Well hey there. It’s been a minute.
Let’s talk about vaginas! Actually to be more specific we’re going to talk about uteruses (uteri??) because I think it’s really really important to stay informed about women’s sexual health. I don’t know about you but I had piss poor sex ed all through school so I had to take it upon myself to get/stay informed. One of the best ways to do this has been through the internet, and I have to say I’ve made a lot of my reproductive health decisions based on personal reviews of all the options. In fact, I spent hours reading blogs and forum posts about IUDs before I got mine put in so I figured I would add to the pool of (hopefully) useful information about what it’s like to get one shoved into your womb. If you’re anything like me, knowing the step-by-step of the procedure will take away a ton of your anxiety. If you’re in the other group of people and you don’t wanna know, well then click that little x now! Okie dokie?
In keeping with the theme of this blog, my decision to get an IUD was influenced by my weight. I FINALLY found a family doctor here in Vancouver and she is lovely and all, but refused to write me a prescription for my birth control because I’m overweight. Apparently in England (where she was trained) if your BMI is > 30, it means you shouldn’t be on birth control because of risk of stroke, blood clot, etc. The risk gets larger the older you are, if you smoke, or have been on birth control for a long time. I’m approaching the big 3-0, don’t smoke but love being around people who do because I like the smell, and have been on it for 16 damn years (before you do that math, I wasn’t a super hooker of a teenager… I just happen to have ovaries that suck and don’t do what they’re supposed to). So I let her refer me to an ob/gyn who suggested an IUD. I took the prescription for the Mirena, went home, asked all my friends if they’d ever had an IUD, heard all the horror stories, and promptly threw away the prescription. I figured I’d just go back to my doctor, tell her I’d researched the options, and wanted to stay on birth control. So I did that… and instead of bending to my will, she put her foot down and said she still refused and that I should go back to the ob/gyn for birth control if that’s what I wanted. Off I went to waste more of his time… but when he came into the room he was super patient and respectful and told me that he knew I had researched extensively and knew all the risks and if I wanted birth control he would write me a prescription for it, but an IUD is basically made for my situation and his opinion was that it was worth a shot first. His bedside manner sold me on the idea… sometimes a doctor treating you like you have a brain in your head goes a LONG way to making you more open to your options. So this time I took the prescription, booked my insertion appointment before I left the office, and went straight to get my Mirena from the drugstore.
I had previously called my health plan office to ask whether it would be covered. A lot of people in Canada can’t get their Mirena covered, but I was lucky enough to have all but $80 of it paid for by my plan. Ordinarily it’s about $400. If you’re thinking of doing this, I definitely recommend finding out what it will cost you. You’ll need to give the health insurance people the code for the Mirena, and FYI it’s J7302.
So I had my Mirena sitting on my kitchen table for 2 weeks while I awaited my appointment. I was told to book the day off work because some women experience cramping/bleeding/discomfort, so I did. I was also told to arrange a ride for myself because any meddling with your cervix can produce a vasovagal response which is a nice way of saying you get knocked the fuck out. So I spent the next 2 weeks obsessively worrying about who could drive me that day, but I suck at asking for help so of course I just prayed that my friends would somehow magically know that I needed them. I do have a guy I’ve been arguably seeing for a year and a half, but he wasn’t sure he could take the morning off work and was more than a little freaked out by the idea anyway. So I decided I would just drive myself.
If you have never had children, your doctor may give you something called misoprostol. There are two tablets that you’re supposed to stick up near your cervix about 8 hours before your insertion. This is actually an off-label use for this mediation, which is intended for something to do with ulcers. So be warned that this means it can cause some serious digestive shit (no pun intended). Vaginal insertion decreases the likelihood of this, however. Its main job in this scenario is to cause your uterus to contract so your cervix can soften and hopefully dilate a little. This means you will have cramps, and you might have bleeding. It also dehydrates you so you might get migraines. Some people report fever/chills, nausea, or diarrhea. Since I tend to react to medications in odd and hilarious ways I expected something bizarre. As it turns out I’m one of the extremely lucky ones and I had only very minor cramping with no other issues. The doctor later told me that most people hate misoprostol. From reading other blogs I gather that a lot of people refuse to use it before their insertion. I think it probably helped a lot with mine, so I recommend trying it. Take imodium pre-emptively (I did, and it worked beautifully).
The morning of my insertion I woke up and showered, and when I got out my ride was standing in my apartment. I had sent him a panicked text in the middle of the night because I was scared about driving myself and he decided to appear. Now that I have been through the whole experience I cannot stress enough that you should NOT drive yourself to/from your appointment. I never would have been able to do it. So, I’m glad he showed up.
On the way to the appointment I was so nervous – the kind of nervous you get as a kid when you’re on the way to the dentist. So I popped an Ativan. Again, I highly recommend this if you can get a prescription for it. Some studies out of a prison I used to work at are showing that Ativan use before traumatic events can actually inhibit the development of PTSD. I figured having something shoved into my uterus counted as a traumatic event.
Once at the office I was asked to pee in a cup. They’ll do this if you haven’t been having regular periods, to make sure you’re not pregnant. But I wasn’t, so they ushered me and homeboy into a room. I chose to make it awkward and said “is it okay if I bring him in with me?” because I knew he didn’t want to come see everything but I also knew he would never cause a scene and argue with me if another person was engaged in the conversation. BINGO! So he sat in a chair and I took off my pants and hopped (okay more like clumsily launched myself) onto the table and listened to him whine about how it was a bad idea for him to be there. “Shut up. When he comes in, get near my head and hold my hand and talk to me.”
My doctor came in and asked if I was ready. I replied with a great big NO. He asked if I knew about all the risks and I assured him I’d googled to my heart’s content. At this point, my partner in crime said “that’s her problem, she googles and then worries and googles some more” and then he and the doctor bonded about how nobody ever posts their positive stories online. That was the point where I decided that no matter what happened, I would post an honest account of my experience here.
The doctor started listing the potential issues, like uterine perforation, expulsion of the IUD, infection, and I already knew these risks so it was no biggie. They’re rare, and I’ll deal with them if they happen.
I’d already had the exam a few months back so the doctor could determine the position of my uterus by bimanual examination (that lovely experience where they basically squeeze you from inside and outside and you’re suddenly made aware that you’re about 200lbs too fat for this). Luckily that didn’t need to happen again and we could jump right into it, so to speak. For the first few moments it’s the same as a pap – speculum inserted and opened, and some antiseptic stuff is put on your cervix to lower the risk of infection from insertion. There’s something called a tenaculum which are like scissors with teeth, and they’re clamped to your cervix to give the doctor a way to move your uterus. It sounds gross but doesn’t feel like anything at all. So I’m thinking okay awesome, I can do this! Then I hear “you might feel a cramp now…” and the doctor inserted what’s called a sound, to measure your uterus. It needs to be at least 6cm to accommodate the Mirena. Well, his definition of “cramp” is likely different from mine, because I made some kind of weird squeaking noise and sorta jumped. It’s the strangest feeling… like some small woodland creature is biting its way out of your internal organs. It doesn’t last long (maybe 10 seconds at most) but it’s definitely intense. Sometime in those 10 seconds my guy grabbed my hand and started petting my head but I didn’t really notice that until it was over. Once the sound was removed the sharp pain was gone but there was a dull cramping sensation still, and I only got a few seconds to breathe before I heard “and now another cramp” and he put the Mirena in. That took maybe 20 seconds because they have to hold it there for a while to let the arms open (which is how it stays put in your uterus). Again, there was sharp pain but only about 80% as much as before. But then everything started to go black, and my ears started ringing, and I have fainted enough times to know what that means. A few moments later though, I opened my eyes and blinked a few times, and the feeling started to go away. I was aware that the doctor was saying something (apparently he was calmly telling me not to move because I was bleeding and he needed to apply pressure to my cervix), but I wasn’t really paying attention. He just sounded so calm about it all I figured it was fine. I think my endorphins had kicked in because I didn’t even realize the speculum was still there until he took it out. He told me that there had been bleeding in the cervix from the tenaculum but that it had lessened when he applied pressure, and if it didn’t stop in a few hours I should go to emergency. He gave me a card with my insertion date on it, told me to make an appointment in 4 weeks to check on the Mirena, and asked how I was feeling. I was still dizzy so he told me to take my time and stay lying down until I felt better. He left the room at that point, came back to check on me (I was still seeing stars), and assured me again that I could stay lying down until I was ready to stand up. Then he left again.
Homeboy informed me that he was awarding me 5 points for enduring such torture, and then kinda just stared at me and said “you were trying not to scream. You never think things hurt. That was weird.” I told him I had no idea how I was going to stand up, so he magically figured out how to make half of the table disappear and I got vertical. We went to the reception desk and booked the follow-up appointment, and the doctor came out to ask how I was feeling. Once in the car my now traumatized audience member said “there was actually a lot of blood. Like a lot. Like… lots. He kept pulling bloody pieces of gauze out of you.” I instantly had visions of a clown scarf being pulled out of my vagina. I didn’t have much bleeding at all afterwards though, and about an hour after I got home it stopped altogether. There was some pretty intense cramping on the ride home, and a lot of dizziness and sweating and nausea. I just felt really out of it, which is why I can’t stress enough that you shouldn’t drive home if you’re considering it. I tucked myself into bed and promptly slept for 3 hours. I woke up with a bit less cramping, and by 12 hours post-insertion I was feeling quite normal.
2 days post-insertion I am having a tiiiiiiny bit of spotting, and the occasional cramp here and there, but nothing to write home about (or write a blog about??). The doctor told me that bleeding can be quite heavy for the first 3 months, which is also when you’re at the highest risk for spontaneous expulsion of the Mirena (in other words, it falls out of you). He told me to reserve judgment until it’s been there for 4 months, so that’s what I’ll do. So far, though, I’m happy I did it. I’d rate the pain as a 9 out of 10. For reference, I have 8 tattoos including 2 on the tops of my feet, and have had most of an ovary and half a Fallopian tube surgically removed. The highest I ever rated my pain after surgery was a 7. So, it’s intense. But it’s also incredibly quick and in my opinion worth it. I feel like having someone there to squeeze my hand and stare into my teary eyes really helped, but it’s over so fast I could have probably done it alone too if I had to. Every blog I’ve read or friend I’ve talked to has said they would never want a guy in the insertion appointment with them because it takes the “romance” away, but my personal philosophy is that if you want to reap the benefits of a vagina, you damn well better be able to sit there and get over the “ick” factor. One writer said she wanted her husband to see her vagina as a place of fun, not pain. I get that, but there’s something to be said for requiring that men grow up and learn how to be there for us in the way we need them to be. After all, penises do some pretty disgusting shit too (and don’t get me started on balls…)
Moral of the story: don’t drive yourself, take imodium before your misoprostol, get someone to hold your hand, and realize that although it will hurt in a way you’ve never experienced, it will also be over really quickly too. Once it’s inserted you don’t feel it at all, and you can feel proud of yourself for making such a responsible long(ish)-term decision about your reproductive health. Use a back-up method of contraception for 7 days following insertion, and read the little info pamphlet that comes with the Mirena – it has contact info for reporting side effects.
I really wish that more people would blog about these things, because it takes some of the mystery away and I think it’s really empowering to be able to read about experiences and make decisions about your own body. Hopefully the days of it not being “proper” to discuss the female reproductive system in mixed company are now long gone because they don’t do us any good.
I’m glad I made the decision to try the Mirena. Even if it doesn’t work out for me, at least I can say I explored the options. I also think it’s REALLY important to have a great ob/gyn. My doctor’s bedside manner is just ridiculously soothing, and I really believe that he sympathizes with what women go through just to stay healthy and/or childless. His demeanor really helped keep me calm during/after the procedure. My doctor is Dr. Hasan Abdessamad and if you’re looking for an ob/gyn in the greater Vancouver area (his office is near Boundary), I HIGHLY recommend him. He’s also a pretty cool dude and his twitter/website are full of LGBT links and feminist resources (google him). Lastly, he doesn’t make me feel like I’m inconveniencing him by being overweight. I once had a female ob/gyn sigh audibly while performing a pap smear, and then state “these exams are a lot easier when you’re not incredibly overweight.” Well screw you too.
I promise this will be the only time I blog about my uterus and/or vagina. 🙂