The first time we met was fraught. I was 24 years old, wearing a paper dress and sitting on a paper sheet, when my nurse practitioner held up the small item, twig-like and somehow menacing.
“So, this is what it looks like,” she said, holding it out to me. “Would you like to hold it?”
I extended my palm somewhat automatically; I’ve always been the kind of person who answers “yes” to questions of that nature. She placed it in my hand and proceeded to walk me through its parts.
“You can see that it has strings, which help us remove it when it needs to be changed. They’re also there so that you can check the placement from time to time. The little arms fold down for insertion” — she took it back, pressed the arms to the sides, and showed it to me again — ”so it’s about this big when it goes into your cervix.”
This had all looked so carefree and fun in the brochures; all of those images of smiling women with dark hair and plaid shirts, joyous with the knowledge that they could do it literally anywhere. Now, staring up at me, it felt aggressive.
“It seems…too big,” I choked out as I did a small mental calculation about the size of my cervix, which I’d hear was smaller than the head of a pin, and the size of the IUD even with its arms folded.
“It is, but we’ll numb your cervix beforehand and insert a sound to make sure it’ll fit.”
I must have blanched, because she followed up quickly.
“…And I can prescribe you up to two Xanax for the day of the appointment,” she added quickly.
I looked at my bare feet dangling off the end of the exam table.
“It lasts for up to 10 years,” she explained “so you won’t have to go through the replacement process for a while.”
“By the time I’m having it replaced,” I reminded her “I hope that I can also get my tubal done at the same time.”
She pursed her lips and turned to write the prescription for exactly two tabs of Xanax.
Since I was 18, I’ve asked every doctor and nurse who’s ever had the pleasure of gazing at my reproductive parts, speculum-in-hand, about a tubal ligation. In all of those years—more than 10 now!—I have been told that I’m too young, that I might change my mind, and that they will not, no matter how much I ask nor how well I’m insured, perform the procedure.
The IUD, according to my nurse practitioner, was the next best thing. In fact, it was kind of the only thing.
So I made another appointment.
The second time we met, I was wearing the same paper outfit (embarrassing!) and had taken all of my medicine. I was sweating and a little bit numb but not numb enough to make folding-of-the-arms less unpleasant.
“And after 10 years, when you take it out, I can finally get my tubes tied?” I asked, staring at the ceiling.
“After 10 years, when you have it replaced, you can probably discuss having a tubal ligation with the doctor, yes.”
I don’t remember much about the moment that my IUD went from a copper shape in the palm of my hand on the outside of my body to a sharp pain and two weird strings on the inside of my body, but it happened quickly and while a very kind-faced blonde woman held my hand.
I left the Planned Parenthood feeling somewhat grownup. This was the beginning of the rest of my life. How exciting. And in 10 years, I’ll finally be old enough to have my tubes tied.
That was four years ago. I guess you could say my IUD and I have gotten used to each other; it’s one of my longest relationships, and most of the time, I don’t think much about it.
But, confidentially, my IUD is kind of an asshole.
Like many an intimate relationship, there’s a substantial chasm between our public appearance and private interactions. I’ll tell anyone who listens how great my IUD is — it really is! IUDs are effective as hell and make a great first line of defense in reproductive health! — and I encourage IUD use, particularly among adolescents. I joked during a political event once that my American dream is “an IUD in every uterus that wants one.” I am firmly on #TeamIUD, particularly because it can serve as a temporary bridge between when a woman decides she doesn’t want children and when a doctor will perform a tubal ligation.
However, in private, our relationship is…tense.
I chose a copper IUD — its proper name is ParaGard — for several reasons, including (but not limited to) the fact that I’ve had a hard time with a hormonal birth control (I’m not alone in this) and the fact that the copper one lasts longer, thus creating greater space between the instances of the folding of the arms and the poking of the cervix.
Unfortunately, this means that not only do I not get to reap the rewards of a consistent dose of hormones (one of my friends has a hormonal IUD — properly named Mirena — and she told me she literally has not had a period IN YEARS. YEARSSSSS.), I also have worse periods that are longer and more painful than I had before.
And that’s really saying something! Because my periods have been fairly terrible since I was 11 years old.
For all of its merits, the copper IUD comes with some pretty rough side effects, like heavier bleeding (really, really heavy), worse cramps, periods that easily last more than eight days, and a generally ouchy feeling from time to time.
I weighed all of these options when I chose ParaGard, and I knew they were coming. That still doesn’t make it easier, though, when I feel as though I’m perpetually on my period and, as a result, am constantly scooting off to the bathroom to ensure my tampon hasn’t betrayed me, only to find that it definitely, definitely has*
Every month as my Clue app warns me that “THE PERIOD” is coming, I groan a little groan, ensure that I am fully stocked with naproxen sodium and tampons the width of a very large man’s index finger, and wish there were a better way. But then I remember that the better way is a fairly routine elective surgery that would be extremely effective but for some reason (lol actually a lot of reasons, actually, chiefly having to do with the policing of female bodies) many doctors, including every one I’ve ever talked to, refuse to do it.
Which makes me resent my IUD even more. Because it doesn’t need to be like this. I could be having nice, normal, light-ish periods and also not be concerned about getting pregnant if a doctor would just do the damn thing that I’ve been trying to get done since I was 18 years old.
The IUD can be a game-changer for some women. And it truly, truly is an effective piece of the reproductive health puzzle that many of us trying to piece together at any given time. But the idea that it offers a kind of set-it-and-forget-it ease is just not accurate. Nor is it accurate to say that the use of an IUD or other long-acting reversible contraceptive devices is somehow a good substitution to the procedure that many, many women actually do want and in fact are qualified to request and receive because we are autonomous creatures who are capable of making decisions all our own.
I love my IUD because, though it did not turn me into a smiling woman in a plaid shirt, it did help me feel a bit like I was regaining some semblance of control over my own body. At the same time, though, it’s been a disruption and caused amounts of discomfort that hardly seem worth it. There are months when, gritting my teeth through a workday as my guts roil, I consider having it removed, but the process of getting an appointment to take it out (and then recovering from a particularly sharp tug) sounds somehow worse.
The worst part is, though? In a perfect world—one where women are trusted implicitly to make decisions about our own health—my IUD and I wouldn’t have ever had to be acquainted at all.
*Yes, I have also tried using menstrual cups but my months-long attempts to figure that situation out is a story for another day.