Tuesday, 18 August 2009

Gyno frusteration

Today I went to the gyno. It wasn’t that kind of a visit, thankfully (women, you can uncross your sympathetic legs). Today I went to the gyno to convince her to give me an IUD.

I am one of the most informed 18 year old girls you (as a gyno) could get. I have sexuality and sexual health education training and I work at an organisation where I learn about women’s health. I know a lot about all this stuff. This is to say, when I express concerns about some of the more traditional forms of contraception, it does not come from ignorance or hearsay. I can speak doctor speak, to an extent. I’m not fluent and sometimes I mix up tenses or whatever, but that comes from a divide between me and them.

That divide I find can be hard for doctors. As I recently said to my mother during an episode of ER “No wonder they get a complex; with internship and residency, doctors only see other doctors for years!”. I hesitate to make an sweeping generalizations, but I can see how the kind of environment of learning that doctors participate in could breed a very tight team mentality. This doesn’t mean they’re not good doctors. It just means sometimes, when you are not a doctor, you have to be firm about what you want.

Here’s what I mean. When I said IUD, my doctor pursed her lips.

“If you want me to put one in, I will do it. But I’m not sure I’d recommend it.”

She then went on a bender detailing the various scary side-effects possibly associated with said form of birth control. That’s ok; it’s her job to tell me about the risks. She went to medical school and I have not. But after a few minutes of listening to “possibility of constant pain” and “There’s concern about the tubes” and feeling the blood drain from my face, I was about to throw myself at her, sobbing “give me the pill! I’m sure I’ll be better at taking it this time and I won’t get any side-effects!” It was enough to make me seriously rethink leaving my mother in the waiting room.

I am an expert on me, and I had to pull myself together to say NO, new memory tools like stickers would not help with the pill, and NO I do NOT want to stick a patch on my ass for weeks at a time and I really don't want the side effects that hormonal method give me. Thanks anyway. Is an IUD really so bad? I know people who have them, and it’s A-OK. Also, what other choice do I have?

She seemed to think that was ok and was done discussing and went a made me up an appointment and a prescription. I was still barely breathing. I was worried about the infertility I would apparently be faced with if I went ahead with this. When she returned I stammered something about how likely it was that my “tubes” would be “compromised”.

She sighed and backed down a bit, once I’d made my choice. The main concerns, she explained to me, are Chlamydia and Gonorrhea climbing up the IUD and to my tubes. If I use condoms, and don’t have too many partners, I should be fine. I breathed a big sigh of relief and walked away on my shaking legs. Minutes later I’ll realize C&G can cause infertility all on their own, it's not all the IUD's fault. And I calmed down more.

I think I have made the right decision for me. I just wish I didn’t feel like I’ve opted to walk a tightrope unassisted when a sturdy bridge is available. Also, sidenote, if IUD is not so medically accepted, why are there not other non-hormonal options available for young women? Why must we pump ourselves full of hormones that may not mess up our tubes but can have other, potentially awful, side effects?

Leaving the doctor, my mother suggested I try celibacy.

Tomorrow will hopefully be better -- I'm heading to see Stella/Andrea at Irene's. A last show before I hit the road back east. I leave one week today.


J. said...

One thing about an IUD that was downplayed when I got mine (funny, they didn't try to talk me out of it, perhaps because I'm older than you!) is how insanely painful it is to get it put in. Make sure they give you the drugs to relax your cervix first because I had those and even with those it was the most painful thing I've ever experienced. I'm not trying to scare you, because they are a good form of birth control and I don't mind mine, but holy crap, it hurt a lot to get it in. If you have access to any mega painkillers (perhaps leftover from your wisdom teeth?) take those first. I really mean it.


Milan said...

The IUD seems like a good option for women who have trouble with hormonal birth control approaches.

I think one reason why doctors in North America are so hesitant to prescribe it is simply because it is relatively uncommon. If they prescribe the pill and there's a problem, they can protect themselves by saying it's standard practice. If they do something different, they might be more open to allegations of malpractice.

Milan said...

Slate had a story about IUDs, explaining another reason why some doctors are wary.

Stella said...

One of my best friends got an IUD. Not a great time getting the thing in, but now? CONSTANT WORRY-FREE SEX WITH HER PARTNER.

I say go for it, and enjoy.

See you tonight!

Emily said...

Good for you for sticking to your gynecological guns.

When I asked for an IUD my doctor looked at me quizzically for a moment, and then told me to explore other options. She then piled up boxes in my hands containing cervical rings, pills, diaphragms, and shooed me out the door.

I'm also dismal at taking the pill, and end up razing small cities when my hormones are played with.

I will probably end up getting an IUD just to make life simpler, but I think I will have to beat my doctor in an arm-wrestle or something first.

Milan said...

This may be of interest:

Title: Interventions for pain with intrauterine device insertion

Publisher: John Wiley and Sons, Ltd. for The Cochrane Collaboration

Description: Fear of pain during intrauterine device (IUD) insertion is one reason women may not want to use this highly effective birth control method. Different ways of reducing pain during IUD insertion have been explored.

Date: Feb 2009

Milan said...
This comment has been removed by the author.
Milan said...

Cochrane systematic reviews of IUD trials: lessons learned
Contraception, Volume 75, Issue 6, Supplement 1, June 2007, Pages S55-S59

Background: Intrauterine devices (IUDs) are the most widely used reversible contraceptives in the world today, and decisions about their use should reflect the best available evidence.

Study Design: We performed a computer search of the Cochrane Library for all IUD-related reviews.

Results: Eleven reviews related to IUDs have been registered in The Cochrane Library; 10 have been completed, and one is in progress. Topics include type of IUD, timing of insertion, clinical management, emergency contraception and use as gynecological treatment. The copper T380A is the most effective copper IUD; the levonorgestrel intrauterine system has efficacy comparable to that of IUDs with >250 mm2 of copper. The frameless device may be comparable in efficacy to the copper T380A, although whether problems with the initial inserter are resolved is unclear. Immediate postpartum and postabortal insertion appears safe and effective, although trials comparing immediate to delayed insertions are scarce. Prophylactic antibiotics at the time of insertion appear unwarranted except in populations with a high prevalence of sexually transmitted diseases. Many nonsteroidal anti-inflammatory drugs reduce pain and bleeding associated with IUDs, although prophylactic use of ibuprofen does not improve continuation rates. The levonorgestrel system is superior to oral progestins in treating heavy uterine bleeding. This IUD compares favorably with endometrial ablation techniques and presents an alternative to hysterectomy for many women.

Discussion: Trials are needed to evaluate immediate vs. delayed insertion after delivery or abortion and to explore emerging therapeutic uses of the levonorgestrel system, such as treatment of endometrial hyperplasia.

La Canadienne said...

J: I have heard about the pain and I'm not looking forward to it. My mom said she'd hold my hand though, which I will definitely appreciate. Moms are helpful that way.

Milan: Thanks for the articles! I wish they had a more definitive painkiller recommendation.

Stella: Sounds good to me!

Emily: I guess everything has its risks and you just have to know what you want. According to some of the reading Milan sent my way, IUDs are more common outside North America.

zoom said...

Woman have been asking themselves for decades why our birth control options are so dismal. It seems there ought, by now, to be a convenient, painless, risk-free, sex-positive way to keep sperm away from eggs.

Nat said...

Sorry late on this one.

I think a lot of the issue with the IUD was the high rate of infection associated with them back in the 70s because of a device called the Dalcon Shield which caused, well, death.

I can't take hormone based birth control. Side effects. High Blood Presure and yes, age. I really didn't want an IUD either, but there were no other options... either for him or me.

My doctor suggested an IUD, but would rather we be relatively sure that we weren't having kids again soon. Because you have to take it out too... The Man decided to get a vasectomy. Made it easy.

La Canadienne said...

zoom: It's things like this that make me wonder why many of my friends say feminism is useless now. Like, do they live in the real world?

Nat: I am definitely sure I will not want kids in the next 5 years, so I will leave it as long as it wants to hang out there. I had a friend who had it fall out though, which is kinda strange.