The IUD Diaries

I’ve rolled the windows up and the midafternoon sun is trapped in my car. I sit in the parking lot, sweating. I scroll through Instagram and Twitter. After ten years—approximately the latter forty percent of my life thus far—I am going off hormonal birth control. Finally I take a straight-faced selfie: the “before” picture.

A gynecologist asks me to remove my underwear and wait for her with a paper blanket spread over my lap. This always makes me feel like a naughty teen in a bad porn, a daughter gamely seducing her unsuspecting stepfather under the blanket during movie night—right in front of Mom! Perhaps this is why I am dressed like a child in sandals, acid wash jeans, and graphic T-shirt that reads Enjoy Oregon weather, 10 million slugs can’t be wrong!

I’ve been told that getting your IUD removed is far less painful than having it inserted; the T-shaped arms are built to slide right out of your cervix like a child with their arms raised, whooping down the chute of a waterslide. Still, I’m nervous. The pain I felt when I had the device inserted over three years prior was blinding. I remember crying out as the doctor put it in. A nurse squeezed my hand and I squeezed back, normally loath to touch a stranger but thankful she was there.

I remember thinking if the feeling had lasted any longer it would have been the worst pain of my life. I remember having a new awe for my mother, my grandmother, my aunts, my friends, anyone who’d passed a baby through that hole.

A week or so after my IUD is removed I’m still not sure that I made the right choice. I’m afraid of becoming pregnant, and I remember why I always hated condoms. I start to research the origins of hormonal birth control, because I can’t give it up. It must still be in my system, after all.

In the 1950s, Margaret Sanger, the founder of Planned Parenthood and champion of the modern birth control movement, teamed up with Clarence Gamble, heir to the Procter & Gamble soap fortune and proprietor of a network of women’s health clinics in Puerto Rico, to conduct the first widespread study of the efficacy of the hormonal birth control pill. Sanger’s organizing skills and the money she raised from millionaires like Gamble allowed Gregory Pincus, mammal reproduction expert, and John Rock, obstetrician, to create Enovid, the first birth control pill.

Puerto Rico was the perfect test location for Enovid. A widespread clinical study of contraception would have been highly illegal on the mainland, but the rules were different here. The island had what Gamble would call a population crisis, poverty was widespread and deeply felt, and there was already a network of women’s health clinics that had been built during the New Deal era. It was a godsend for Sanger, who wanted to make birth control cheaply and widely available for American women. And it was a godsend for Gamble, a eugenicist who wanted an efficient way to stop undesirable (read: poor, Black, brown, etc.) parts of the population from reproducing.

There was also another thing. There was la operación.

La operación, the operation, sterilization. So ubiquitous on the island that it was known by just one word. A parallel, I can’t help but notice, to the pill. The operation. The pill. The things that we all orbit but to which we can devote no more language than a solitary word.

By the time the Enovid trials came to Puerto Rico, the US-backed process of sterilization was well underway. Up to a third of Puerto Rico’s women were to be sterilized, often immediately after giving birth. They were prone and disoriented, their bodies already at the whims of the hospital, already primed to say yes, please, and thank you to anything a doctor suggested.

In those days my father was just a child in Puerto Rico. My mother was not yet born, but would be soon, on Long Island. I barely speak to my father and know nothing about my Puerto Rican ancestors, or whether any of them are alive today. But I’ve imagined them many times, and they rise, misty in the front of my mind when I read about la operación. Did they operate on my grandmother? My Tití Carmen, whom I know only by name and who has been dead for years? Did they know that their wombs, much like their country, were being colonized by hatred and fear mongering in the name of civilization and progress?

The sterilization program was a response to the imagined issue of a population explosion, the very issue that kept Clarence Gamble up at night and was the focus of his life’s work. Women—often poor, undereducated women—were having their tubes tied at an alarming rate. The procedure was voluntary by the thinnest definition of the word. It was pushed on women as a way to free themselves from unwanted pregnancies, and as a way to ensure they could remain productive members of the workforce rather than mothers, and as a way to keep the population under control. All of this is nonsense because most of the women who were operated on were already mothers of at least one child, usually two.

Many women didn’t fully understand the consequences of la operación, namely that it was irreversible. La Operación, a 1981 documentary by Cuban-Puerto Rican filmmaker Ana María García, showcases the voices of these women as they recount their experiences with la operación.

In one scene, a young mother sits on a couch. Her hair is light brown, wavy, and thick. Styled short, just above her shoulders. Her eyebrows are two perfect, thin lines. She wears a double stranded necklace and a spaghetti strap dress, tied at the tops of her shoulders.

“If someone had told me,” she says in Spanish, “look, there are other ways to avoid having children, where you can still have children when you want to, well. That would have been the solution. But at no time was I told that.” She’d thought it was reversible. She didn’t know what happened until she read her medical record, which a doctor accidentally left on her bed.

“Decía que me habían cortado y me habían cosido con hilo negro,” she says, laughing. It said that they’d cut me and sewed me up with a black thread. “Y yo decí, ay Dios mio que me habrán cortado?” And I said, oh my God, what did they cut? She speaks with a smile on her face, her brows arched, like she’s telling a funny story. Like, hey, you’ll never guess what happened to me last weekend!  Her dark haired, somber daughter looks down and intently picks at her fingernails throughout the interview.

The pill was marketed to Puerto Rican women as an alternative to la operación. If the world wanted you to stop reproducing, would you choose between the reversible option or the irreversible one? Frightened women flocked to the Enovid trials.

In another scene the interviewer speaks to two women who lean on the stucco balcony of an apartment complex. These women were part of the Enovid trials. One of them, Doña Maria, wears a bandana tied behind her head. It flaps lightly in the wind as she relays the story of her first day on the pill. She took it on an empty stomach. The world became dizzy, Doña Maria says, and she almost lost consciousness. Her only thought was to ask God to care for her children.

“Las personas que tomen las pastillas fueran las primeras mujeres en el mundo entero que tomaron las pastillas,” the interviewer says from behind the camera. The people who took the pills would have been the first women in the entire world to take them. “¿Esto sabías, Doña Maria?” Did you know this, Doña Maria?

Doña Maria looks dazed. She smiles a little bit, in the way our faces do when they don’t know what else to do. She blinks rapidly, shakes her head, and breathes a small, quiet, “No.”

The women were given incredibly high doses of progesterone, much higher than the pills of today. Their side effects were much the same as ours, but many times more intense. Dizziness, nausea, bloating, spotting, loss of appetite and libido, weight gain, depression. And then there were the blood clots and strokes. Three women died during the Enovid trials, but no autopsies were performed and their deaths were never investigated nor officially linked to the pill. All of this could be dismissed, excused by the urgency of the feminist sexual revolution that had set the United States on fire.

The pill was meant to keep poor people of color from procreating. The pill was meant to control population growth. The pill was meant to help Puerto Rico. The pill was meant to end poverty. The pill was meant to allow American women to feel sexual pleasure without fear of pregnancy. The pill was feminist. The pill was good for us all, as long as we all were white and American and willing to ignore a little nausea, some bloating, a touch of depression, maybe death.

My own birth control journey started when I was sixteen and manically in love with my first boyfriend, who simply could not maintain an erection with a condom on, never having felt the oppressive latex squeeze when he masturbated or, later, when we fooled around together. I was lucky enough to have an open minded and trusting mother, who took me to see my pediatrician. I was prescribed the birth control pill. I took the pill diligently for a week, then dipped my fingers in a tub of Vaseline, slathered up, and lost my virginity.

The first few years on the pill were not bad. My period flow lightened. My cramps, which had always been incredibly painful, stayed the same, until I told my gynecologist at an annual exam and she put me on a lower estrogen pill. My breasts grew. My skin cleared up. Sometimes penetration made me bleed. A lot. But no lover was ever unkind about it, and as long as we had tissues on hand I could deal with it. For the most part, a full, satisfying sex life and a regular period cycle, characterized my high school and college years.

Something changed after college. I’d been on the pill for six years when the pain began. Penetration was a hot knife inside me. I had a new boyfriend at the time. At first, I tried to grit my teeth through the pain. I thought if I could get myself properly aroused the pleasure would overshadow it, but it’s hard to feel good when you’re being stabbed repeatedly in your most sensitive, soft parts.

So I’d scream and cry when we tried to have sex. He was kind about it, in that he tiptoed around me and tried not to ask for sex too often. But his concern dissolved when he was inside me; all memory of our discussions of my pain fled his mind and he was back to pumping away in the name of his own pleasure.

It is so easy, too easy, to misinterpret sharp gasps, keening wails, and fingernails digging into the skin on your back.

I learned from my doctor that taking the pill for prolonged periods can thin your vaginal wall, which makes penetration painful. I resented the way she spoke, so matter-of-factly. I’d been on the verge of tears as I described my symptoms to her. My voice had quavered; so great was the physical and emotional pain I’d kept in until that moment that it threatened to break me in that small, close office. She acted like it was normal. That my relationship was on the verge of imploding. That I hadn’t felt physical pleasure in months. Just another side effect, just another part of being on the pill. She recommended I switch to an IUD.

The IUD was the hormonal kind, Mirena, and it made the hot-knife-feeling go away, although that particular relationship didn’t last much longer anyway. A few days after the Mirena was inserted into my cervix, my shoulders and upper arms broke out in massive swaths of acne. But it was fine; the painful sex had ended. A few weeks after that my appetite changed and I craved sweets all the time. But it was fine; the acne had died down. Soon after that I lost nearly all sensation during sex, and quit masturbating altogether. But it was fine; at least it didn’t hurt, and I was adept at faking orgasms. It was all worth it, to hate having sex so I could have sex safely.

It went on like that for years. Sometimes sex was great, but most of the time it was an effort to feel anything at all. I couldn’t not think about it either, dismiss it as something I wasn’t interested in, like a bad movie. I was dating; I had a serious boyfriend, and then another, and everyone wanted to have sex. Sex was on my mind more during the time I didn’t want it than ever before. When to do it, when not to do it, what to think about it, how to feel about it, how to make it better, how to make it end.

There were other things, too, like the near constant, low-grade nausea, the inability to exist without shivering in anything below room temperature, the spike in panic attacks and hyperventilation episodes. And then there was the blood.

A commonly acknowledged side effect of hormonal IUDs is that users may no longer experience a period. For a year and a half, this was true. Then my period came back and never really went away. I bled heavily for five to eight days a month, and in between I spotted constantly. If I had penetrative sex it always, without fail, ended with both parties covered in thick, bright red blood. I worried I might become weak from blood loss. I ruined a lot of underwear and sheets. I developed a robust, complex anxiety around sex. Not only was I not going to enjoy it, but I was also going to bleed as if I’d been wounded. Most sex acts ended in tears. But I did nothing to fix it, because it was all part of using birth control.

I was raised in a world in which birth control—no matter what anyone says—has nothing to do with the pleasure of the person who uses it. Birth control has one job: to prevent pregnancy. It doesn’t matter if it makes you want to vomit; it doesn’t matter if it makes your nails brittle to the point of breaking; it doesn’t matter if you cry or bleed or if you’re torn apart from the inside. It didn’t matter when all of these same things happened to the first women to try the pill, back on the island that gave me half of my blood. It doesn’t matter today.

If you do a cursory internet search for any negative hormonal birth control symptoms, you will find a handful of articles from disreputable sources, and a seemingly infinite network of forums in which birth control users from around the world air their grievances and commiserate. Sometimes people find the answers they’re looking for; they learn how to make the discomfort or the pain or the sadness go away. Most of the time we leave with nothing more than the knowledge that we are at least not alone.

All of us are here, it seems. Typing missives into text boxes, reading posts from years before that make us cry out in recognition today, searching and clicking and searching some more and logging off when we can’t take it any longer.

Eventually I stopped reading, but my partner kept it up, sending me links to forums in which women’s experiences matched my own. I ignored them. Every time he pleaded with me to get my IUD out, citing my own woes back at me, I bristled.

It was so easy for him to suggest such a thing. It was so easy for him to talk about it. And every time I opened my mouth I ended up weeping or found myself in a breathy panic episode. I resisted blaming anything on the birth control, and then I blamed everything on the birth control. Mysterious anxiety in the mornings? It’s the birth control. Sharp pains in my stomach? That’s the hormones. Mood swings, anger, depression, an inability to recognize the signals my body was sending me, had been screaming at me for nearly a decade? That would be the IUD and the years on the pill.

Whether I was right or wrong, I was always right. I could track everything about my multifaceted self—my personality, my likes, dislikes, interests, hobbies, skills, and fears—back to my birth control. It wasn’t just in my blood; it was who I was.

I learned from a new gynecologist that my excessive bleeding was yet another side effect of hormonal IUDs. The IUD breaks your body’s cycle so that your uterine lining no longer builds up, meaning that it no longer needs to shed, meaning you will no longer experience a period.

Unless that isn’t what happens. Unless your uterine lining continues to build, but your body isn’t able to shed it. It builds and builds until it reaches a critical mass inside your womb. Then, the slightest thing can cause it to dislodge. Strenuous exercise, the prolonged abdominal muscle contractions that can accompany a panic attack, or sex. You will build and build and build until you shed and shed and shed and you won’t ever stop.

The doctor’s solution was to put me back on the pill in addition to my IUD. The pill would regulate my cycle. After three months I will have built and shed enough times to have emptied my uterus, and hopefully it would take another year or so to fill up again. The irony was hilarious and sickening. I thanked the doctor. I took the pills. They worked. When I received a five hundred dollar bill in the mail for the ultrasound the doctor performed I paid it with little fuss; I was happy just to have an answer. I still felt nothing when I had sex. A month after I finished the last pack of pills, I started to bleed again. In a daze, I made an appointment to remove my IUD.

I wake up the morning of my appointment with a stomachache and an almost overwhelming dread. Maybe my IUD knows its time is up. My partner asks me how I’m feeling. “Fine,” I lie. I make coffee, knowing the caffeine will do nothing to quell the anxious ripples spreading outward from my stomach. I text some friends who are far away.

They joke about the condoms I’ll have to buy, and will inevitably forego. They joke about all the abortions I’ll have to get, and tell me to come visit them in New York if I need one, because they must be ludicrously expensive and inaccessible in Wyoming, where I live. (They’re not wrong.)

It makes me feel better to put words to my fears. And it helps me understand this one: I fear that I don’t know who I am without hormones in my veins. I was sixteen when I started this thing; I’m nearly twenty-six now. The only constant in my life during all that time has been the birth control.

“This is gonna be fun,” I text. “I will finally get to meet my adult body and hormonal cycle. Never knew her.”

I know this is most likely temporary. Maybe I’ll try the copper IUD next, or the one they shoot into your arm. I’ll spend some time free of side effects and symptoms, and when I feel strong again I’ll spread my legs and let the hormones do their worst, because I can’t live without them. They give me a freedom whose only price is my bodily health and my sanity. It wouldn’t matter if birth control had punched my grandma in the face. I’ll still come back to it, still take the pills and insert the devices, because I really, really do not want to have a child. But for now at least, I’m going clean.

It only takes a few seconds for the doctor to remove my IUD, and I’m glad it’s true that it’s not terribly painful. She triple checks that I don’t want to insert another one in that moment. She asks what kind of hormonal birth control I plan to use next. She falters when I tell her just condoms, but recovers and recommends a spermicidal foam as well.

I’ll have to trust myself from now on. First I have to meet myself.

I put my underwear and jeans back on, slipping a panty liner onto my underwear, because the doctor says I may spot and I know I can count on that. Out in the parking lot I blink in the sun. I get back in my car and take my “after” selfie as the heat slowly becomes overwhelming. I check to see if I look any different. I don’t. I turn the key in the ignition, roll down the windows, and drive off.

________

Rachel Attias is a writer and librarian in Jackson, Wyoming. She’s been published or has work forthcoming at The Rumpus, The Masters Review, The Portland Review, The Blue Mountain Review, and more. Connect with her on social media @multi_rachel.