IUD is one of the most cost effective forms of contraception because of its long lifespan. Yes the ACA mandates all insurances cover reversible contraception; however, they are extremely expensive for providers to keep in stock and IUDS are not something usually stocked in EDs. ED physicians, PAs, and NPs are usually not skilled at insertion and SANEs unless they are Women’s Health NPs or Nurse Midwives (or an Family Planning provider in their spare time) are not going to insert them. IUDs are extremely expensive for providers to keep in stock and often have to be a patient specific request and order. If someone without insurance goes to their health care provider and asks for an IUD for EC and has not had a forensic exams paid for by Victims’ Comp, the cost will be prohibitive. Can you imagine an adolescent paying $800+/- for an IUD because she does not want her parents to know she was raped or because she was engaged in some risky behavior and was raped?
I think it is a great idea. I don’t worry about infection with EC for a sexual assault because of prophylactic antibiotics. I would worry more about an IUD for EC for someone having unprotected sex. When you combine adolescents(15-19 years) with young adults (19-24 years)young people whose brains are still developing,you have the group with the highest rate of STIs that can cause PID. Sixty eight percent of chlamydia diagnoses are in this age group. GC is less. (http://www.cdc.gov/std/stats13/adol.htm). Good screening has to be done first. Sorry about the rant. The latter does not have to do directly with sexual assault. The good news is if it stays in, decreased pregnancy rates. My two cents.
Hannah