Avaliação da influência dos dispositivos intrauterinos na microbiologia observada em citologias cervico vaginais de mulheres jovens

Abstract

The choice of long-acting contraceptive methods can modulate the composition of the vaginal microbiota, with direct implications for the reproductive health of young women. This observational, cross-sectional, and analytical study retrospectively evaluated 358 liquid-based cervical cytology reports from women aged 16 to 25 years using intrauterine devices: copper IUD, levonorgestrel (LNG) IUDs of 19.5 mg and 52 mg. The microbiological variables found included isolated microorganisms (Gardnerella vaginalis, Candida., Actinomyces, bacilli, and cocci) and polymicrobial patterns suggestive of bacterial vaginosis. Statistical analysis used Fisher's exact test and odds ratio (OR) calculation with a 95% confidence interval. The results revealed that users of the 19.5mg levonorgestrel-releasing IUD had a lower chance of colonization by Gardnerella vaginalis compared to users of the 52mg LNG IUD, and a lower prevalence of a polymicrobial pattern suggestive of bacterial vaginosis compared to the 52mg IUD and copper IUD groups. Regarding the presence of Actinomyces, the copper IUD had a higher prevalence when compared to hormonal devices. No significant differences were observed in the prevalence of Candida. It is concluded that a locally released dose of levonorgestrel exerts a differential effect on the vaginal microbiota, with the 19.5mg levonorgestrel IUD associated with a microbial profile showing fewer dysbiosis taxa than the 52mg levonorgestrel IUD and copper IUD, while the copper IUD presents a risk of Actinomyces colonization. These findings reinforce the need for personalized contraceptive counseling that considers not only contraceptive efficacy, but also the specific impact of each method and its dosage on the vaginal microbiome.