A 28-year-old nulliparous woman requests contraception and is counseled about IUCDs. All of the following are true regarding IUCD insertion and safety in nulliparous women EXCEPT:

Explanation

## IUCD Use in Nulliparous Women: Safety and Efficacy ### Correct Statements **Key Point:** Nulliparity is **no longer a contraindication** to IUCD insertion. Both WHO and ACOG recommend IUCDs as first-line contraception for nulliparous women, including adolescents. [cite:Park 26e Ch 8] **High-Yield:** Expulsion rates are higher in nulliparous women (5–10%) compared to multiparous women (2–5%), likely due to uterine size and cervical tone. This is an important counseling point but does not contraindicate use. [cite:Park 26e Ch 8] **Key Point:** LNG-IUS reduces menstrual blood loss by 40–50% and is an excellent choice for nulliparous women with menorrhagia, offering dual benefits of contraception and therapeutic effect. [cite:Park 26e Ch 8] ### The Incorrect Statement **Warning:** The statement that IUCD insertion "significantly increases the risk of PID if the woman is asymptomatic at insertion" is **FALSE**. Current evidence shows: 1. **No increased PID risk** if the woman is asymptomatic and has no STI at insertion. 2. **Screening is recommended** for gonorrhea and chlamydia before insertion, not because IUCDs cause PID, but to identify and treat existing infections. 3. **Antibiotic prophylaxis** is not routinely recommended for IUCD insertion in low-risk populations. 4. The **small transient increase in PID risk** occurs in the first 3 weeks post-insertion and is related to insertion technique and pre-existing infection, not the device itself. [cite:Park 26e Ch 8] ### Key Safety Data | Risk Factor | Actual Risk | Counseling Point | | --- | --- | --- | | PID in asymptomatic women at insertion | No increase | Safe to insert without prophylaxis | | PID if STI present at insertion | Significant increase | Screen and treat before insertion | | Expulsion in nulliparous women | 5–10% in first year | Higher than multiparous; not a contraindication | | Perforation risk | 1–2 per 1000 insertions | Slightly higher in nulliparous; operator-dependent | | Ectopic pregnancy (if pregnancy occurs) | Not increased | Absolute risk still very low | **Clinical Pearl:** Modern evidence supports IUCD insertion in nulliparous women without routine antibiotic prophylaxis, provided STI screening is negative. This has become a major shift in contraceptive counseling and is frequently tested in NEET PG.