Why Women Don't Get IUDsS

Slate's Kate Klonick wonders why more American women don't use IUDs. As the recipient of one of the devices as well, I sometimes wonder the same thing.

When Klonick felt done with the Pill for a variety of reasons, she, too, went shopping for something that would give her equal contraceptive control with as little hassle as possible.

That was my question when, after eight years and more than a dozen different incarnations of oral contraceptives, I decided to go back to the drawing board. I had never been good at taking the pill every day, and while my doctor suggested the patch and the ring, both were still under patent, making them more expensive than my monthly grocery bill. I needed something cheap, un-mess-up-able, and, ideally, hormone-free. So I did what any modern girl would do: I Googled. And thus began my research into the IUD and its mercurial history in the U.S. market.

Notably, her gynecologist didn't suggest an IUD — a relatively common experience for childless women our age. One reason is its association with infertility, stemming from a specific device no longer on the market and a lack of STD testing protocols prior to insertion."The major reason why women in the United States aren't using IUDs and doctors aren't recommending them is due to the erroneous belief that they're highly dangerous," says Dr. Katharine O'Connell, a gynecologist at Columbia University who specializes in contraception.

Many in my mother's generation remember the IUD's heyday, when the contraceptive was linked to the horrors of pelvic infection, hysterectomy, and possible death. That negative rap stems from a particular device known as the Dalkon Shield. Heavily marketed in the early 1970s, it was the most popular model in the United States until a number of deaths from septic miscarriages caused the manufacturer to halt sales.

A study at the time linked the shield and other IUDs to pelvic inflammatory disease, and lawsuits were promptly filed.

But, Klonick points out, research since (as well as the experience of women in other countries) has shown those beliefs to be invalid.

Eventually, stateside science caught up to the IUD witch hunt. In the early 1990s, a study in the Journal of Clinical Epidemiology challenged the validity of the research that had condemned the IUD. It's now generally understood that the problems in the 1970s were due largely to the Dalkon Shield's faulty design, which made users more susceptible to infection, as well as a lack of testing for sexually transmitted diseases before insertion, says O'Connell.

One thing Klonick doesn't mention — though it's important, as it comes up often at my gynecological exams — is that routine STD-testing, rigorous condom use (outside of a committed monogamous and STD-tested relationship) is still important for IUD users, as there is evidence that women with IUDs who contract (or have) particularly chlamydia are at increased risk for Pelvic Inflammatory Disease, which can cause infertility. This, too, is one reason that gynecologists often don't recommend IUDs for women outside of monogamous relationships.

On top of that, as with too many women's health issues, medical schools seemingly ignore teaching students about IUDs.

Many medical schools limit their classes on contraception to one lecture, says O'Connell, leaving insertion and removal of an IUD to be taught during rotation, if it's taught at all.

This lack of training can leave many doctors feeling uncomfortable recommending the once-controversial devices to their patients, which might explain why only 58 percent of family-planning clinics in the United States offer the IUD.

Some doctors are also not keen to recommend IUDs to patients who've never had children, in case they are unknowingly infertile and might later sue alleging their infertility is the fault of the doctor and the IUD.

Certain doctors who do know how to insert and remove an IUD still refuse to recommend it to childless patients because of the device's checkered history.I experienced this with the first two doctors I visited. Though recent scholarship shows that the risk of an IUD creating infertility is almost nonexistent, some doctors prefer to insert them in patients already known to be fertile-so the IUD (and the doctor) can't be blamed for any future infertility.

Although my gynecologist at the time I chose an IUD was both knowledgeable and willing to provide me with one (possibly due to her medical training outside of the United States), we actually drew up and notarized an agreement that if I did later turn out to be infertile, I wouldn't sue her — without it, she would not have agreed to do the procedure.

While Klonick may have had an easy insertion — she doesn't say — she brings up the discomfort only in passing.

Though the insertion hurt and her periods were heavier and more crampy for a few months afterward, she describes it as a "very small price to pay for the peace of mind, money, and time" she saves with the IUD.

While I agree with the sentiment that it was worth it, I would like to highlight something: having the IUD inserted was exceedingly unpleasant. If you are squeamish about your vagina or your cervix (you have to check for the presence of the string once a month), or you are a wimp about pain and discomfort or pain or discomfort in your genitals is triggering to you in some way, having an IUD put in might not be a good idea for you (despite it being good for Klonick, her friend and I).

The Best Birth Control [Slate]

Related: Appropriate Use of the Intrauterine Device [American Academy of Family Physicians]

Earlier: My IUD: How I Learned To Stop Pill-Popping & Love My Cramps

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