I found myself laying on the table with a sheet over my knees blocking my view. Yet, it was not enough to fully hide the metal contraptions jutting out from between my legs. I stared at the ceiling while my gynecologist poked a long syringe containing lidocaine into my cervix and waited patiently while she removed the IUD, a t-shaped piece of plastic containing hormonal birth control, from its packaging.
My doctor made small talk with me to calm my nerves. She had another patient currently in labor at the nearby hospital, “it’s her first, so with my luck, we’ll be waiting all night,” she said in jest. The first time going into labor must be a long endeavor I gathered.
She fiddled with the plastic inserter—a long tube with two small strings at one end and the IUD at the other—because the strings were stuck, and she was not able to fold the IUD into the position necessary to complete the operation. She roughly pulled the strings until the wings of the IUD relaxed.
In my head I wondered, “what happens if they don’t open properly once she puts that inside of me”? I had heard that these operations were painful, so if this did not work, she would have to remove it then reinsert it, extending my pain. She told me to breathe.
Finally, she positioned herself below me and quickly said, “this will hurt like a contraction”. She said she just wanted to warn me for what I would feel in the next ten seconds. I inhaled sharply. I was trying to get contraception to avoid having a baby, but had to subject myself to the pain of labor to do it. That didn’t make sense.
I had read, and my doctor had told me beforehand, that there was no sure-fire method proven to substantially reduce or prevent pain of insertion. Besides, I had followed every instruction: taking extra-strength ibuprofen, eating beforehand to keep from fainting, and popping cervix softening drugs─like those used for women in labor─to hasten the process. However, the lidocaine shot into my cervix would not reach my uterus, where the IUD would ultimately go. I tried meticulously to control every part of the process up to this point, but at that moment, I lost all control.
Once the IUD was inserted, my doctor told me calmly that she was opening the wings halfway, then fully. It did not feel like a pinch or bad cramps like I had heard from my friends. It felt like I was being torn apart.
A small minority of women experience severe pain upon insertion, and all at once, with hot tears rolling down my face, I realized that I was one of the unlucky ones.
“I know it hurts. We’re almost done”. I didn’t move. She worked quickly, pulling out the plethora of metal tools clanking them on the table beside me.
“Do you feel faint”? I nodded and she replied, “don’t sit up. Your body has a natural reaction to faint whenever anything passes your cervix. It’s normal”. I could hear the crinkle of the sterile paper she was wrapping around her tools. She left the room to grab me some juice before asking me to sit up slowly.
“Don’t look at the blood. It looks like a lot, but it’s not”. I averted my gaze from her supplies. I could tell she was in a hurry to get back to her patient in labor, so I told her I was feeling back to normal. “Thank you”. She gave me a sheet to track my cycle and to remind me of my IUD’s expiration date in three years, August 2019, before she was on her way.
Alone in the quiet room, I looked between my legs and saw a bright red spot. Not wanting to sit in my own blood, I gently dropped one foot, then two off the side of the exam table and slowly slid until my feet hit the floor. My paper hospital gown was loosely tied behind my back and made a rustling sound as I leaned one hand on the table; waiting with my eyes closed for the stars to subside. Once I was dressed in the loose, black clothes I had arrived in, I hobbled into the lobby where my dad was waiting. He, not one to express concern, saw my pale face, put his arm around my shoulder, and took me home.
While IUDs are 99% effective at preventing pregnancy, they have side effects that impact people differently, making them suitable for some, but not all. Throughout the process, I wondered why my options were so constrained and felt deeply hurt by the unfairness of the situation. I experienced severe side effects from the different versions of generalized hormonal birth control with which I had experimented over the prior three years. I had tried using condoms, but not only suspected I had a latex allergy, but also felt pressure from my partner not to use them. I was also concerned about the efficacy of spermicide and sponges, and the anxiety of potentially becoming pregnant pushed me away from testing less effective options.
Every alternative had serious side effects that impacted my quality of life. Given the fact that types of birth control have rapidly expanded since the 1960s, I was disappointed by researchers and doctors’ general disregard toward the indirect health effects of birth control.
More importantly, I was going through all this alone. I had booked appointments months in advance, been poked and prodded by my doctor during consultations, and stressed over the decision. I questioned with profound distress why I had to endure severe pain, stress, and financial burden for a responsibility that was shared between my partner at the time and me.
Thinking about this reminded me of all the men I had overheard making jokes about “going raw” and complaining ceaselessly about the meager effort of putting on a condom. That last thought was seared in my mind. Their manipulation and irresponsible flippancy towards what had become a defining part of my overall health and wellbeing was infuriating.
I went in knowing I would not only have pain during the procedure, but for days afterward, and what turned into the three months of non-stop spotting and periods. During that time, I had to pay for a never-ending supply of pads that I stuffed in pockets of all of my bags and replaced nearly every pair of underwear I owned. How could I, in good conscience, commit to something that would likely exacerbate my already chronic yeast and bacterial infections? My mind raced. I knew my partner considered birth control non-negotiable. I thought, “In order to have this relationship, this is my only option”.
The pain lasted for days. Eventually, however, it dissipated. After three months of spotting, my periods stopped. Having an IUD became normal.
I am relieved that necessary health care did not go awry like it did for friends who were not so lucky. Arguably, I feel wrong saying that I am grateful for that. While their anecdotes do not represent the majority of cases, their lives, relationships, and self-esteem were seriously impacted by not only a bad reaction to IUDs, but hurried doctors and insurance constraints.
Medicine will always be imperfect given the uncertainty of science, but the inequality women identifying people and people with uteruses face every day is amplified in situations of imperfect information, vulnerability, and stigma when attempting to access health care. Doctors ignore our pain and we internalize these messages and doubt ourselves.
This is true not only at an individual level, but in a structural sense. The clinic in my insurance network was Catholic and I lived in a state that codified discrimination based on religious beliefs. Thus, birth control procedures were strictly prohibited on site, or within the hospital except in emergencies. This meant that my gynecologist was forced to rent out an unfamiliar space outside of the hospital once a week where she inserted her patients’ birth control─one after the other like an assembly line. Although, impersonal healthcare like this wasn’t optimal, we─the patients and providers─were resigned to saying, “it’s better than nothing”.
I was infuriated at the injustice, the domination of a religious institution that I did not believe in or ascribe to, having the power to alter my and other people’s access to crucial healthcare and then a patriarchal society telling me that anything but gratitude would be ignorant and selfish. This burden not only increased my anxiety prior to the procedure but left me bitter.
Surprisingly, after three years living with an IUD, I did make the decision to have another re-inserted. It was a cost-benefit analysis that I labored over for months. I had just graduated, and I knew that having (now) 5 years of safe, predictable birth control was powerful considering the instability of entering the workforce, relocating, and aging out of my parent’s health insurance. I also had to consider that if I waited, restrictions on birth control may become so severe that I would miss my opportunity to choose altogether.
The second time around the circumstances were worse. There were two unfamiliar doctors in the room, no anesthetic, a longer procedure, and panic ripping through my body. The pain was excruciating. Recounting the memory alone brings tears to my eyes. I decided on the table that I will never do this again. The benefits of an IUD—pregnancy prevention and lighter periods—did not outweigh the agony I experienced from the procedure.
Although my experience is not one I wish to repeat, I had insurance to reach doctors and their counsel to guide me through the process. That is not to say that every step in the process of accessing care was adequate─it was fraught with inequality and misogyny leading to negative outcomes for me and for others. Nor does it mean that I am satisfied with the care I received or medical best-practices. However, I was forced to calculate my options in the event that even that painful, imperfect, unfair choice would be taken from me.