The IUD Chronicles, Part 3: The Insertion

Let’s dive in… my cervix.

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TW: Blood, medical procedures involving the cervix and vagina, brief sexual assault mention, gender dysphoria mention

I made the appointment for my IUD insertion last Thursday, while I was in bed recuperating from a nasty stomach bug. I was able to secure a time slot the following Tuesday, at the very late-sleeper-friendly time of 2:15pm. God bless Planned Parenthood and its very approachable online appointment booking system. On the “Reason for Appointment” drop-down menu, I selected “IUC”.

(IUD’s are now sometimes being called IntraUterine Contraception devices, or IUC’s, instead of IntraUterine Devices, IUD’s. On most of the Planned Parenthood website, they are still referred to as IUD’s, but on the appointment menu, they’re called IUC’s. I can’t find any information on the reason for the switch in terminology.)

I wasn’t sure if I’d be getting the actual device inserted at that first appointment. In some offices, you are tested and measured for the IUD on one day, and experience the actual insertion a few weeks later. Some offices prefer to wait until the patient is on their period to do the insertion, as menstruation (squick warning) softens the cervical wall, making insertion much easier. Other doctors want to prescribe their patients with a pre-emptive pain med prior to insertion, introducing a delay so the patient can fill the ‘scrip and take the med before showtime.

I wasn’t sure what would be the case for me. So, I kind of half-assed my pre-appointment pain prep. I took two ibuprofen (a total of 400 milligrams). I swung by the Walgreens near the office and bought a single capcacin pain pad. I ate a scone.

Which brings me to Planned Parenthood’s recommended pre-IUD-insertion tips, which I read beforehand:

As you can see, I didn’t quite hit the mark. But I wasn’t sure I’d even be getting that cute little metal T shoved in me that day. I didn’t want to take a fuckton of Advil for nothing! I was still on the mend from the aforementioned stomach bug and didn’t want to irritate my delicate stomach. (Man, deciding to get a foreign body inserted in my uterus right after being violently ill was a great idea, wasn’t it).

— — — —

I showed up to the Planned Parenthood exactly on time. I was gonna be early, but I forgot that the building had moved, so I had to dash 7 blocks south from the former Devon & Broadway location to the new Broadway & Hollywood storefront:

The new Planned Parenthood of Roger’s Park office is spacious and sparkling clean, no small feat after an already very salty and slushy winter. To get in, a visitor has to speak to the reception desk through a phone on the wall, and then be buzzed through a second set of doors. This was the case at the old office as well — and I’m assuming it’s PP’s standard MO, what with all the ignorant, hateful fucks who want to blow their offices up, including occasionally the ones that don’t provide abortions.

The lobby had new, fresh-smelling furniture and immaculately clean floors. Two tween-aged girls were sitting in the corner with their mother; a toddler-aged girl was wandering around, occasionally stopping by the older girls to engage them in conversation. As I filled out my paperwork, several other patients came in — I overheard couples discussing birth control methods, young women contemplating their first contraception prescription, and trans people discussing their hormone levels and blood tests. The place was buzzing and bright.

I had to wait a long time because my insurer Cigna wasn’t picking up the phone. That was okay. It gave me plenty of time to read and re-read the consent form I was given. It was about six pages, and outlined the common- and not-so-common risks of the IUD. After about forty minutes, Cigna got back to us: they would be covering the full cost of the IUD and its insertion. FUCKING THANK GOD.

(If you have health insurance in the United States, whether from an employer or through the Marketplace, you should be covered for at least one gynecological exam, and for birth control. This includes a copper or hormonal IUD. Still, I don’t trust insurance companies and I was worried my ultra-cheap plan would rip me off. They did not. Thank you Cigna. No, strike that: thank you Obama.)

I peed in a cup in the massive, very Americans-with-Disabilities-Act-compliant gender-neutral bathroom, then slid the cup through a metal hatch. I was delivered to a waiting room. The assistant measured my height and weighed me. I requested to not know my weight, as I have an eating disorder and body image issues; the assistant was happy to have me face away from the scale as she measured me. She even asked if I wanted to hear my height or not!

From there, she led me through PP’s standard patient questionnaire: do I smoke, have I been pregnant, have I used intraveneous drugs, have I ever had sex that I did not want to have. When I said yes, she checked in and told me that I didn’t deserve that, and that Planned Parenthood could connect me with services if I wanted someone to talk to about my experiences. I got a little misty and said no, I was okay, I was already working on that. We continued; she asked about domestic violence, relationship safety, sexual partners, sexually transmitted infection history, and so on. She asked if my partner knew about & supported my decision to get an IUD. I said yes.

(Planned Parenthood is excellent about providing contraceptive options to people in abusive relationships. The office will even call you using a pseudonym, and pose as a friend of yours, to help make scheduling appointments more circumspect. One really excellent contraception option for people in controlling relationships is the birth control shot; it cannot be detected and only has to be administered once every three months, making it a great fit for someone who cannot take pills or use a birth control method that is detectable on their body, such as an IUD).

After I provided my background info, the assistant walked me through the procedure, using a see-through plastic vagina model and a sample version of the tools. The steps were as follows:

  1. The doctor would feel the inside of my vagina with her (gloved) fingers, and touch the top of my stomach with her other hand, to locate where my uterus is placed within my body.
  2. The doctor would insert a speculum to open up my vagina.
  3. To clean the area, a pinkish clear fluid would be applied to my cervix using a cotton swab.
  4. A long, thin stick called a sound would be inserted, slowly, to measure the depth of the vagina and cervix. If the depth was between 6 and 9 inches, we could proceed with IUD insertion.
  5. A clamp would be used to hold the cervix open and stabilize it.
  6. A plastic applicator, similar to a tampon, would be inserted into my vagina and pushed past the cervix. This applicator would release the IUD into my uterine cavity.
  7. The doctor would remove the applicator and cut the strings that trail off the end of the IUD, so that the strings hung a few millimeters outside the cervix, into the vagina.
  8. All the fucking clamps and sticks and metal shit in my vagina would be taken out and I’d bleed and feel like shit for a while.

After that, the assistant gave me a paper sheet to use to cover my lower body, and told me to strip and hop in the saddle.

— — — —

Because my appointment got off to a late start (thank you Cigna), I was pushed behind another patient in the schedule. As it turned out, I had about half an hour to kill in that room, sitting bare-assed on a giant maxi pad with a paper sheet around my waist. So I took a bunch of photos of my surroundings:

Here is the bag of sterilized equipment. That long black instrument is the sound, which is used to measure vagoo-goo depth. Those long cotton swabs are used to clean the cervical area. The metal objects with scissor-like appendages are used to…shove shit in there? Clamp shit? I don’t know. As you can see on the bottom of the bag, this gear was sterilized on 12/29/17.

Here is the copper IUD in its cute pink clam shell case. It’s about an inch and a quarter long, and the arms of the “T” are foldable. During insertion, they are folded down. After the doctor has the applicator inside of you, they raise the arms of the T. You can barely see the two fishing-line-esque strings coming from the bottom of the case.

These are my beautiful strong androgynous legs. I was sitting bare-assed on the exam table for far, far longer than I needed to be. I should have waited a while to get undressed. I could hear my doctor faintly talking to another patient in another room; I knew it was gonna be a while.

After I ran out of photos to take, I scrolled through Instagram, then answered a few emails. I drank from my water bottle and stood in the middle of the room, the paper sheet wrapped around my hips. I sat back down and did some deep breathing exercises.

— — — —

My stomach was tense with nervousness. I was terrified of the pain. I’d been putting off this procedure for a year, really — I’d been meaning to do it for so long. But vaginal/cervical pain disturbed me; getting pap smears was disturbing enough on its own! The first time I got a pap smear, I couldn’t masturbate for weeks. I felt like my junk was not my own. It felt so disembodied and unfamiliar; my feelings toward my own anatomy were cold and dissociated.

I have bottom dysphoria. This means I feel dissociated from my genitalia in various ways, for somewhat gendered reasons. I don’t want to have surgery to change what my parts are, but I do feel detached from, and slightly “wrong” about, the parts I have. I enjoy penetrative sex most of the time. Much of the time, I don’t mind having my external genitalia touched by a partner. But sometimes, and for some sensations, contact with my genitals just feels “wrong”.

When dysphoria strikes, my head fills with static and my blood runs cold. My connection with reality and my body feels fuzzy. Some sensations, such as receiving oral, are so unpleasant, uncanny, and wrong-feeling that I cannot enjoy them at all. This has always been the case for me, and predates experiences of sexual trauma.

Since my relationship with my genitals is tenuous, I was not looking forward to any experiences of discomfort, or any perceived loss of control. I was afraid the pain would be disturbing. I was especially terrified of the remote prospect that IUD insertion would trigger pregnancy-like contractions. This happens to a very small number of people, but it sounded like a goddamned nightmare for dysphoric, pregnancy-fearing me.

I wanted to get this shit over with. I didn’t want to wait anymore. I took long slow breaths. I kept it together.

— — —

The doctor, Marybeth, was a late-fifties white woman with a grandmotherly air about her. Throughout the procedure, she told me I was very brave and that I was doing a hard thing. She said this stuff in a syrupy, warm tone that I did not find condescending, despite myself. She also called me “wonder woman” and “girlie” a lot, which was not ideal, especially since my gender and pronouns were already on my chart. But she was so kind and warm that I couldn’t bring myself to mind very much.

Dr. Marybeth walked me through the procedure once again, in agonizing detail. This caused feelings of dysphoria and fear to flare back up. At this point, all I wanted was for the procedure to be done. She used a plastic model vagina, once again, to walk me through the steps. She held the thing model up and said, “Here is your vagina, pink and perky and cute”.

(Why are so many gynos like this? The love to tell you how cute your vagina is. It’s borderline creepy. I know it’s not intended to be, but it still is not something I want to hear. Still, I couldn’t help but be charmed by her.)

She asked me if I had questions and if I was ready. I said I was worried about the pain but that I was gonna get through it. She gave me an approving “good for you” and got to work.

She followed the exact steps I outlined above. It turns out I have a non-tilted vagina, which is a good thing, as it makes insertion easier. As she inserted the speculum and prepared the sound, she told me about how she’d ordered her first Lyft in the past few days. Her driver was a nice Somalian man who got out of the car to open the door for her. He offered to walk her to the door of her apartment, wasn’t that so nice? He said she should call him, directly, for all her future rides. I said that was all very nice.

Then she clamped my cervix and inserted the sound.

— — — —

JESUS CHRIST. I cannot do justice to the uncanniness of this feeling. Having a speculum inserted is uncomfortable, like having your vagina be stuffed too full of something hard and cold. Well, not “like” that, that’s exactly what it is. But having a fucking hard metal binder clip PINCH OPEN your cervix, deep inside you, and then feeling a long plastic tube snake its way up into your organs until they cramp and sting in protest? It’s a whole order of magnitude worse.

The sensations were terrible. It wasn’t just the pain, it was the mysterious detachment of all of it. Your vaginal canal is pretty numb, really; you can feel things moving around but not a lot of detail beyond that. Your organs are also numb, until they’re not…then they’re howling in sharp, stinging, piercing pain that is confusing and hard to place and travels right up to your head, making you feel faint.

The clamp hurt. It felt like my insides were being pulled taut and then pinched tight by something firm and incredibly strong. It made me bleed. I could feel the blood oozing out of me. I was terrified to breathe too hard or sneeze or shudder; it seemed like my anatomy would be torn apart and that all the equipment would sail from my body in a spurt of hot blood if I did anything but remain very still.

Then there was the sound. At first it felt like nothing, like a very thin tampon applicator or a really unsatisfying dildo…and then it kept going. For a moment, I couldn’t feel where it was going at all, because the area past my cervix was such a mystery to me. And then my head spun and my organs cried out in hot pain and my hands flew to the paper sheet around my waist, grasping at nothing, while I breathed out and yelped.

“Oh, my gosh,” I whimpered. I started breathing out reflexively, like I was in a Lamaze class.

“You’re doing so good,” the doctor said, sweet as pie.

“That really…oof,” I breathed. I was afraid of embarassing myself. I wanted to holler and moan. But I didn’t.

She kept moving the sound in, slowly, and pain shot up my sides. Fuck. Actual internal private delicate body organs were being probed and it was not something that any human should have to experience, and it was horrible. It felt so bizarre. It seemed like something that could never actually be santiary or safe. Man was not meant to be stuck like this.

Then the sound was out, and the applicator slid in. The same pain shot out, and I whimpered again.

“Ooof!”

“You’re so brave, you’re doing so good, you’re so tough,” she continued. It did not feel pat or patronizing.

I kept breathing through the pain.

“And there, you did it! Now I’m going to cut the strings…”

The scissors went in — sharp, cramping pain — and then came out. She started talking to me about the length of the strings, and tried to show me where they were, using her curled hand as a analogue for my vagina, but my face was flushed and my body was tight with pain and all I could focus on was keeping myself from yelling at her to go ahead and remove the clamp and the speculum already dammit.

The clamp came off with a sting and a pop. More blood flowed out. She mopped it up carefully with a napkin while talking to me. Some dripped onto the maxi pad stuck to the medical table. I felt like a baby being changed. The speculum popped out. My vagina gasped for air, metaphorically speaking.

“Now,” she said, “Nothing should be inserted today, so no big parties— “ I started laughing, “ — I mean, haha. That’s not what I meant. No tampons, no fingers, no penises in there tonight. After that, you know, have fun.”

She gave me a panty liner in a pink plastic wrapper. “Now, you’re gonna be bleeding for the next couple of days. Ibuprofen is your friend. You’ll want to take 800 milligrams. That’s four of your usual pills. How many are you on right now?”

“400,” I said.

“Oh, you low balled yourself,” she said. “We’ll give you another extra-strength Advil, that’s another 400 milligrams.”

“Okay.”

“Are you going right home?”

“Yes.”

“Good,” she nodded. “I had a patient last week who worked at the Botannical Garden, like 11 miles away? She came here on her lunch break and then bicycled back up! I told her don’t do that, try a Lyft.”

— — — —

I was in pain pretty immediately. I took my extra pill, then had to wait an extra ten minutes for PP to get my health insurance’s approval to cover the medication (thank you Cigna). Then I took my receipt and left. The grand total for the procedure:

Thank you Cigna. Thank you Obama. Thank you Planned Parenthood.

— — — —

This is part of an ongoing series about transitioning from hormonal birth control to a copper IUD. You can read the series from the beginning here. In the next entry in the series, I describe my recovery from the IUD insertion.

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