Pelvic actinomycosis is an extremely rare disease that can occur in women with a long duration of intrauterine device (IUD) use. This type of abscess is usually unsuspected and, thus, diagnosed and treated surgically; however, long-duration treatment with penicillin can be completely effective. While the occurrence of actinomycosis is well documented by case reports, it is not possible to quantify the risk during IUD use. Approximately 7% of women using an IUD may have a finding of Actinomyces-like organisms on a Pap test. The prognostic significance of this finding is minimal because of the lack of sensitivity and specificity and a low positive predictive value. In the absence of symptoms, women with Actinomyces-like organisms on a Pap test do not need antimicrobial treatment or IUD removal.