After President Donald Trump was elected, I cursed, cried, and typed three letters into my search browser: IUD. I was beginning a months-long journey that would end with me in medical stirrups, naked from the waist down, squeezing a silicone boob in stress, as an intrauterine device, or IUD, was inserted in me.
I was not alone in this journey. Immediately after November 8, the top Google search terms for contraception were “iud,” “iud Trump” and “get an iud now,” according to ABC News. After President Trump was elected, the idea of birth control that can work for over a decade by just sitting in your uterus spiked in popularity. In an uncertain future, people with uteruses wanted to take control of their reproductive choices. Around this time Planned Parenthood also reported it saw a 900% increase in patients wanting IUDs.
Before I could commit to a decision, I turned, as I usually do with my private concerns and neuroses, to the internet. I found Subreddits, Tumblrs, and Livejournal communities dedicated to all-things-IUD and I lurked in these spaces for months.
The more-recent IUD evangelism stems from all the benefits of long-acting reversible contraception. Beyond the gift of years-long contraception for zero effort, they’re low-maintenance and cost-effective. While pills, rings, and patches have a 9% failure rate, IUDs are over 99% effective because they don’t rely on you remembering to take something, at a certain hour, every day or month. Because the hormones in IUDs are localized in your uterus and not your bloodstream, my doctor even promised me that the mood swings that the Nuvaring gave me would disappear. It’s no wonder then that IUDs are the preferred contraception of choice for gynecologists to use on themselves.
And in the long-run, IUDs are cheaper that most other forms of birth control. The Affordable Care Act requires insurance plans to cover all government-approved methods of birth control without out-of-pockets costs. Under this mandate, an IUD is free under many insurance plans. If the ACA is repealed, an IUD could cost up to $1000. This may become a reality —President Trump has vowed to repeal the ACA and Republicans are desperately trying to fulfill this promise. So far, the administration has already cut $213.6 million in teen birth control research.
Even having science and doctors on the side of IUDs, what drove me to action was this last point. What initially had held me back from seriously considering an IUD—fear of pain in the procedure, complacency, inertia—now seemed silly. I made a commitment to myself. Once I turned 26 and lost my father’s health insurance and used my employer’s, I would celebrate this adult milestone with an IUD.
But first, I wanted to know the people whose forces I would be joining. I wanted a space where strangers would stop being polite and start getting real about the IUD side effects, like potential months of bloody discharge.
I found all that and more. In these online forums, there were success stories, testimonies to the limits of pain endurance, complaints of hormonal side effects, and pleas for advice. As each of the IUD communities is quick to emphasize, they are not a substitute for your healthcare provider. They are your space to support and vent. Unlike face-to-face interactions, on social media posts like these, you always have the mic, and can speak uninterrupted. This can be freeing for people to unburden themselves of big and small worries they’re unable to tell their lovers and families. Snaps of solidarity and applause are seen in the replies, reblogs, and upvotes your story receives.
What’s better is that there are referees. The moderators of IUD_Divas, an IUD livejournal community that’s been running since 1997, enforce a rule around pronouns. “Our users come from all over the world, get IUDs for myriad reasons, have different medical coverage situations, and vary in relationship status, sexual orientation and gender identity,” the moderators advise in their submission guidelines. “Say ‘people,’ ‘iud users,’ even ‘iud divas’ instead of ‘ladies’ or ‘girls.’ Don’t assume that everyone’s here to prevent babies, or that we’re all from your country.”
In other words, speak your truths, but recognize that you can get your mic unplugged.
We make our private parts public knowledge because we seek answers we’re not getting from our known circles. For some IUD seekers, these online spaces may be giving them better advice than they’re getting offline.
“Through moderating this community, we have come to realize that many healthcare professionals prescribing birth control do not offer adequate education to their patients about possible side effects and how to use birth control most effectively,” the moderators of /r/ birthcontrol, who are a medical student and a lawyer in the daytime, told me in a message. “We hope that this community serves the purpose of allowing patients to educate each other in a friendly and non-judgmental manner.”
Here, your pain is believed. Advice is taken seriously. Misery over jammed IUDs is shared. Whatever happens, you’re not alone. There are never enough public spaces for people to talk about their imperfect bodies, full of irregular bleeding and unwanted pain, and have them be recognized and celebrated as valid.
Each time I wanted to back out, I would read these stories, and I would watch healthcare legislation battles on the Senate floor. I eventually chose the newest IUD approved by the Federal Drug Administration, Kyleena, that is slightly smaller than Mirena, has fewer hormones—19.5 mg of levonorgestrel vs. Mirena’s 52 mg—and lasts just as long —five years.
Bolstered by science, the looming threat of Trumpcare, and the stories of many IUD divas behind me, I turned 26 in May and booked an appointment for the middle of July.
When the day finally came, the wait was longer than the procedure itself. My doctor’s office only had one room equipped for IUD insertions. My appointment was delayed for over an hour because insertions were taking too long. At least that’s what I was told. But when you’re the only person sitting in a waiting area, you hear too much. The woman before me fainted getting her old IUD out and her new one in. The woman before the woman who fainted got sent home because she was too nervous and kept bucking away from the doctor’s hands. I overheard one nurse tell another that it would take a while to “clean up the mess.”
Foreboding! I did not want to check my heart rate on my watch because I could already feel it pounding in my ears. When it was my turn to enter the room of horrors, I undressed from the waist-down and toured my cell. Someone had tastefully covered the medieval scissors that would be used to cut my IUD strings with a paper towel. There was a footlong box that carried the insertion device that would soon be in me. It looks like this.
Despite knowing all the ways this procedure could go wrong, the months of online reconnaissance had left me at peace with my decision. I had read all the timelines that could happen. At best, I would be like the lucky woman who said the pain was so minimal she could’ve “gone back to work.” At worst, I would black out from pain or be sent home because my uterus was too small to fit an IUD. All my fates were laid bare before me.
The physician assistant’s advice to me was to bear down and not move. If I moved, the doctor may need to reinsert the device. The threat of having to go through the insertion process twice was enough to make my body go still.
The physician assistant would be too busy helping the doctor to hold my hand, so she gave me a silicone boob to squeeze my anxiety into. During the insertion, there are three obstacles your body needs to overcome to reach birth control Valhalla. After your clinician disinfects your vagina, they will put an instrument up your cervix to stabilize it for the insertion. This is where the pain comes in: your cervix is the gatekeeper to your uterus and will attempt to expel this foreign invader. It will helpfully alert you to this intruder through an intense, sustained cramp that reverberates from your core. “Out, damn’d spot! out,” it protests. The next moment of rebellion comes when an instrument reaches your uterus to measure its depth. Your queen uterus is unhappy with this action and will tell you so. The cramping insurrection continues. If your uterus is big enough, your reward will be the third moment of pain when the IUD gets released into your uterus. This all happens in less than a minute.
Theoretically I had known this, but the cramping still made me suck my breath through my teeth in shock. I crushed the silicone boob in my hand, but I did not faint. The IUD successfully went inside me. The experience was better than the “molly sweats” of dizziness one woman described, but worse than the vague possibility of “discomfort” the Kyleena pamphlet undersold. The closest parallel of pain I found was with the woman who recorded her IUD insertion for a podcast. Her strained ‘hah haaaaahhhhhhh’ of discomfort was me.
After conquering the IUD, I downed the painkiller the nurse gave me, shook myself off and hobbled to the subway like a newborn deer. My cyborg body was still attempting to expel this foreign object and adjust to its new reality.
Following the advice of Redditors, IUD_Divas, and my doctor, I had made an end-of-day appointment and had cleared the rest of my schedule for the day. A heating pad, my favorite takeout, and Motrin awaited me at home. Whatever you do, my advice is to take it easy and treat yourself tenderly afterwards. You deserve it. The next day, I woke up with minimal pain, five years of continuous, foolproof birth control, and a sense of deep satisfaction.
I had finally become the IUD diva, a Redditor “experience” story tag that I had read so much about. The billed procedure would be over $800.00 but thanks to health insurance, I would pay nothing. I would never need to wait in line at the pharmacy for birth control again. I was bleeding on a pad. I couldn’t wait to tell people on the internet about it.