IUDs, or intra-uterine devices have seen a recent resurgence in popularity in recent years. If you're in need of pregnancy prevention, here's why you should consider getting one.
IUD pictures from Shutterstock
Don't be Discouraged by the History of IUDs
A lot of women are wary of IUD usage because the history of IUDs is a little creepy. The first IUD was made out of silkworm gut and was spread across the uterus and vagina. (Fun fact: another key figure in the creation of IUDs was Ernst Gräfenberg, who also discovered the G-spot.) It didn't get much better from there. The Dalkon Shield was one of the first widely-used IUDs, but it led to a huge number of bacterial infections, internal injuries and subsequent lawsuits. Google what the Dalkon Shield looked like, and tell me if you'd want that thing implanted in your body. Not only did it have horrible side-effects and a scary name, but it also looks ridiculously creepy!
The first copper IUD was created in the '60s. This was also when the "T" shape we recognise today came into use. Hormonal IUDs came along shortly afterwards. Unfortunately, some of these more "advanced" models were no better than earlier ones. There were a number of cases where IUDs were found to have dislodged from their implantation site and ended up piercing the uteruses of their users. This new round of IUD-related lawsuits created even more fear about the devices.
So yeah, the IUD doesn't have the greatest history. To be fair, most medical inventions don't! Just look into the history of the hypodermic needle, or what dental tools used to look like. But the technology has improved, and today's IUDs are now considered incredibly safe. Only about one in 1000 women will experience even minor problems with their IUD.
Your IUD Options: Hormones or No Hormones
If you go to the doctor today, you'll have two basic types of IUD to choose from: non-hormonal and hormonal. Both versions are T-shaped, and less than two inches long. Both get implanted directly into the uterus in a procedure that takes about 20 minutes. Today's IUDs are also extremely effective at preventing pregnancy. Planned Parenthood reports that they're over 99% effective, making them the most effective form of birth control.
The non-hormonal version is made out of copper. It is effective immediately, and can remain implanted for up to 12 years. It's an older model of the IUD, but a great option for women who don't want a side of hormones with their birth control.
The hormonal versions, as the name implies, contain the hormone progestin, which prevents conception by thickening the cervical mucus. The hormones slowly get released into the body over the course of several years. It's a smaller dose than you would get from taking a standard birth control pill. The hormonal IUD is sometimes referred to as the Mirena and can stay implanted for five years. It requires a week of wait time until it's effective and was created to address some of the side effects of the non-hormonal IUD: cramps and heavier menstrual bleeding. Of course, you may have to deal with the side effects of the hormones instead (mood changes, weight gain, acne, headaches, and so many other fun possibilities).
Picking the Right IUD for You
The decision to choose a hormonal or non-hormonal IUD is highly personal, so we can't give a universal recommendation. If you go with the copper version, you can have the peace of mind of knowing there aren't any hormones messing with your sex drive, mood, weight, or general well-being. If you choose the Mirena, you can have shorter or lighter periods, or no period at all. If you don't like the way your body is responding to your IUD, you can always have it taken out, or switch to a different model.
Once you've decided which IUD you prefer, you should be willing to advocate for your decision. I've heard stories of doctors who pushed their patients to choose the hormonal version (the cynic in me guesses it's because the Mirena has better marketing departments than the old-school copper version), but you may feel strongly about not wanting hormones in your body.
What to Expect When You Get Your IUD
Once you've made your decision, you'll need to make an appointment with your doctor to have it implanted. Don't worry, it's an outpatient procedure, and only takes about 20 minutes. During your appointment, your doctor will perform a physical examination to ensure that an IUD can be safely implanted in your body. You'll have to lay back with your legs up in stirrups and a speculum spreading your vaginal canal, just like in a typical OB/GYN examination. The IUD is loaded into a long, thin implantation device. If you've ever used a vaginal suppository for a yeast infection, you may have used a somewhat similar-looking tool. The doctor will insert the device into your vaginal canal, then push a little trigger to release the IUD and open up its arms.
Let's get real about the pain aspect, because it's the thing that makes a lot of women hesitate about getting an IUD. Some women describe the implantation process as feeling a little uncomfortable, but mostly painless. It may feel no worse than a standard pap smear. On the other hand, about five per cent of women feel severe cramping during implantation. Unfortunately, there's no way to know the level of pain you'll experience during your implantation. Try not to freak yourself out about it beforehand, because the odds are it won't be that bad. To be on the safe side, arrange for someone to drive you home, and spend the rest of the day in bed with an ice pack. Taking a couple of Advil before your appointment will also help with any potential discomfort.
You may experience some mild cramping in the days after implantation. If you got the non-hormonal IUD, your periods for the next three to six months may be heavier, and may be accompanied by more cramping. These changes will eventually ease up. It's best to avoid penetration when you're hurting, but masturbation can relieve some of the pain! If you got the hormonal IUD, you may experience way less cramping, and your periods may lighten or shorten up significantly or even disappear.
Your doctor will have a record of when your IUD was implanted, but it's a good idea to put it on your calendar or write it down someplace safe. You will eventually have to remember when to remove and/or replace your IUD. Whenever you're ready to have it taken out, you'll need to go back to the doctor (don't ever try to remove it on your own!). IUDs have nylon threads attached to the end. The doctor will pull your IUD out using these threads. Most women say that removal is less painful than implantation, but you may want to plan for another day of rest.
What Sex Is Like with an IUD
Remember those threads we were just talking about? Unfortunately, they can come into contact with your partner's penis during intercourse (I'm making the assumption that you're at least occasionally having P-in-V intercourse since you're in need of birth control). These strings may feel a bit stiff for the first few months. They will soften up over time (and with more sex!), but until they do, getting poked by them can be a bit jarring, especially if you're not expecting it. This doesn't happen for every couple, it's common enough to mention.
I think it's good to give your partner a heads-up ("hey, so apparently you may be able to feel the strings from my IUD during sex"), but too much talk might freak him out unnecessarily. If you're worried about it, try finding the strings with your fingers and getting a sense of what they feel like.
It's extremely important to remember that IUDs don't protect against STIs, so you may still need to use condoms if there's a risk of contracting something from your partner.
Despite some of the drawbacks, IUDs are an excellent option for a lot of women. IUDs last for a long time, and require hardly any effort on your part. The up-front cost can be high if you don't have insurance, but it can end up being much cheaper than birth control pills over the long-term. They're the most effective method of birth control that's currently available -- even more effective than sterilization! IUDs also don't affect your fertility; you can get pregnant immediately after removing your IUD.
Vanessa Marin is a sex therapist and licensed psychotherapist based in San Francisco.