Objective: The purpose of this study was to evaluate the acceptability, efficacy, and complication rates of the ParaGard intrauterine device (IUD; Duramed Pharmaceuticals Inc, Cincinnati, OH) and the Mirena intrauterine system (IUS; Berlax Laboratories, Wayne, NJ) in a cohort of women who attended an urban university-based obstetrics and gynecology resident clinic. Study Design: A retrospective chart review was conducted for 194 women who had an IUD/IUS inserted between January 2000-December 2005. Results: One-third of the women who received an IUD had a history of sexually transmitted disease before the insertion. No differences were found between women with an IUD or an IUS regarding demographics and obstetric and gynecologic history before IUD insertion. The IUD was associated with significantly higher rates of herpes simplex and Neisseria gonorrhea infections, complaints of expulsion, and unintended pregnancy after the insertion. No increased risk of pelvic inflammatory disease was associated with IUD use. Conclusion: IUD/IUS use appears to be safe, acceptable, and feasible in high-risk patients. The IUS had lower rates of complications and greater acceptability than the IUD. © 2007 Mosby, Inc. All rights reserved.