IUD and UTI Risk
No, intrauterine devices (IUDs) do not meaningfully increase the risk of urinary tract infections (UTIs) in healthy adult women without a history of recurrent UTIs. The available evidence shows no significant association between IUD exposure and UTI occurrence, and UTIs are not mentioned as a relevant infectious complication in major contraceptive guidelines.
Evidence from Guidelines
The CDC Medical Eligibility Criteria for Contraceptive Use extensively addresses infectious complications associated with IUDs but does not list UTIs as a concern or contraindication 1. The guideline focuses on:
- Pelvic inflammatory disease (PID) as the primary infectious risk, with increased risk only in the first 20 days post-insertion 1
- Sexually transmitted infections (STIs) as relevant considerations for IUD candidacy 2
- Other infections including tuberculosis, schistosomiasis, and HIV, but notably excludes any mention of UTIs 1
This absence from comprehensive contraceptive guidelines is telling—if UTIs were a clinically significant concern with IUD use, they would be addressed in these detailed eligibility criteria.
Research Evidence
Systematic Review Findings
A 2021 scoping review specifically evaluated IUDs as an exposure risk for UTIs and found that studies to date have not reported a significant association between IUD exposure and UTI occurrence 3. This review identified nine studies meeting inclusion criteria and concluded that the relationship between IUDs and UTIs remains incompletely understood, but current evidence does not support a causal link 3.
Conflicting Individual Studies
While the systematic evidence is reassuring, there are isolated reports suggesting possible association:
- A 2005 cohort study found asymptomatic bacteriuria in 9.9% of IUD users versus 1.3% of controls (risk ratio 7.74), with E. coli being the predominant organism 4
- A 2014 case report described recurrent ESBL-producing E. coli UTIs linked to an infected IUD 5
However, these findings must be interpreted cautiously: The 2005 study measured asymptomatic bacteriuria (not clinical UTIs), had a small sample size, and has not been replicated in larger studies 4. The case report represents an extremely rare occurrence and does not establish causation 5.
Clinical Context and Mechanism
There is no biologically plausible mechanism by which an IUD in the uterine cavity would increase UTI risk:
- IUDs are positioned in the uterus, anatomically separate from the urinary tract 6
- The primary infectious concern with IUDs is ascending infection from the vagina/cervix to the upper genital tract, not the urinary system 7
- Historical concerns about IUD-related infections have focused on PID, with the understanding that beyond the first month post-insertion, IUDs do not increase PID rates above baseline 1, 7
Practical Recommendations
For a healthy adult woman without recurrent UTIs:
- Proceed with IUD placement without concern for UTI risk 1, 3
- Screen for gonorrhea and chlamydia at the time of insertion (can be done simultaneously with insertion) 1
- Counsel that IUDs do not protect against STIs 2
- If recurrent UTIs develop after IUD insertion, consider the IUD as a potential (though unlikely) source only after excluding more common etiologies 5
Important Caveat
In the rare scenario of a woman developing recurrent UTIs after IUD insertion that persist despite appropriate treatment, consider IUD removal and culture of the device, as it may serve as a nidus for persistent infection 5. This represents an exceptional circumstance rather than a routine concern.