IUD insertion is barbaric
Thoughts and news for the week of September 4
Hi and good morning, my loves -
If you’ve been reading Reclaiming since the early days, this topic (and my opinions on it) will not be new. (Also: thank you!) But since then, I’ve heard from so many people with uteruses about their own struggles and felt like it deserved another discussion.
I have had three Mirena IUDs inserted in my 36 years. Before each insertion, my doctor(s) required a consultation to discuss the procedure and what I could expect. During this appointment, they all advised me to take Motrin an hour before the procedure. I would probably be fine going back to work after, two out of three of them said. [Narrator: She was, actually, not fine to go back to work.]
Each time I went through the procedure, my blood pressure plummeted and I almost passed out. I also remember apologizing to the doctor, who could’ve at least tried to prevent my pain, for my extreme reaction to it. I had to call out of work all three times. A half-hour after the last procedure, raw-dogging it without Motrin because I knew by the third time it was pointless, I had to have my husband Uber to me on the floor of the clinic’s parking garage where I sat crumpled against the wall, trying to breathe and not throw up. It was gruesome.
But I never questioned the doctors’ Motrin and chill plan. And despite going through it three separate times, I truly never thought to ask why there weren’t better options for me and all the other people with uteruses who have to go through this excruciating experience without help. After all, adequate pain management is available for so many other invasive procedures. Why not this one?
According to the CDC, more than eight percent of people with uteruses ages 15 to 49 are using IUDs. While some may experience little to no pain during insertion, many report extreme discomfort. There are no comprehensive guidelines around how to make the procedure more comfortable, and not enough research to make any one method the standard of care. Sedation is too expensive; laughing gas isn’t really used in the US like it is in the UK. Some providers are using lidocaine gel or local anesthesia such as paracervical blocks, and there are even some gynecologists who prescribe misoprostol (one of the two pills used safely in medication abortion) prior to an IUD insertion. IUDs have been a safe form of birth control for decades, yet there has been no consensus about - or priority to discuss - how to make it less painful.
And IUDs aren’t the only thing that should be addressed: other excruciating gynecological procedures like colposcopies are subject to the same pain management plan (which is to say no pain management plan.)
The American College of Obstetricians and Gynecologists admits that more research is needed, acknowledging in a 2019 review of pain interventions that in the modern era of medicine, “our inability to recommend any positive treatment for pain relief with IUD placement creates professional discomfort.” (Okay cool but like, how about the discomfort the patients feel?) Despite the fact that so many professionals see this as a problem, very little work is actually being done to develop less painful, long-term, and reversible contraceptive options for people with uteruses. And that shouldn’t come as a surprise: study after study finds that government agencies like the National Institutes of Health continually underfund medical research about women.
So doctors, for the most part, are left to do the best they can with what they have - and women and people with uteruses are expected to endure the pain. The fact that there is no research or default practice that could help patients get an IUD inserted without excruciating pain speaks to the deeply rooted misogyny and patriarchal practices in medicine. And I think we can all agree that if men were the ones getting IUDs, the procedure would resemble going to the Apple store to have your iPhone fixed.
After the Dobbs decision and resulting abortion bans in several red states, it’s more important than ever to remove barriers to accessing safe contraception.
So here’s my call to action: Advocate for yourself when you don’t understand something a healthcare professional tells you, when you have a question, or when something hurts. You don’t need to be confrontational, but be unwavering in your pursuit to get the attention from your insurance and healthcare providers you need. You are your best advocate. You also know your body the best. Treat her/him/them accordingly. You deserve the best, more thoughtful care.
That’s it for this week, my love. I hope you have a great week ahead and remember to always advocate for yourself and your body. You deserve it. Until next week, I love you to pieces -
Sarah
Rec of the week
Bottoms, which is hands down my favorite movie of the summer, Barbie included. A campy queer teen sex comedy that somehow makes violence and blood funny. I wish this movie had been around when I was in high school. This is a don’t-miss-it, 10/10 watch (it’s in theaters.)
In the news
Well, this is deeply embarrassing: Canada has issued a travel advisory to its LGBTQ+ residents, warning them that some states in the U.S. have enacted laws and policies that compromise their safety. Per the site: “Not all countries have the same values and legal system that we have in Canada. As a result, it is important for you to be informed about the legal framework and social customs governing sexual orientation, gender identity, gender expression, and sex characteristics in your destination country.” Are enough of us mortified yet? Can we get the fuckers responsible for this out of office already?
For all the Millennials: this week, a third woman accused Nick Carter of sexual assault. In a new lawsuit filed last Monday, an unnamed woman - identified only as A.R. - claimed the singer sexually assaulted her on his bus and yacht on two separate occasions when she was 15. The filing details one occasion when Carter “knowingly provided alcohol and drugs” to her and “enticed three other men” to watch him “engaging in sexual intercourse with then-minor A.R. from a vantage point of an outside window in the cabin of Carter’s yacht.”
Conservatives in Texas are pissed that women are finding ways to get abortions despite their dystopian “heartbeat” ban. Anti-abortion advocates are now seeking to make it illegal to transport anyone to get an abortion on roads within the city or county limits if the end destination is an abortion clinic. They are literally aiming to keep pregnant people trapped in Texas and force them to give birth. In the new legislation, anti-abortion advocates are proposing to target regions along interstates and in areas with airports to block off the main arteries out of Texas. These provisions have already passed in two counties and two cities, creating major risk for those traveling on major highways including Interstate 20 and Route 84, which head toward New Mexico, where abortion remains legal and new clinics have opened to accommodate pregnant people from Texas. Several more jurisdictions are expected to vote on the measure in the coming weeks.
70,000 daycare centers are expected to close in the coming months as pandemic funds from the federal government come to an end, and as you may have predicted, this hurts low-resource families the most.
Final thoughts
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PREACH. Lucky / unlucky for me the only IUD I had was inserted at the same time I had an abortion. This was in New Zealand where they thankfully put me to sleep for the whole procedure, so I didn't have to feel any of it. However I felt that thing in me for years that followed. I never had period cramps prior to an IUD but once that bad boy was in, I was in a lot of pain a lot of the time. I don't remember how many years it lasted, but I had them take it out. I couldn't take it anymore and I knew I didn't need to. It was an awful experience and I didn't even have to go through the pain of insertion. Most of gynecology is barbaric because our pain has historically been dismissed and ignored.
IMPORTANT: If a medical provider ever denies you any care, medication, testing, etc. HAVE THEM WRITE IT IN YOUR CHART. Depending on what it is you're asking for, if they need to document their refusal, they may change their tune and if they don't, you at least have a paper trail of their refusal.
OMG. Luckily, I've aged out of the system. However, the pain scars remain. I recall that during an excruciating dilation and curettage procedure (no anesthetic), one gynecologist informed me that it didn't hurt and to stop complaining. Yup. Good old boys at work.
And a side note: IUD's aren't always effective - at least not the old-fashioned Copper-7 I had.