I have been providing birth control education, information, and devices to women for many years. One of my favorite LARC ( Long Acting Reversible Contraceptive) methods is the IUD (Intrauterine Device). The IUD is a device that is inserted into the uterus in an office visit, and is effective for a long period of time (3,5, or 10 years, depending on which device you use) to provide pregnancy prevention. While no method is 100% effective (besides abstinence), the IUD has about a 97–98% pregnancy prevention rate, mostly because it does not rely on remembering to take anything or to use anything, is not affected by the calendar, the timing of a menstrual cycle, or how responsible either partner is about using contraceptives correctly.
It was only when I heard my own family member tell me that having her IUD inserted “was probably the most painful experience of her life” that I decided I should take a closer look at exactly how women are getting these devices placed, and why some health care providers and clinics may not be doing everything they can to make the experience less traumatic and uncomfortable for their patients.
When a girl/teen/woman comes into my office either to discuss birth control in general, or to speak specifically about her desire for an IUD, we first review all the details on how the IUD (and, sometimes, other methods) work, what they can expect after IUD insertion, what are the risks and benefits of using this method, and what the effect on their menstrual cycle may be. We discuss any current and future childbearing plans, and any past history of infections, pregnancies, medical problems, surgeries and past use of contraception. If after this conversation, it seems the IUD is their method of choice, and they seem a good candidate, we go on to do an exam.
At the exam, I can do a Pap smear (not 100% necessary for an IUD insertion, but if the patient is due for a Pap smear, better to know if the Pap smear is negative prior to having an IUD inserted. Having an IUD in, with a string protruding from the cervix, in some cases may make it difficult to evaluate the cervix later on). I can do cultures to be sure there is not a current vaginal infection (again, not 100% necessary, and even according to the CDC guidelines, should not preclude someone from inserting an IUD, but common sense…
