title: Barriers and myths that limit the use of intrauterine contraception in nulliparous women: a survey of Brazilian gynaecologists.
abstract: OBJECTIVE
  To understand the extent to which barriers and misperceptions about intrauterine contraception (IUC) remain among Brazilian gynaecologists, particularly for nulliparous women.
  
  
  METHODS
  An online survey was developed to assess Brazilian gynaecologists' knowledge and attitudes towards IUC. Data collected included demographic and professional data, main barriers when considering IUC for women in general and/or nulliparous women, attitudes towards inclusion of IUC in contraceptive counselling, and opinions on what could increase IUC prescription for nulliparous women. A question regarding knowledge about WHO medical eligibility criteria (WHO MEC) was also included in the survey.
  
  
  RESULTS
  101 gynaecologists completed the survey. The insertion rate in nulliparous women was 79.2%. Brazilian gynaecologists were more likely to consider IUC in counselling or provide it on request for parous than for nulliparous women (p<0.05) and perceived more complications in nulliparous women. 74.2% of gynaecologists recognised a higher risk of pelvic inflammatory disease (PID)/infertility associated with IUC use in nulliparous women than in parous women. Difficult and painful insertion were also relevant for 83.2% and 77.3% of the gynaecologists, respectively. Respondents showed a high level of awareness of the WHO MEC classification.
  
  
  CONCLUSIONS
  The three most commonly reported barriers to considering IUC as a contraceptive option for nulliparous woman were concerns about PID and difficult or painful insertion. The challenge is to ensure that gynaecologists understand the evidence and do not disregard IUC as a potential option for nulliparous women.
authors: Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors: Agnaldo Lopes
authors: AL
authors: da Silva-Filho
authors: Department of Adolescent Gynecology, Instituto Nacional de Perinatologia; Universidad Nacional Autónoma de México, Mexico City, México.
authors: Josefina
authors: J
authors: Lira
authors: Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors: Ana Luiza Lunardi
authors: http://orcid.org/0000-0002-4717-9541
authors: ALL
authors: Rocha
authors: Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
authors: Márcia Mendonça
authors: MM
authors: Carneiro
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001938:Brazil; D005260:Female; D006176:Gynecology; D006801:Humans; D007434:Intrauterine Devices; D010298:Parity; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Healthcare practitioners; Intrauterine contraception; Intrauterine device; Knowledge; postgraduate medical education