Can an IUD Cause Bacterial Vaginosis?

Vaginal health issues are never fun to deal with, but nothing adds insult to injury like having one arise due to taking care of your health in another way—by using nonhormonal birth control.

In recent years, many women have found having a copper intrauterine device (IUD) inserted may give them the nonhormonal birth control they desire. However, it can also bring an issue they could not have imagined.

While most devices and medications come with warning labels and lists of side effects, so far, the potential for getting bacterial vaginosis (BV) as a result of having an IUD isn't on the list. BV is an inflammatory condition that results from an overgrowth of "bad" bacteria in the vagina, causing a change in odor, intense itching and burning with urination.

After a decade-long relationship, Ena Dahl, a writer and performer from Berlin, wanted an easy form of birth control. After having the copper IUD inserted, she noticed a change in her scent down under; an OB-GYN confirmed she had vaginosis.

"I went on a few rounds of antibiotic suppositories, which all helped, but only temporarily," she explained.

After consulting with an OB-GYN, a friend of hers said it was the device's insertion itself that may have caused the issue.

The BV was recurring, rearing its ugly head every few weeks. She did all the right things, from wearing breathable underwear to avoiding scented soaps and synthetic lube, and using a menstrual cup to avoid chemicals from tampons. She adjusted her already low-sugar diet and stocked up on probiotics and any other recommended food and supplement she could find.

After talking with a number of other women, she found she wasn't the only one dealing with chronic BV after IUD insertion. In fact, after consulting with an OB-GYN, a friend of hers said it was the device's insertion itself that may have caused the issue.

A study published in November 2018 in Annals of Clinical Microbiology and Antimicrobials examined the long-term use of intrauterine devices and biofilm formation on the surface. Researchers performed culture- and PCR-based detections of bacteria/fungi from the biofilm on IUDs removed from 100 women.

PCR, or polymerase chain reaction, is a test to detect genetic material from a specific organism. The researchers found 76 percent of the IUDs were PCR positive for at least one of the four BV "signaling" bacteria, and the percentage of positive results increased the longer the IUDs were in place.

Why BV is a problem

BV is an inflammatory condition resulting from the overgrowth of "bad" bacteria in the vagina. Beyond unpleasant symptoms such as fishy-smelling odor, burning during urination and intense vaginal itching, this microbial imbalance can lead to an array of more serious issues.

BV is linked to premature deliveries in pregnant women, higher susceptibility to sexually transmitted infections such as HIV, herpes simplex virus, chlamydia and gonorrhea, higher risk of infection after gynecological surgeries, and pelvic inflammatory disease (PID), which can lead to infertility in serious cases. So while the odor is more than enough to make a patient unhappy, BV is not just about discomfort. It can be dangerous and life-altering, especially if it goes untreated.

For IUD users, that complicates things. The copper IUD often causes irregular, heavy periods, thought to disrupt the vagina's microbial imbalance. On top of that, there's some indication that bacteria such as E. coli can feed off copper, which may encourage overgrowth.

So beyond removal of the IUD, the only treatment options are to take antibiotics continually or address the pH imbalance in other ways, such as through diet, supplementation and lifestyle changes, which may not be enough.

So while the odor is more than enough to make a patient unhappy, BV is not just about discomfort. It can be dangerous and life-altering, especially if it goes untreated.

The relationship between copper IUD and bacterial vaginosis

Copper IUDs aren't all bad news. They are a good option for people who don't want to use hormonal birth control, work as emergency birth control because they begin working immediately, and can prevent pregnancy for up to 10 years. Once removed, barring any other medical issues, pregnancy can be achieved almost immediately, unlike with hormonal birth control.

Right now, research pertaining to copper IUDs and bacterial vaginosis is slim.

Janice, an OB-GYN nurse with 20 years of experience, works closely with women in the Novant Health System in North Carolina when they're making birth control decisions. She and her office staff only recently began hearing complaints from patients about bacterial vaginosis in conjunction with IUDs.

"Nonhormonal birth control is an option that's become more popular in recent years due to ease of use," Janice said. "However, I think it's important women know any and all potential side effects with any procedure or device they're choosing. While bacterial vaginosis is typically benign, it can cause serious issues if left untreated. I highly recommend anyone who is having vaginal health issues of any sort talk to their doctor immediately and begin a course of treatment that's best for them and their situation."

Medical concerns stemming from symptoms should be treated as soon as you become aware there's an issue. A birth control method doesn't have to be linked to bothersome side effects. There are potential side effects to any device or medication, so chat with your medical provider and make sure your vaginal health is in tip-top shape.