adventures in birth control, or: emily has a small uterus

This morning I got an IUD. And then I spent the rest of the day in bed with a heating pad over my abdomen and an ice pack at the small of my back, doped out on ibuprophen and acetaminophen. I decided I should write a blog post about the experience, as anecdotal reference for anyone else who’s thinking about it. It happened like this:

Step 0. Take 1,000mg of ibuprophen before arriving at the doctor’s office. Wear comfy, warm clothes. (I always get cold at the doctor’s.) The usual pee in a cup/ blood pressure and heartrate/naked from the waist down rigmarole. The doc comes in. Okay.

Step 1. Describe to the patient what is about to happen.

DR: The first step is I’m going to feel the position of your uterus. Then we measure the depth of your uterus. This is called sounding —

ME: LOLZ. Like a well?

DR: Yes! You know, most people don’t know that term. Are you familiar with Mark Twain?

ME: Uh, sure.

DR: Well “mark twain” was what you called when you were sounding the depth of the river, so he chose that as his pen name.

ME: And now I’m going to name my IUD Mark Twain. Or Mr T for short.

DR: Well, then the next step is to place the Mirena. This is what it looks like. (He shows me an IUD in its kit, identical to the one I keep in my office to show to students.)

ME: Uh-huh.

DR: Now, they did tell you that because you’ve never had children this is likely to be more a uncomfortable procedure for you?

ME: Yeah. Um, listen in 2000 I had a colposcopy and cervical biopsy and I experienced a lot of vasovagal sensations and nearly passed out.

DR: Oh I see. Well, we’ll make sure we’re set up for that.

(It transpires that “set up for that” consists of having smelling salts in the room. I kid you not.)

Step 2. And so I set myself up in the stirrups. He inserts two fingers and palpates my abdomen – this is the “feeling the position of my uterus” part. No problems here.

DR: Relax that muscle just as much as you can. Good.

ME: (deep, slow breaths, relaxing pelvic floor muscle. I’m good at this.)

And then.

Oh and then.

I get “sounded.”

At first it was just a bit of pressure and a pinch, like a Pap smear, …but then.

I yelped like a kicked puppy and jolted my hips off the table.

DR: Try not to pull away like that.

WHAT?!?!

ME: Okay. I’ll do everything I can.

He coaches me to breathe slowly in through my nose and out through my mouth. “Slower than that,” he says. I teach that kind of thing; I’m working on it. But it FUCKING HURTS.

Step 3. Placing the Mirena.

Feels like stabbing my uterus. The assistant puts in ice pack behind my neck and I press my hands to it, desperately trying to shut the gate on the stabbing pain shuddering from my uterus to my toes and back up to my teeth.

Step 4. Cut the strings, while soothing at the patient who is shaking and crying, pale lipped and trying not to hyperventilate, pass out, or throw up. And it’s over.

DR: Roll over slowly on your left side for a minute or two. It’s not that hard for everyone. You’ve got a small uterus.

ME: (through slow, shallow breaths, lying in the recovery position) Well. It’s not the size that counts.

You learn something new about yourself every day. Me, I have a small uterus. Which has no consequences in my life until I decide to go for long-term contraception.

I lay on the table in the office for about an hour, sipping juice and rotating an ice pack from my forehead to my lower back, until I could sit up without feeling dizzy and the pain resembled really bad menstrual cramps. The doctor continued to soothe at me, telling me, “Make sure you tell your guy about this and get him to buy you something real nice.”

I swear to god he said that. I couldn’t have made that up if I tried.

All I could think to say was, “I’m going to have to cancel my meetings for this afternoon.”

Eventually I could put on my shoes and stand, at which point I drove home, got in bed, and have barely left it since. I played a lot of Angry Birds an listened to Ian Carmichael reading “Strong Poison.”

It’s been nearly 12 hours and the pain has subsided to the intensity of slightly bad cramps. I expect it’ll be tolerable without meds in the next 24 hours or so.

And after that, I’ve got 5 years of worry-free pregnancy prevention, for the cost of about two months of contraceptive pills.

Worth it? I expect it will be.

It doesn’t hurt for everyone – some women, and even some women who have never had children, have quite benign experience with getting an IUD.

But I do wish someone had let me know ahead of time how much it MIGHT hurt, so that I could have, for example, take more pain meds beforehand and brought someone with to drive me home.

My advice then: be prepared for the worst. Hope for the best. Take what comes. It’s an amazing piece of technology and I fully appreciate what it means for me and how privileged I am to live at a time when such effective and effortless birth control is readily available covered by my health insurance.