Cytological studies in women with IUCD (Lippes loop).

A follow-up study of 208 IUCD insertions was carried out over a 1-year period to study the effect of Lippes loop on vaginal discharge vaginal epithelium and cervical epithelium. Of eighty women who complained of vaginal discharge before insertion eight had trichomonas five monilia and thirty erosion. In nineteen women having no history of vaginal discharge eight complained of a discharge for a week or two after insertion and the rest throughout the follow-up period. Six who had no vaginal discharge for 6 to 8 months after insertion later started having excessive discharge. Subsequent investigation indicated trichomonas in three of them. These observations indicated that the loop had no adverse effect on women with trichomonas and monilia infestation. It was also observed that in some women the loop itself was the cause of vaginal discharge. During the follow-up period vaginal smears of women having regular periods before insertion were taken every 4th week. Smears taken more than 5 days before the onset of a period or those showing inflammatory cells were excluded. Of 227 smears taken from ninety-nine women 157 were ovulatory and seven were anovulatory. These results are suggestive of an increased number of anovulatory cycles in regularly menstruating women after insertion of the device. Cervical smears taken with Ayres spatula and stained and typed according to Papanicolaou technique were examined before insertion and then once every 3 or four months. Pre-insertion smears were: 114 (54.8%) type I 74 (35.6%) type II 19 (9.1%) type III and I (0.5%) type V. The women have type V smears were subsequently proved to have invasive carcinoma. During the follow-up period 47.2% were type I 51.7% type II and 1.1% type III. Out of nineteen pre-insertion type III cases five were lost to follow-up. Of the rest all but one reverted to type II or type I. One which remained type III for 4 months became type II in a subsequent follow-up. None of the pre-insertion type I became type III. Only one of the pre-insertion type II changed into type III after 10 months of insertion. She complained of excessive discharge and a fresh infection of trichomonas was detected. Thus the above observation is contrary to that of Pincus in whose series there was a tendency towards type III smear after 9 months of insertion. (Full text)