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Barriers and myths that limit the use of intrauterine contraception in nulliparous women: a survey of Brazilian gynaecologists
  1. Agnaldo Lopes da Silva-Filho1,
  2. Josefina Lira2,
  3. Ana Luiza Lunardi Rocha1,
  4. Márcia Mendonça Carneiro1
  1. 1Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  2. 2Department of Adolescent Gynecology, Instituto Nacional de Perinatologia; Universidad Nacional Autónoma de México, Mexico City, México
  1. Correspondence to Professor Ana Luiza Lunardi Rocha, Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, MG 30130100, Brasil; ana_lunardi{at}


Objective To understand the extent to which barriers and misperceptions about intrauterine contraception (IUC) remain among Brazilian gynaecologists, particularly for nulliparous women.

Methods An online survey was developed to assess Brazilian gynaecologists' knowledge and attitudes towards IUC. Data collected included demographic and professional data, main barriers when considering IUC for women in general and/or nulliparous women, attitudes towards inclusion of IUC in contraceptive counselling, and opinions on what could increase IUC prescription for nulliparous women. A question regarding knowledge about WHO medical eligibility criteria (WHO MEC) was also included in the survey.

Results 101 gynaecologists completed the survey. The insertion rate in nulliparous women was 79.2%. Brazilian gynaecologists were more likely to consider IUC in counselling or provide it on request for parous than for nulliparous women (p<0.05) and perceived more complications in nulliparous women. 74.2% of gynaecologists recognised a higher risk of pelvic inflammatory disease (PID)/infertility associated with IUC use in nulliparous women than in parous women. Difficult and painful insertion were also relevant for 83.2% and 77.3% of the gynaecologists, respectively. Respondents showed a high level of awareness of the WHO MEC classification.

Conclusions The three most commonly reported barriers to considering IUC as a contraceptive option for nulliparous woman were concerns about PID and difficult or painful insertion. The challenge is to ensure that gynaecologists understand the evidence and do not disregard IUC as a potential option for nulliparous women.

  • Intrauterine contraception
  • Intrauterine device
  • Healthcare practitioners
  • Knowledge
  • postgraduate medical education

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  • Contributors All authors: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests ALSF acted as consultant to Bayer HealthCare and received consultancy honoraria.

  • Provenance and peer review Not commissioned; externally peer reviewed.