To study colposcopic and cytological changes in cervix in women using intrauterine contraceptive device

Objective(s) : To study cervical changes in copper-T users, along with effect of Cu-T on cervical pap smear and colposcopy to ascertain the safety of Cu-T with reference to cervical dysplasia. Method(s) : 50 women with Cu-T in situ were subjected to detailed history taking, clinical examination, pap smear study, high vaginal swab culture sensitivity and colposcopic examination. These women were compared with 50 asymptomatic women without any IUCD matched for age parity and socioeconomic status. Results : Backache (48%) and menorrhagia (38%) were most common complaints. 46% of subjects had normal cytology as compared to 96% in controls. Atypia of squamous cell of undermined significance were seen in 2% of subject as compared to none in controls. Infections were present in 20% of subjects. Conclusion(s) : There is no precipitous carcinogenicity of Cu-T but a long term follow up is needed. Subjects having Cu-T deserves continuous surveillance but are not subjected to increased risk of malignancy.


Introduction
About 106 million women throughout the world are using IUCD. At present Cu-T200B is the most commonly used IUCD in India 1 . It is a reliable, reversible, economic & safe method for regulation of population. Thread of IUCD tail being a source of constant irritation may be responsible for cervical erosion and dysplasia. It may provide a conduit for ascending infection from vagina. This study deals with the changes n cervical cytology & colposcopic findings in subjects using IUCD for a variable period.

Methods
The present cross sectional study was conducted in the Department of Obstetrics and Gynecology, S N Medical College and Hospital, Agra. Women coming to Family Planning clinic and out patient department and using IUCD for contraception were selected for the study.
Study group included 50 women using IUCD for variable period. 50 women of reproductive age group without any gynecological complaint were selected as control. After taking informed consent the case and control groups were subjected to detailed history, physical examination, pap smear, high vaginal swab culture, sensitivity and colposcopic examination.
The study was cleared by the ethical committee of the institution. The results of study were analyzed using paired t test.

Discussion
A number of reports suggest that copper devices are effective & safe but the effect of copper on cervical epithelium with regard to dysplasia has not been specifically reported. IUCD usage by a large of women has caused concern about its safety especially regarding carcinogenicity. The aims of this study are to report clinical, cytological and colposcopic findings among women using IUCD. A total of 50 women using IUCD failed to reveal any case of malignancy or severe dysplasia. Most of the subjects with IUCD presented with backache (48%), menorrhagia (38%), lower abdominal pain (38%), vaginal discharge (18%). Similar results were found by study done by Naik et al 2 in 2007 the most common complaint was backache (44%), followed by menorrhagia (38%). ASCUS was seen in one subject using IUCD for 3 years and CIN I was in seen one subject using IUCD for more than 3 years. The incidence of ASCUS & CIN I increases with the increase in duration of insertion being maximum when the duration of insertion is more than 3 years. Rahmy 3

Conclusion
Based on this study it can be concluded that women using copper containing intrauterine devices are not subjected to increased risk of cervical malignancy. However a long term follow up is required to rule out the possibility of any increased rate of dysplasia or carcinoma in situ. Thus these women require a regular follow up for counseling, clinical examination and further investigation as needed.