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Words matter: perforation… or transmural migration?
  1. Stephanie Irene Amaya,
  2. Andrea Henkel,
  3. Paul D Blumenthal
  1. Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
  1. Correspondence to Dr Stephanie Irene Amaya, Obstetrics and Gynecology, Stanford University, Palo Alto, CA 94305, USA; samaya{at}

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The intrauterine device (IUD) is a safe and highly effective form of reversible contraception, and IUD use is increasing globally.1 The paper published in this edition is a credible and comprehensive review of early postpartum IUD (PPIUD) experiences.2 In summary, the authors show that PPIUDs decrease unintended pregnancy rates and short-interval pregnancies, lessen economic burden, and are safe for most people seeking contraception. Despite the safety and benefits of IUDs, the authors state that PPIUD insertion is underutilised, and they call for further studies to understand better such low utilisation.

Despite the generally positive findings of this paper and the abundance of evidence indicating IUD benefit, it remains important to consider risks and complications around IUD use when discussing potential reasons and solutions for underutilization of PPIUDs. Certainly patients who receive counselling on IUD use are more often counselled about its potential adverse effects than about its benefits.3 As such, it is important to note that misperceptions or misclassifications of complications can impact IUD use. This is particularly true for PPIUD use since this approach is relatively new in the spectrum of IUD initiatives.

In reviewing complications, especially perforations—occurring in about one in 1000 IUD insertions4 5—a gap has evolved in perception and terminology. Conventionally, all IUDs found outside the uterus are termed ‘perforations’. …

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  • Contributors SA and AH performed the literature review and co-authored the editorial. PB generated the concept, outlined the initial draft, and provided subsequent edits.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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