EDITOR’S NOTE: This article is part of a Bedsider Providers series highlighting the lived experiences of getting sexual and reproductive health care. Articles in this series allow sexual and reproductive health care providers to see through a patient’s perspective how their entire interaction with the health care system impacts their reproductive well-being. Bedsider Providers is committed to strengthening health care providers ability to provide high-quality, culturally responsive sexual and reproductive care that meets patients where they are. That commitment includes celebrating all that birth control has to offer, but it also includes shining a light on some of the harsher realities, like inequities in health care.
Seven years after my first IUD insertion, I found myself back where it all started — thinking about birth control access and planning ahead. My Mirena was almost due to be swapped out. I knew the IUD was the method for me, but my situation was a little more complicated — when I got my IUD inserted, the strings were cut way too short, so I knew removal might be a challenge. I was stepping into this process with some potential obstacles.
Over the years, I’d moved, changed insurance, and rotated through a few different providers. Each one assured me they’d be the person with the magic spoolie who could coax my strings back out. Without fail, they’d gear up, go fishing, and then have to admit defeat when the strings were nowhere to be found. Every time, I’d explain that my strings weren’t locatable, and every time, they’d try anyway, all while I white-knuckled the table with an “I told you so” grimace.
After a few rounds of this, I stopped agreeing to any exam to “prove” my IUD was still in place. I had done my research, and was confident it hadn’t expelled from my uterus. I wasn’t about to go through more painful prodding or pay hundreds of dollars out-of-pocket for an ultrasound to satisfy a provider’s disbelief.
During these visits, I also started to inquire about removal and/or replacement. I wanted to know the plan: How are we going to get this thing out? Every provider told me the same thing: they’d go digging for it, it would be extremely painful, and I’d “just have to deal with it.” When I asked about anesthesia or other pain management options, I was met with dismissiveness, and sometimes even laughter. One doctor told me, with an eye roll, that the only place you can get sedation is a hospital. (Meanwhile, I had my wisdom teeth pulled in a strip mall, so… sure.)
It felt like no one was taking me seriously. Between unhelpful providers and dead-end conversations with insurance reps, I started to think I’d just have to stretch my IUD’s lifespan to its absolute limit and kick this can until the road ran out.
Then, by complete happenstance, a post on social media from a local abortion clinic shared that their office routinely offers anesthesia for IUD appointments. With an anesthesiologist in the office on set days for abortion procedures, scheduling IUD insertions was no problem. The appointment coordinator even offered to help me submit the insurance paperwork so I would be confident that all aspects of my appointment would be covered.
I was floored. How was something that every other provider made sound impossible suddenly become so simple? Why did I have to jump through so many hoops and endure so much frustration just to get to this point? Was it really just a matter of finding someone who would take the time to help me navigate the system and help me get what I knew I needed?
The swap itself was smooth and uneventful. I fell asleep with my friend by my side and apparently insisted on taking home my old IUD as a souvenir as I came out of anesthesia. The cramping afterward was uncomfortable, but familiar. This time I felt ready, with a ride home, a heating pad, pain meds, and the luxury of a day off to recover. After years of being dismissed, doubted, and made to feel like I was asking for too much, I can’t overstate how validating it was to have my needs met without a fight.
Yet again, my IUD experience was a storm cloud that eventually gave me a rainbow and a pot of gold. But yet again, I’m left wondering why pain management depends so much on whether you’re lucky enough to be able to access supportive care. Instead, too many patients walk out of the exam room not just in pain, but in disbelief that they weren’t given real options in the first place.
Self-reflection questions:
- What pain management options do I routinely discuss with patients?
- Am I aware of local resources for patients seeking pain management options that I don’t provide?
- How has my practice changed over time with the evolving research on the importance of adequate IUD pain management?