I’m a worrier, always have been. I overprepare for everything —I was even born a week early. As I’ve grown older and into my identities of being fat, Black, queer, nonbinary, and femme — I’ve learned that over-preparation is essential to my survival. After a pregnancy scare during graduate school, I threw myself into researching something more guaranteed than condoms. With school rapidly consuming my life, I needed something I didn’t have to constantly check in on; I wanted the Crockpot of birth control.
A friend of mine had told me about how much she loved her IUD, so I looked into it. I was hooked by the promise of long-lasting birth control with minimal maintenance. The procedure sounded simple enough: a doctor would insert a little hunk of plastic into my uterus, and five years later, I’d get it removed. Easy! At least, easier than reckoning with my lifelong needle phobia for the quarterly Depo-Provera shot, or the other popular long-lasting birth control Nexplanon, a matchstick-sized item fired into my arm, only to be cut out of me three years later. IUDs were the clear choice.
Although my decision was clear, I still agonized over IUD horror stories — perforated uteri, risks of the device expelling, and even becoming pregnant anyway — but the Mirena offered to stop my period altogether. I couldn’t pass it up. For years, menstruation fucked with my mental health and sense of self. Despite being terrified of the pain, I made an appointment to have an IUD placed. Anxiety coiled in my belly thinking of what could go wrong and was worsened by gynecological resources constantly tying birth control to cis womanhood and ignoring non-women like me. I tried finding better sources, but they were all by white, middle-class, cis women. I felt like an anomaly.
I considered skipping my appointment, but I couldn’t handle the threat of pregnancy again, so I went. The insertion itself was pretty standard. They measured my uterus’ depth, and an intense full-body cramp cracked through me. When they replaced the measuring tool with the IUD applicator, I was still too focused on the initial pain of measurement to feel the hurt of insertion — maybe that’s a small mercy. Afterward, the nurse gave me a pad big enough to ride home on. Back at my apartment, I crawled into bed, my poor uterus whimpering.
My periods never fully disappeared, but they did lighten significantly. Aside from checking the strings to ensure my IUD hadn’t rocketed out, I didn’t have any issues or think much about the small device inside me. By the time my T-shaped comrade’s expiration date arrived, I’d finished grad school, moved cities, and entered a new age bracket. With my periods becoming more irregular, I started researching replacements. The procedure was so simple that some go-getters had theirs replaced on their lunch breaks. I figured it couldn’t be any worse than the original placement, and I scheduled an appointment with Planned Parenthood. I’d never been to one before, and when I pulled up to the building a few weeks later, I wasn’t sure what to expect. I just knew I wanted the experience to be quick.
Thankfully, everybody at Planned Parenthood was so fucking nice. It was as good of an experience you can have when pulling out your vulva for strangers. I sent last-minute texts to friends letting them know I’d see them on the other side, and the nurse cranked me wide open with the tiny jaws of life. He grasped my IUD’s strings with forceps and pulled; I felt one dull cramp, then another. With the third cramp, he said, “It seems your IUD’s embedded. I’m not comfortable removing it because of the risks of infertility.”
Granted, I was there to become temporarily infertile — or at least temporarily hostile — but I appreciated his concern for my terrible, terrible womb. I rescheduled with the Planned Parenthood across town, where I was told they’d slather me with ultrasound jelly and guide out the device. I went home and worried I’d somehow caused this by not being careful enough. I scoured the internet for information on what to expect, but everything was either polysyllabic Latin or irrelevant, cheery articles, making me feel even worse. I just wanted someone to explain what would happen and provide reassurance that it wasn’t my fault.
There was nothing.
The night before my appointment, I was barely holding it together. Terrified at what could go wrong, I stayed up late trying to decipher complicated medical articles. When morning arrived, I was sleep-deprived and cranky getting into my Uber. We drove up to the building where a small group of protesters patrolled the sidewalks, demanding people like me be forced to carry children we didn’t want — they immediately cemented my decision to replace my IUD.
I checked in with the front desk, and after what felt like hours, a nurse called my name. We headed to the exam room where I laid on the table and of course, worried. What if they couldn’t remove my IUD and I’d have to spend the rest of my life carrying around this grim passenger? The gynecologist arrived, doing her best to put me at ease while reminding me to open my legs wider. She tugged on my IUD, but it held firm. “We’re going to give you some lidocaine,” she said, her smile pleasant. My heartbeat skyrocketed to rates you’d expect in someone being hunted for sport. I nodded weakly, preparing myself for needle horror, but it was just three tiny pinpricks, comparable to a mild period cramp. Soon, I felt absolutely nothing. They could’ve held a block party in there and I’d have no idea — it was incredible.
The gynecologist coated my FUPA with lukewarm ultrasound jelly; I could see my raggedy IUD on-screen, mocking me. While the gyno tried to wiggle out the device, she seemed to forget I was even in the room; it was just her and my uterus, locked in a battle of wits. I was window-dressing at best. That worked for me; the longer it took to remove my IUD, the more my dysphoria built. I felt invaded and on display. It took everything just to focus on breathing. She asked if I’d be comfortable if she applied more pressure, i.e. put her back into it; I gave a limp thumbs up. With some experimental angles, out popped my hormonal nemesis, gleaming underneath the hospital’s lights. “Would you like to replace your IUD?” the doctor asked. “It’s unlikely it’d embed again.” I paused, looking at the unopened Liletta box in her hands.
Even with the risk of repeating this entire process, nothing could ever be as painful as sitting alone and crying myself hoarse while waiting for the result of a pregnancy test. I didn’t want to be guilted into pregnancy by white evangelicals who’d destroy my child once they were old enough to be considered a threat. I said yes to replacing my IUD. I’m still a worrier but birth control offers me survival on my terms, and in a country hellbent on killing me — I’m not giving that up any time soon.
“I didn’t want to be guilted into pregnancy by white evangelicals who’d destroy my child once they were old enough to be considered a threat.”
Damn, that line hits HARD.
Simone, thank you for sharing your experience! There’s so little queer coverage of IUD insertion and removal. I recently learned that Planned Parenthood surgical centers now offer local anesthesia for insertion/removal to make the process less memorable and traumatic. Wish that had been an option when I got mine in, it’s certainly not the “gentle pinch” so many blogs say it is. ❤️
Some providers also recommend taking a low dose of misoprostol before IUD insertion, since it softens and dilates the cervix. It seems like, in general, there’s more awareness of the fact that IUD insertion can cause significant pain, although the literature can sometimes be…dispiriting.
I had misoprostol before my IUD was inserted. If that’s what it was like with it, I don’t wanna know what it would have been like without it! I’m not saying don’t do it, but I am saying if I have the option of local anesthesia too when I go to get it replaced, for sure I’m taking it. I almost didn’t finish this article because I was like “ok this sounds like it’s gonna be about a horrific replacement experience and I really do not need to read that right now.”
I don’t want to come across as anti-IUD. It has been so nice to have minimal to no periods that I was planning on getting it replaced even without knowing local anesthetic was an option (thank you Mo, I will be looking for my local PP!). Just saying if you’re going to get one, ibuprofen and misoprostol might help but aren’t enough to make it pain-free or even only mildly uncomfortable.
Simone, thanks so much for sharing your story.
For my first placement, they had me take ibuprofen beforehand, and it didn’t make much of a difference. I love my IUD, even with the issues of my first one and the (small) risk of future problems, and I think conversations like these are really important to help everybody make informed decisions about their birth control.
Hopefully you’ll be able to have local anesthetic; it makes a huge difference!
I wonder if I could get something like that for IUI (Intrauterine insemination)…most people say it feels like a pap smear but for me IUIs were intensely painful and made the experience of infertility all the worse. We’re getting ready to try for our second child and this is what I’m most anxious about.
You can ask an expert about it but based on my understanding misoprostol wouldn’t be advised for IUI. It does a lot of different things but among them is cervical ripening, which induces abortion. I don’t know the mechanics of how that would work prior to implantation- it might even help? But I would guess with it being a drug used for first trimester abortion, it’s likely not good for IUI.
My IUI for my daughter was really painful, but IUI for my current pregnancy was honestly nbd. I told the doctor to let me know when he was going to do it, and he already had! I had a vaginal birth with my daughter, so if you had a belly birth it might still be painful. Good luck!
Definitely not a gentle pinch! I’m happy to hear more centers are offering local anesthesia. Hopeful that trend continues. Thanks for reading! :)
Thank you for this. I’m trying to decide if an IUD is right for me. I have terrible periods and suspect I have PMDD. Pregnancy is not a risk for me, and I don’t like the pill because it totally wrecks my sex drive. I’m glad overall you were able to get the care you needed and had a good experience with your IUD!
I originally got an IUD for pregnancy prevention. I kept it because living (mostly) period free improved my life considerably. I like it so much a got a second one despite the fact I’ve only needed it for birth control for maybe 10% of the time I’ve had it. YMMV.
Thank you for sharing this experience.
Wow, thank you for sharing! I considered getting an IUD years ago, but ended up not getting one because I was too afraid of the pain involved. To me, standard pelvic exams seem to be painful, getting an IUD inserted or removed probably would have been off the charts for me
Oh this sounds horrible! So sorry that you had to go through this. I’ve removed IUD’s before, and it’s usually just a pull and it slips right out. Placement and removal are easier after someone has given birth, but it’s not a requirement as some doctors say.
For anyone wondering: a part of the people who get a hormonal IUD get no to minimal periods afterwards. Some people do have side effects or worse periods, and for some people these are bad enough to have the IUD removed before it’s expired. The hormones are very minimal but it can have mental health effects, although much less frequent compared to the pills.
A copper IUD last longer but has more side effects and often causes heavier periods.
Also be aware that you can ask your doctor/nurse to use a smaller speculum if you need it, ususally they have several sizes.
I’ve had friends wonder why they hadn’t gotten one years earlier because they’re so happy with it and friends who had to have theirs removed after some months due to side effects.
For more information I recommend the website and app of Clue. It’s gender neutral and has scientifically based information. I like the app to track my periods, and it does some calculations and if I go to my gynaecologist I just hand her my phone and it’s so easy.
I had the copper one and it gave me horrendous periods so I eventually gave up, but the insertion and removal were fine, I assume because I’ve had kids.
Thanks for the article and I hope next time round is smoother for you!
Quite late to this article but weirdly timely as I just had mine replaced a week ago.
Through a series of random events, the original appointment was moved four times before I actually was able to get into the room, at which point there was an inflammation issue my doctor wasn’t comfortable irritating. The second appointment also didn’t go smoothly since she couldn’t find the strings or get it out at all, which led to an ultrasound to find the bugger’s placement and a recommendation to a gyno to get it out rather than a general practitioner.
Thankfully the gyno sent me a script for an anti-anxiety med and strong painkillers. My insertion was a body wrackingly painful event that was worth the 5 years of no period/pregnancy but was still awful and with the medication this time was much less painfully traumatic.
Still absolutely worth it but oof. Anyone who had a “mild pinch” of an experience is someone I’m a bit jealous of!