You should probably take two Tylenol beforehand,” my gynecologist advised me.
“What about codeine?” I asked.
“Well, codeine won’t make you feel less pain,” she said. “It’ll just make you not care about the pain.”
Two hours before the appointment I gulped down three tablespoons of liquid codeine. Ultimately, I still cared about the pain. An intrauterine device insertion is mildly painful for approximately five seconds and extremely painful for a lucky 5 percent. With my feet in stirrups and the speculum in place, I screamed mightily, one hand bashing the wall and the other crushing a midwife’s fingers. It felt sort of like giving birth. Except instead of producing life, I was eliminating my ability to produce life for five to seven years.
For those unfamiliar, an intrauterine device is one of the oldest forms of Federal Drug Administration approved contraception. There are two kinds — progesterone and copper — the former preferred by young women, the latter by married moms. Both are a 1-inch plastic “T” that is placed in the uterus through the cervix.
In France, 23 percent of women on birth control use an IUD, as do almost half the married women in China. The IUD is the second most common contraceptive in the world, behind female sterilization.
Yet in America, less than 2 percent of women on birth control do. Americans, and especially American co-eds, are not fans of the IUD. Many have no idea what it is. High school sex-educators tend to place the IUD in the same quirky vintage birth control category as diaphragms and cervical caps.
In our mothers’ generation, the IUD came to mean deformed children, inflamed pelvises and bitter lawsuits. In the 1970s, the Dalkon Shield, a now-defunct brand of IUD, damaged hundreds of thousands of uteri and led to the largest tort liability case since asbestos. Although both types of IUD on the market are now perfectly safe, there are few parents, teachers and doctors in America who enthusiastically recommend either.
So women today choose instead a sexier and less stigmatized form of birth control. Thirty-eight percent of American undergrads currently pop a pill every day to keep their uteri sperm-unfriendly. But if women can get over the idea of a foreign body in their uterus, the IUD has much to recommend it over oral contraceptives.
Unlike the pill, the IUD is a one-time insertion. The intense but very brief pain involved is a bargain for half a decade of pregnancy-scare-less intercourse. If sometime in that window you become interested in impregnation, the IUD is conveniently reversible.
I tried the pill the beginning of my freshman year. It was a problem. For starters, the pill has to be taken at the same time every day for optimal effectiveness. My first semester freshman year, there was not a moment every day that I was consistently awake.
Take it first thing in the morning, my doctor suggested. Um … the first thing of what morning? The morning I wake up at 6 a.m. to do my maximally procrastinated problem set? The morning I wake up at 2 p.m., since it’s Sunday? The morning that I have no idea what time of day it is, because I’ve been upstairs in G-Heav writing a paper for 24 hours?
The price of a missed dosage is the dreaded, but scenic, Hillhouse shame walk. Of course a girl from your section is also in line at the YUHS pharmacy, picking up malaria pills for her internship in Uganda. You tell her you’re “getting antibiotics” for a “skin thing.”
The pill also made me crazy. A lot of people first semester freshman year feel occasionally overwhelmed, numb and nauseous, spontaneously burst into tears, gain weight and radically swing between manic and depressed. Maybe it wasn’t the pill. At the time, however, it seemed those little white pills contained 50 mg of mental meltdown.
These are all common complaints about the pill. Loss of libido, vaginal dryness and acne are other reported side effects, as well as an increased risk of heart attack, stroke and possibly breast cancer. Sexual liberation isn’t all that useful with a palpitating heart, zero sex drive and a dry vagina.
There’s also the cost factor. Most Yale students’ birth control regimens are heavily subsidized by insurance, but some prescriptions are still over $50 a month. Changing to a cheaper brand is tricky, when the product in question is a particular bundle of hormones.
The IUD, in contrast, is a single expenditure. On the Yale Health Plan, if you haven’t yet paid the $100 deductible, it’s a one-time installment of $180. I’m baby free for less than a dime a day — half the cost of the cheapest, best insured pill.
You’ll also save a lot of money on Tampax. For some women, the pill can cause heavier and screwier periods that reappear mid-cycle or last for weeks. An IUD, however, can make them magically vanish.
The progesterone IUD makes many women’s periods shorter, lighter and ultimately nonexistent. If, like me, your period is not a monthly reminder of your earthly fertile womanhood, but a scourge on your life, than the IUD is a one-inch miracle. Yes, the insertion procedure can involve intense pain. But menstrual cramps are also painful, as is calling your roommate a “demon bitch” because of hormonal madness.
No amount of liquid codeine can anesthetize those hurt feelings.
Claire Gordon is a senior in Saybrook College.