Lions and tigers and tenaculums, oh my!

The IUD, I’m beginning to learn, is a much maligned form of contraception. It got a terrible reputation in the US because of all of the furor surrounding the Dalkon Shield in the 1970s, however, the two modern versions of the IUD (ParaGaurd, aka The Copper-T, and Mirena, aka The Hormonal One) are actually safe, effective, more or less painless, and for many women, an ideal form of birth control. In fact, IUDs are one of the most popular forms of birth control in other countries—in most of Europe, actually.

Which is all well and good. In fact, great! Go IUDs. I will happily recommend them to all of my clients who want a no-fuss, highly effective, low cost (expensive at the outset, but cheap given that they last 5-10 years), low side-effect contracetive choice—especially my clients who have already been pregnant once. Nevertheless, tenaculums give me the heebies. The teeth of these gruesome little things are actually inserted into the tender flesh of the unsuspecting cervix, and then the instrument is gradually secured, one click at a time, followed by gentle traction in order to straighten out the axis of the uterus so that the IUD can be properly placed (and we spent most of the afternoon practicing this skill on models). And while I am well aware of the fact that supposedly the cervix has very few nerve endings, and antiseptic washes followed by anesthetic gels are applied before the tenaculum, and the entire procedure is done slowly and gently, one step at a time…even so: my initial reaction was a full-body grimace, and the mental thought of OUCH. Ouch ouch ouch. Poor cervix!

However, don’t let this bias you against IUDs! Insertion is not without its discomforts (usually cramping for the first few hours, which can be managed by a trusty dose of advil or motrin), but luckily, as a consumer of IUDs, you never have to watch the actual insertion process. As a student midwife, watching will probably be the least of it—actually using a tenaculum?? It makes my hair cringe just thinking about it (and the professors had the cheek to say, with eager, chipper voices “Hopefully you’ll get several opportunities to insert IUDs during your upcoming clinicals!”.) Yeah.

I. Can’t. Wait.

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9 Comments

  1. Posted January 25, 2006 at 10:18 pm | Permalink

    Oh my. Oh wow. I didn’t realize they were inserted into the cervix. And they have teeth, hmm. The concept sounds lovely but the actual insertion does sound painful, it’s kinda making me squirm just thinking about it!

  2. The Student
    Posted January 26, 2006 at 9:15 pm | Permalink

    It’s inserted through the cervix into the uterus, where it lives for the next 5-10 years. And yeah, I’m prolly just adding to the bad press on IUDs with this post. Here’s my disclaimer as a future primary care provider: IUDs are a fantastic contraceptive option, and while the insertion process might be *uncomfortable*, it’s probably not excruciating–especially not to a woman who’s already given birth! However, this post was written from the point of view of a student midwife, in which case, tenaculums intimidate me!! Aiiieee! I’ll let you know what I think after I’ve actually had to use one. Maybe my entire perspective will change. :-/

  3. heatherw
    Posted January 27, 2006 at 8:58 pm | Permalink

    Poor cervix? Tenaculum? Baby’s head? I’ve had both in my cervix in recent months, and… well… I’m not afraid of that tenaculum. Little teeth cannot compare to an entire cranium. Really, it was just a little pinch, no worse than any other gynecology procedure.

    (Yes, I did see the tenaculum before it was used because I rifled through all the equipment when they left me to take my pants off. I should stop that. I was a bit more turned off by the long bent stick.)

    What the IUD needs is a new image. Perhaps it should be called Petunia-Gard and have some commercial with hippie chicks in it. I got one anyway, but when I think “IUD”, I think “cramping and heavy bleeding”, and the image that comes to mind is Tim Roth in Reservoir Dogs.

    One thing to keep in mind for when you are a primary care provider – the manufacturer insists that they be inserted during a menstrual period. Consider that many of your clients will breastfeed, and therefore, won’t get their period for about six months. But as it is nonhormonal, the copper IUD is a great method for the breastfeeding mom. My OB/Gyn happily put mine in 9 weeks postpartum, but he also knew I was breastfeeding. He knew how *well* I breastfed, because I still had milk from my first child when I came in pregnant with my second. What would your criteria be?

  4. The Student
    Posted January 28, 2006 at 8:59 am | Permalink

    That sounds about right to me: the only reason they recommend insertion at the end of the menstrual cycle is that then you’re 100% certain that you’re not pregnant before insertion. With breastfeeding moms who aren’t necessarily doing on-demand feedings and haven’t had their first period yet, it’s hard to know with certainty that they’re absolutely not pregnant (although I guess a pregnancy test before insertion might do the trick, or maybe an ovulation preditor test). Anyway, I think my criteria would be similar: if I know my client well, and know that she is actually doing true on-demand feeding, and is still amenorrheic, I’d prolly go ahead and insert the IUD–but now that you’ve raised this point, I want to go check out the literature and find out what the official recommendation is for breastfeeding moms…if there even is one. (You wouldn’t believe how many drugs and medical devices never even bother to take breasfeeding women into account…or maybe you would).

    That scary bent metal thing is the uterine sound, which is what you use to measure the depth of the uterus so you know how far in to place the IUD. And it’s a bit intimidating, too. Our professors told us that you’re more likely to perforate the uterus with the sound than with the IUD itself, which is why they recommended just holding the sound up to the cervical opening and gently gliding it in, without using *any* force or pressure at all, and helping the woman use deep breathing and visualization techniques to relax her cervix and help guide the sound in. It sounds like slow and gentle is the key to the entire thing.

    Anyway, I’m glad the IUD is working so well for you! Tell all your friends, so that some more good IUD press can get out there and begin to combat all the heresay. And yeah, it definitely needs a new image…and a new name. Maybe we should just start saying Mirena and copper-T all the time, because at least those names sound a little bit less freaky than IUD, which sounds like a some weird, futuristic alien probe.

  5. heatherw
    Posted January 30, 2006 at 11:14 am | Permalink

    Well, honestly, I’m not so happy with it. It really was like a Quentin Tarantino movie for a little while, and I told all my friends that if I had sex, the Wolf was going to have to buy me a new bedroom set. The damn thing has ruined all my panties. Sexy, sexy. Not a good image.

    By the way, ParaGard is advertised on Baby Center. The ad is something like, “Sick of your birth control”? Because that is the best that they can come up with. Might I suggest, “Because I never want to change diapers again!” or “I’d rather die than have to drive a mini van.” Or, “Yes, we’ve been married ten years and we still have sex every once in a while.”

    Indeed, I am aware of how frustrating it is to have to consider medication when breastfeeding. I asked my OB/Gyn to recommend a breastfeeding-friendly primary care practitioner, because I had such difficulty with that after I had my first child. He laughed and said, “Move to California!” Fortunately, my local Walgreen’s pharmacist ALWAYS remembered, and was extremely helpful. He would tell me before I actually filled the scrip that I couldn’t take it.

  6. Posted February 16, 2006 at 12:33 pm | Permalink

    Heather–Can I ask how heavy your bleeding was before the IUD? I’ve heard of heavy bleeding as a common side effect, but I don’t know how it correlates to how heavy ones periods were beforehand.

  7. The Student
    Posted February 16, 2006 at 2:01 pm | Permalink

    Miriam: I’m not sure about the correlation between how heavy your period was beforehand and what it’s like afterwards (maybe Heather can give us more information on that), but I do know that if you use the hormonal IUD (Mirena), your period generally becomes much much lighter over time, and often disappears completely after about 6 months. At least, so sayeth all my books, and the information we were taught regarding IUDs (the Copper T is the one that may make your period heavier).

  8. heatherw
    Posted February 18, 2006 at 2:47 pm | Permalink

    Miriam-Joyce

    Just checking back in on this. My bleeding was not heavy before I got the IUD. When I was nursing my first child, I could go with pantyliners for all but the first day of my period. However, I bled pretty heavily for about 5 weeks postpartum after my second child, and the IUD was inserted 9 weeks postpartum. I have yet to get a menstrual period, as my exclusively breastfed baby is only 15 weeks old. Supposedly, exclusive breastfeeding is supposed to minimize bleeding in general, but that has not been the case with my second baby.

    But as an update, it has calmed down considerably. It was inserted on Dec 30. I am almost ready to go out and buy new panties. I have lost nearly all the baby weight, so I’m due for a clothes-shopping spree anyhow.

    I did not choose Mirena because, although they claim it doesn’t interfere with breastfeeding, I don’t entirely believe them. I have a couple of challenges with hormonal birth control, as well. The first time I tried it, I got on the lowest dose available at the time and ended up at the psychiatrist with depression. (Magically, it disappeared two weeks after stopping the pill). Also, I weigh around 100lb, so with medications in general, I tend to need a kiddie dose. Thirdly, I work full-time and pump. So I don’t need any more challenges to my milk supply. My OB/GYN agreed wholeheartedly with me.

    HeatherW

  9. louralann
    Posted October 22, 2009 at 7:42 pm | Permalink

    Just wanted to add in my two cents on the IUD.

    I have had very painful long heavy and irregular periods since I was around 12, so for about 15 years I have had a monthly “bane of my existence please kill me now I need drugs!!!”. There would be months where I would bleed for 2-4 weeks straight and then go for 3-7 months without anything. I tried about 7 different kinds of birth control pills to try and even it out but it just got worse. For some reason oral contraception really disagreed with me.

    I moved and got a new doctor the end of 2008 who specialized in Female health. At my first appt I described to her the problems I’ve had and that I was at the end of my rope. She suggested that the Mirena IUD might be a good solution and while I was wary of something being stuck into my uterus (the word perforate is not a friendly word) I decided to give it a go.

    I am not married, I have not had children nor do I have a steady partner who I may be interested in having children with anytime soon, so a 5 year birth control I wouldn’t have to remember to take every morning or get injected with every 3 months appealed to me.

    We set up an insertion appt and she gave me a prescription to get the IUD from the parmacist.

    On my way home after the appt I called my sis to tell her what was up, as she has alot of problems as well. She has 4 children and is done but the pill has failed for her…on numerous occasions :P I thought she might be interested. Well, I was totally wrong. She flipped and regaled me with horror stories of IUD’s gone wrong.

    I went to my IUD appt on Jan 12th/09 and before my doctor started I asked if I could go over some concerns first. She was fantastic and allayed all my fears.

    I then got ready and on the table (horrible things, doctor tables..nothing like being laid open and exposed, but Doc is great at keeping me calm). I had taken 3 advil beforehand as I was warned it could be a little painful, especially since I have not had kids.

    Also because my period is so irregular and we were not sure when the next one would occur she decided it’d be best to just go ahead and not try to wait for one. Even if I was not bleeding monthly I was still getting debilitating cramps and she thought the IUD might help with those at least.

    The insertion was not the most comfortable thing I’ve ever dealt with. I was gripping the sides of the table pretty hard but it was over really fast. The worst part was when it was pushed through my cervix into the uterus. After it was in I didn’t feel anything. And all in all…it’s probably less painful than birth lol

    She trimmed the strings up and we made a follow up appt for 5 days later to check how I felt and if the strings had softened up.

    I went home, took another 3 advil (I have an extremely high tolerance to pain meds…nothing seems to really even take the pain away and I don’t take them very often but I wanted at least the edge off). I put a warm pack on my stomach and laid down.

    I was crampy for the rest of the day but by the next day I was fine. At my follow up on the friday, the 16th, I asked her to trim the strings a bit more if possible as the internal feeling was weird with them brushing against the walls. She trimmed them to just below my cervix.

    I’ve had the IUD for 10 months and I adore it! I have had one episode of spotting about 3 months after and that lasted a week. All I used were liners.

    Nor have I have anywhere near the severity of cramps as before. In fact I’ve maybe had only a total of 3 episodes where I had to take pills….in 10 months! I used to have to dose myself up daily, for an average of a week and a half a month!!! And since the amount of pills I have to take are obscene to even take the edge off…well now that I don’t have to take those anymore, I feel so much better too.

    I have not gained any weight either, which was a big issue on the birth control pills, so I’m just trying to get the weight off now.

    I know every woman is different, hormones etc. So for some the Mirena IUD may not be a good choice, maybe the copper would be better or pills or Depo.

    But for me it’s been a god send and the only time I will have it out is if I’m trying to have a baby…and then I’ll have one put in as soon as I can afterward.

    So that’s my opinion and experience. Good luck with your contraception :)

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