Study on Vaginitis Among Intrauterine Contraceptive Device Users in Ibadan, South-western Nigeria

ObjectiveTo investigate IUD-related vaginitis in IUD users at the University College Hospital Ibadan, South-western Nigeria.MethodsA prospective cohort study in IUD users present with abnormal vaginal discharge at the family planning clinic of the University College Hospital, Ibadan was conducted between 10th of October, 2008 and 31st of May 2009. High Vaginal Swabs were taken from the clients for microbiology, culture and drug sensitivity test. Diagnosis of bacterial vaginosis was made based on gram stained vaginal smear using the standard Nugents criteria. Other aetiological agents were identified either on wet preparation or culture using standard techniques. Treatment given was by the family planning nurse, as was the protocol at the family planning clinic.ResultsTwenty-four IUD users present at the family planning clinic with vaginal discharge were studied. Their ages ranged 28–51 years(38.14 ± 5.9 years). Mean parity was 4.4 ± 1.4. All the women were married and all used CuT 380A. The mean duration of IUCD use was 2.5 years only. Majority (46%) had used it for more than 3 years and most (75%) of the visits were unscheduled. All the clients complained of abnormal vaginal discharge which was copious, watery and foul smelling, or clumpy. Nine users (37.5%) complained of pruritus vulvae, 3 users (12.5%) lower abdominal pain, 1 user (4.2%) dyspareunia and 1 (4.2%) dysuria. The diagnosis of bacterial vaginosis was made in 16 (66.7%) and vaginal candidiasis in 8 (33.3%). Age less than 40 years, Christianity and IUD use more than 3 years were associated with a higher risk of bacterial vaginosis (OR=1.29, 1.67 and 6.6, respectively), while women above 40 years, Muslims and women with lower educational status had a higher risk of candida-related vaginitis (OR=1.67 and 4.2, respectively). Eight clients (33.3%) were treated for candidiasis with antifungals (3 empirically, and 5 after obtaining results of vaginal swab), 9 (37.5%) were given oral metronidazole, 3 patients were referred to the gynaecological emergency unit on account of abdominal pain and 4 did not return for follow up.ConclusionIUD associated vaginitis is a disturbing condition causing unscheduled visits among IUD users. Bacterial vaginosis and Candidia albicans are major aetiologies in south western Nigeria Ibadan. Persistent discharge is a documented reason for discontinuation of IUD use. Periodic empirical treatment for candidiasis and bacterial vaginosis with antifungals and oral metronidazole is advocated. This may reduce the discomfort caused by IUD-related vaginitis, the risk of PID and other risks exposed to the IUD users and ensure continued use of the IUD.