Why are intrauterine devices (IUDs) not recommended for young sexually active patients?

Intrauterine devices (IUDs) are generally considered highly effective for contraception; however, they are not the first choice for young sexually active patients primarily due to their association with an increased risk of infections, particularly sexually transmitted infections (STIs).

When an IUD is inserted, there is a potential for introducing bacteria into the uterine cavity, especially if the individual is at high risk for STIs. This risk is amplified in younger patients, who may have a higher prevalence of STIs due to factors such as multiple sexual partners or inconsistent use of barrier methods. Infections can lead to serious complications, including pelvic inflammatory disease (PID), which can result in long-term reproductive health issues.

While IUDs do require surgical placement, this is a minor outpatient procedure that is typically well-tolerated and is not the primary concern. Additionally, while there can be rates of expulsion with IUDs, these rates are generally low and do not surpass the concern regarding infection. Therefore, the increased risk of STI-related complications is a critical factor in the decision-making process for contraceptive options in young sexually active individuals.