My only real problem with the IUD (or IUS as the Europeans call it) thus far has been the letters. “I got a UTI!” I tell people. Wait. I got a USB! A DUI! An STD!* Christ. No. Come back!

It’s something way better: a small hormone-releasing plastic T in my uterus that just hangs out for up to five years being the most effective type of birth control there is (on par with sterilization), at 1/7th of the hormone levels of typical birth control pills, without me having to pay for, get an authorized refill on, insert, or swallow anything on a monthly or daily basis! Hooray!

So pictured, above, is what my insides look like now, or what they would look like, if my uterus took up the majority of my torso and my ovaries were like fingerling potatoes**.

* All of these examples taken from real conversations.

** This is actually a misconception I had about my reproductive system until pretty recently, when I got the IUD put in. Here is the actual size of the IUD. “Whaaaaaat!” I said. Right?

Frequently Asked Questions:

1.) Did it hurt?
Because I am of that particular temperament, I read every single testimony I could find online about women’s experiences getting an IUD. Obviously all of these anecdotes terrified me. Many of them read like this:

It felt like my internal organs were being wrung out like a soggy towel — just twist as far as it will go, and then farther. I screamed in pain.

And it went on and on and on. I know there is no such thing as measuring time in a situation like this, and I kind of wish I had looked at my watch so I could know how long it really was. But I’m pretty sure that it was longer than a few minutes. Longer than the time to set everything up. And I continued to scream.

One woman described fainting and then barfing all over her doctor, which is maybe my second biggest fear (first: pooping all over my doctor). A lot of women reported passing out and/or feeling extreme pain for days. One woman pulled it out by the strings herself (not recommended). Women who’d gotten the IUD put in, then taken out, then gotten pregnant, then given birth, said that the pain of getting that IUD put in the first time was equivalent to the pain of childbirth. Ah!

I got mine put in twice within the span of about ten minutes. I expelled it at first. The doctor pulled my cervix back open again with the things that looked like medical-grade salad tongs, and reinserted it.

“How you doing up there?” she asked.

“Is this as bad as it gets?” I replied. “I was at work yesterday feeling this way.”

Granted, I was at work really wishing I was home. I was at work struggling to concentrate and looking at customers a little bug-eyed. But I had not, in fact, been screaming at work.

2.) Does it hurt now? Can you feel it at all? Can he?
It’s been about two months since I got the IUD put in. For the first month I was taking six to eight ibuprofen every day for the cramping, and only then feeling kind of okay about things. Rough-ish month. But now I can’t feel it at all. Tiny plastic thingy? Inside me? Whatevs!

I expressed a concern about my partner “getting poked” to my doctor before getting it put in. I’d heard from friends experiencing this with their partners. And, it turns out, this is a thing. It’s not the IUD which is actually poking (as that’s located above the closed cervix, and within the uterus), but the strings, which have a little bit of stiffness to them and tend to shift around; so sometimes they’re in the way and sometimes they aren’t. My boyfriend says he is occasionally aware of the strings that come down and that he sometimes feels poked, but it’s not, he says, in a painful or injurious way. (“The pokeyness would be the equivalent of, say, a single stubbly hair.”) So that’s okay I guess.

3.) Why didn’t Planned Parenthood recommend one for me if they’re so great?
IUDs got a bad rap in the United States in the 70s, when the Dalkon Shield uh, gave some pelvic infections and killed some people. Everyone panicked, lawsuits were filed, it was taken off the market. Forty years later, even with the new safe models, there’s a paranoia that remains here. My doctor said, “I . . . can’t remember the last time I put in an IUD.”

They’re not recommended to you if you’re not in a mutually faithful relationship. If you get exposed to an STD with an IUD, it has immediate access to your uterus, fallopian tubes, and ovaries, all through those little strings hanging down from your cervix: that can mean a lot of serious problems including infertility.

So doctors still don’t tend to recommend them to unmarried women, since that remains the standard of “monogamous relationship,” but — “relationships have changed a lot in the last twenty years,” my doctor told me, “people make monogamous partnerships but don’t get married right away, or sometimes at all. So now we’re starting to say it’s okay if you’re not married, to get an IUD.”

They’re also not generally recommended, in the U.S., to women who haven’t had at least one baby yet: as insertion is much more comfortable after childbirth, and there’s an extremely low risk of uterine perforation or of Pelvic Infection Disease, both of which, if not caught in time, can mean infertility.

But meanwhile, in other countries: “The [copper] IUD is the world’s most widely used method of reversible birth control, currently used by nearly 160 million women … Usage in many countries has been measured by surveys of married women of reproductive age. In this population in the 1990s, IUD use ranged from 1.5% in North America, to 18% in Scandinavia, 33% in Russia and China, and 40% in Kazakhstan. Use in China increased to 45% of married women by 2002.” (Emphasis mine.) Here’s a neat chart showing percentages of contraceptive users in different countries using the IUD from 2006 (Norway went up to nearly 1/3).

4.) Hormonal? Copper? How did you decide?
The complete lack of hormones was attractive to me with the copper IUD, but ultimately, I opted for the hormonal Mirena. (But for the other perspective, here’s a pretty great blog post I read about one woman’s ultimately positive experience with the copper IUD.) The thing is, copper IUDs can increase your bleeding by up to 50% and make cramping worse, and as a woman who naturally has 8 to 10 day long periods with intense cramping, increasing or even doubling that intensity didn’t seem like a good choice for me.

Meanwhile, the hormone level of the Mirena is very small compared to other hormonal birth control options. It also reduces the intensity of most women’s periods, and 20% of women have them stop altogether. Now on month two, my period was 3 days long, light, with no cramps. Un-freakin-precedented.

I would rather my period didn’t stop completely, since I find it’s a pretty handy way to tell that I’m not pregnant. If it eventually does, I’ll likely resort to buying pregnancy tests in bulk and just check in once a month: pregnancies are rare with the IUD, but when they do happen, they can be ectopic. (Although your risk for ectopic pregnancy is still significantly lower with the IUD than with no contraception.)

5.) Why? . . . Also, why are you telling me all of this.
Primarily, I got interested in learning more about the IUD for the same reason I got interested in reusable menstrual products: I was sick of feeling like I was paying a monthly fee for being female. The Nuvaring, which still hasn’t gone generic, was running me thirty dollars a month with insurance. 360/year. Not a huge deal, but that’s a roundtrip flight to somewhere interesting, probably.

And this seemed worth it to me when I was living in the same time zone as my romantic partner, but given that for the past year we’ve been seeing each other about once every two months, it felt a little ridiculous. And I knew I wasn’t going to be ready for kids for at least another two years.

In the end, the IUD was covered by my insurance as a normal doctor visit, so I paid twenty bucks for five years of birth control.

Also, I’ll be honest. I wanted to try it because I wanted to write about it. I wanted to write about it because I couldn’t find too much information on it. And after my drawn-out experience with Vulvodynia, I have stopped trusting doctors as all-seeing sages who will just steer me the right way in all things.

The hormones in birth control pills and the ring can cause life-threatening blood clots, depression, libido problems, heart attack, high blood pressure, maybe possibly cancer risks. Not to mention the environmental bummer of throwing all that extra estrogen around.

The implant and shot are also infamous for causing depression and decreased sex drive.

I’m no more against the old-fashioned condom than the average bear, and I never tried diaphragms, the sponge (ha! Do people still use those?), or the rhythm method, but all of their efficacy rates leave something to be desired.

The bottom line for me was: the more I read about the IUD, the more it seemed like it wasn’t being actively recommended or sometimes even mentioned to me for reasons based upon incorrect assumptions about my lifestyle and desires, and that its cumulative risks were actually far lower than my other options.

It’s not the perfect solution for everyone or maybe, I’ll conclude later, me: a little invasive, a tad limiting in the contexts in which it can be used, and a few rare but major concerns. Right now I’m feeling pretty excited about it. My IUD isn’t causing me any problems, may be on the road to making my daily life easier, and I don’t need to think about birth control again for a while unless I want to change something. Thumbs up.

It’s still ridiculous that the male birth control pill is in a perpetual state of “to be released in the next five years,” because we don’t think men will want it, because we’re worried about what men will think of the side effects, because we don’t think women will trust their partners to take it. Annoying sexism/generalizations aside: what do we ever gain by limiting choices?

The wider our array of options, and the more thorough our education about those options, the more likely we are to find a feasible contraception that fits within our individual lives. Something that allows us to fully express a major side of ourselves as human beings, to be uninhibited and close with the people we want to be uninhibited and close to.

One less thing to fear in our relationships; wouldn’t that be kind of great?

So much of reproductive education involves withholding information and options, all out of our alleged best interest. I look forward to a future that trusts us to know what that is. And I think we’re moving there; just hesitantly, inch by miserly inch, through the decades. Until then, I guess we just get to keep asking, and reading, and talking. And occasionally just trying, to see. Here’s hoping.