On Monday evening at about 5:20 I was wearing a cream-colored sweater and nothing else, lying back on a medical table with my feet in stirrups, breathing like my 80-pound dog when she's having a stress dream. Between my legs was a young and pretty OB/GYN with a short blonde ponytail and an air of capable kindness. She called me "dear" repeatedly and explained every step of what she was doing—this is the speculum, this is the numbing agent, this is the antiseptic, now you're going to feel a device that straightens out your cervix, now I'm measuring your uterus.
Everything was as chill as could be, but the opposite. It is an unnatural state just to be Donald Ducking in a winter sweater, let alone doing it under fluorescent light while a nice woman aims a foot-long applicator straight at your cervix, a body part you'd previously thought of as a sort of Doomsday Gate, set to open only in states of emergency. What was happening was painful; I felt pushed out from the inside. "Now I'm putting the IUD in," she said, and I breathed, dog-like, with one hand over my eyes.
I heard the OB say "Hmm." Then, "Uh-oh." Her head popped up between my knees.
"The device jammed," she said. "It didn't work."
"What do you mean, it jammed," I said. I was embarrassed because I thought that my cervix had rejected the IUD like a bad magnet. I could tell I was about to cry.
Although my blind spot for inefficiency can border on insensible—I once sat through a four-hour Amtrak delay without noticing, and still use caps lock to type every capital letter—I still can't believe how long it took me to bite (metaphorically, and also with my cervix) the T-shaped bullet of the IUD.
The main thing keeping me away from uterine greatness was, like it always is, inertia. Having been on birth control pills since I was a teenager, I had already been consistently de-pregnantizing myself for years. But—"am I right, ladies," she whispered, gently falling off a cliff—the pill is a situation that best-case-scenario can be described as "okay." For most of college I was on the regular estrogen/progestin Empty Ute Special, with the usual side stuff: nausea, thick-headedness, emotions that seemed randomly generated. It Sucked, I Took It Anyway: A Universal Memoir of Female Young Adulthood. At some point I switched to the progestin-only version, which cleared my brain and my emotional weather, but it's a mini-pill and it needs to be taken pretty much exactly on the hour every day to be effective.
This is a simple task and also a bad one. Teaching, graduate school, work, a loud restaurant, a yoga class, a Peace Corps bus where a literal goat is sitting on your backpack, a Sunday when you're comatose till two in the afternoon—it's not always feasible to hear and react to a loud alarm, particularly when it's not for something awesome ("My daily free cheese sample!") but instead for something that will just get you back to your ordinary zero. The pill is a never-ending medicalization of being female. The pill sucks. Whatever. I took it anyway, and for a long time.
Then one day last summer, I was sitting across from my friend Rebecca at a sidewalk cafe. We had icy, salty margaritas, and we were smiling at each other through sunglasses and eating queso fundido in the thick afternoon light, and she pulled her sunglasses off and said—apropos of something I can't remember; maybe I had idly complained about the fact that I'd put 3500 hormone pills in my body before turning 26—"You should really, really think about getting an IUD." She told me about hers, sounding like she was recounting the gospel.
This was not the first time I'd heard a friend with an IUD blossom into evangelism as soon as the subject came up. I already knew that the over-99-percent-effective intra-uterine device—a little plastic T, either containing copper (Paragard, effective for 10 years) or progestin, only about 10 percent of which reaches the bloodstream (Mirena, effective for five years or Skyla, effective for three)—was a best practice. The lingering idea that they are dangerous, or produce infertility, is based on this long-defunct monster model, and today IUDs mean no effort, no human error. There's no standing sweaty in your winter coat in the pharmacy line at 7 p.m. on a Sunday, no getting the prescription transferred to the CVS near LAX when you're traveling, no condoms on the nightstand if you're a one-trick pony like me. No paranoia. No periods, often.
And, anecdotally—unlike with almost any other birth control option—most women with IUDs love their situation and report no problems after a few months of spotting and cramps. AND: 40 percent of gynecologists use them, as opposed to 8 percent of us regulars, which in itself, separate from any other information, is a good enough reason to say go.
Well. The closest thing I've ever felt to an epiphany is the realization that I wasn't living my best life. "Yeah," I said to Rebecca, lifting a chip to my mouth and watching the strings of queso catch the light. Everything was beautiful that day. "Maybe I should. I think I will."
I expect that, in the future, the greatest part about getting an IUD will be the part I was anticipating: the part where I no longer have to expend daily effort to prevent being fertilized against my will. But in the time leading up to the insertion, the IUD already seemed worth it for the response it elicited from my girlfriends.
Relatively few women actually have these little devices up their ("OUR," she said thoughtfully, placing a hand on yours across the counter of the feminist bookstore) uteruses—but almost everyone who's not actively trying to get pregnant would like the outcome of the IUD: to stay un-pregnant without doing any work. Thus, the idea—of not being pregnant and also not having to struggle for it, via condom pausing or pill brand changes or Plan B or regular uterine bloodletting or the hiccup of a too-fast pull-out or the continual expenditure of money or the screenshots of your period tracker app sent to two of your friends like "UHHHH DDD:"—sort of feels like magic. I just searched my inbox and found Gchats going back for years: IUD time maybe. IUD makes so much sense. Maybe I'll get one for my birthday. Need a damn IUD. Really wanna get that IUD.
So when someone brings up the IUD in conversation, women get quiet and interested. "I sort of want an IUD," they whisper, like me. And the people who already have one are like: "YASSS BITCH DO ITTT!!! BEING NOT-PREGNANT WITH ZERO EFFORT FOR FIVE YEARS IS EXACTLY WHAT YOUR QWEEN UTERUS DESERVES!!"
The village of bitches went to work. I moved to New York this fall, and a friend recommended a great gynecologist. I've never had a kid and have never been pregnant—which can present a hurdle for some doctors—but this doctor nodded easily when I told her I wanted one. She gave me the insurance particulars and a couple of info sheets, and told me to make an appointment right away.
Then two friends got IUDs in the months before my appointment and gave me the details ("I'm still spotting!" one yelled, smiling, at the bar). One of them remembered my appointment date and brought me a pill at work. The day of—when I realized that the pill I was supposed to put up my vagina in cervix-dilating prep was the abortion pill I had just thoroughly championed in an interview but had spent all my life trying to avoid—I went cold, and my friend emailed me back immediately. "It's hard to believe this would faze you," she wrote matter-of-factly. U can come bleed on my couch, texted another. Right before I left for my appointment, I got an email titled "Thinking of U (terus)!"
Sedated by pills and blessings, I did a tweet.
It's true. I took an extra Advil and headed downtown to my fate.
At the doctor's office, I peed in a cup to show I wasn't pregnant. I sat down with the OB and she answered my questions, which included which IUD I'd signed up for (I had forgotten; it was Mirena), how long I had to wait to have sex (5 days, a period in which she also advised no tampons or vibrators or swimming), how long I had to wait until semen could not impregnate me (just two more days, a week in total after the procedure), if I had to make a follow-up appointment (yes, in eight weeks). She told me what would be normal afterwards (bleeding, cramping, spotting for up to three months) and what would not be (sharp pains, which might indicate a perforation).
"I'm scared," I said.
"I get it," she said kindly. "But most women are just fine after. I have a Mirena. Also, I've put in like five today." She told me that if I was feeling bad after the insertion I could hang out in the office for as long as I wanted.
I followed her to the room, where she gave me some privacy. I stole an Advil packet and took my pants off. I checked my look in the mirror (not great), sent an email (the piece should be up tomorrow!), weighed myself (I don't have a scale and I'm an opportunist). HOW'S YOUR VAGINA, beeped my phone. IS IT A WAR ZONE IS IT FREAKYY?! I snapped a quick selfie (waist up) and sent it back. Here I am, Donald Ducking. Here she comes, my OB.
"This will take less than ten minutes," she said. I imagined the Black Mirror Christmas special and wished my egg-person could do this for me. She gave me the speculum exam, she numbed my cervix with local anesthetic ("Cough for me, dear?" as the swab went up), she swabbed it with antiseptic ("Cough for me again?"), she used a clamp to straighten out the opening ("OUCH," I whimpered, my hands clenched), she sounded my uterus like an ocean (seven centimeters deep, exactly average; "Cool cool," I said, faintly), she got the giant Mirena applicator out and ready. Imagine this!!
And then it jammed.
I started crying very gently. I only cry when I feel both (1) vulnerable and (2) like I've made a mistake. "Did I do something?" I sobbed, like an eighth-grader.
"Oh no my dear," she said. "Oh no. It's the device."
"Uh-huh," I sobbed.
"No, no," she said. "It's—hold on. We can't reuse something that might be faulty. Do you want me to find another Mirena and try again? Or do you want to make another appointment?"
"Try again," I said, hiccuping.
She left the room and my soul went like WAHHHHHHHHHHH!!! My cervix had just crossed its arms and said NO! I DON'T WANT YOU TO BE HAPPY! and I was ashamed of it, and whatever I had done, and my tears.
The OB came back in with another foot-long package. "Are you okay," she said, looking alarmed.
"WAS I TOO TENSE OR SOMETHING," I choked out.
"Oh no!" she said. "Oh, no, no, no, you didn't do anything. It's this button." She showed me, explaining that she has to press a button, which makes the T-shaped arms of the device release, and it just hadn't worked.
Freed of responsibility, I immediately stopped crying.
"Okay," I said, like I was at the DMV getting my photo taken. "Ready."
Back lying down, back in with the speculum and the swabs and the cervix clamp and then the IUD was in. "That's it!" she said. "Everything is great."
I tried to sit up. "Oh, why don't you lay there for a second?" she said, bustling around the room and repeating all the info she had told me earlier while watching me very closely out the corner of her eye. After a few minutes, she told me to sit up slowly, and take my time, and she'd come back to check on me in a bit.
I felt okay, if certainly a little weird, and then all of a sudden like I had molly sweats. The fluorescent light spackled all around me, my vision was thrumming. "Whoa," I whispered, still bottomless. I laid back on the exam chair, whimpering, as sweat soaked through my hair.
Two minutes later, the feeling passed. I stood up like a baby deer and put my pants on and made my follow-up appointment and got in a cab home. Too dizzy and sick to look at my phone, I watched the city lights sparkle on the river and got dizzier. I laid down in the backseat of the car. When I got home I hobbled straight to bed. My dog came out to greet me, cautious. I ordered spicy ramen and put on Election.
(This, on the advice of my friends, is a great plan and one I would recommend: make an end-of-day appointment, take some pharmaceuticals, have someone drive you home, get in bed with a heating pad, get some soothing food, watch TV.)
Within half an hour, I no longer felt flu-sick, but just crampy, and within an hour, I was back in control. (Since then, I have felt vaguely uncomfortable enough to take a lot of Advil but have had no other traces.) I got out of bed, grabbed my birth control pack and tossed it across the room, missing the trash can but feeling free as a damn bird. I was bleeding and it was still already worth it. I pulled my phone out and started texting.
The first one jammed :(
But the second one worked :)
My friends texted back things like, "NOOO" and "R U OK?!?!" and "WHAT" and "Hahahahahaha what the fuck is wrong with your vagina." I'm aliiiiiiiiiive, I texted back, the village of bitches having brought me to a happy end.
Image by Jim Cooke.