Natural methods of contraception do not alter any physiological function. They include natural family planning and fertility awareness, withdrawal, and abstinence.

IUDs/IUSs offer no protection from STIs, carry the risk of uterine perforation, may cause irregular bleeding patterns and spotting, and require painful insertion and removal pro­cedures. The ParaGuard IUD also can increase the amount of menstrual flow and the severity of menstrual cramping. Because of this, approximately 4% to 14% of IUD users have their IUD removed in the first year of use (Stanback & Grimes, 1998).The IUD/IUS may also be expelled from the uterus and may create partner discomfort, and women with several sexual partners who use the IUD/IUS are at increased risk of pelvic inflammatory disease (Masters et al., 1994). It is anticipated that the GyneFix, once ap­proved, will have much lower expulsion rates.

Cross-Cultural Use

IUDs are a popular contraceptive throughout the world. It is estimated that more than 25 million Copper T IUDs have been used in 70 countries (Grimes, 2004). In many countries, such as Turkey, China, Nigeria, England, Russia, and Korea, the IUD is the most frequently used form of contraception (Francoeur & Noonan, 2004). The Mirena IUS has been available in Europe for over 10 years, and it is estimated that at least 3 mil­lion women have used it throughout the world. In some countries, including China, Mexico, and Egypt, IUDs are inserted directly after the delivery of a baby (Grimes,

2004) . Other countries with high IUD/IUS usage include Cuba, Finland, Turkey, Nepal, and the United Kingdom. Low usage has been report in countries such as Hong Kong, Korea, Ireland, Israel, Japan, and Kenya (Grimes, 2004). Overall, usage rates may vary based on media reports and how much the device is marketed in certain countries. For example, in Europe increases in IUD use may be a result of adverse publicity about birth control pills.