Lady Perv’s IUD Rundown

by Lady Perv on February 10, 2011

in Cervices,Contraceptives,Sex Ed

Copper makes sperm retardedMan, it is really disappointing and disconcerting how much misinformation there is about the IUD . Healthcare providers are still telling patients who ask about them that IUDs are only for women who have had children and that they cause pelvic inflammatory disease. I thought that maybe this was because these are older providers who are just stuck on out of date protocols, but a friend of mine in nursing school in Seattle told me that she was taught the same thing! ParaGard, the copper IUD, is pretty much the only non-hormonal, non-barrier method of contraception out there. It’s definitely the only reversible method that’s effective for over a decade. So why is there still so much misinformation out there about it?

If you want to read more about IUDs, check out this presentation from the Association of Reproductive Health Professionals. It gets into a lot of statistical study results and stuff that’s probably not super-pertinent for most people, so here’s Lady Perv’s IUD rundown.

IUD stands for intra-uterine device. You might also see it referred to as IUC, for intra-uterine contraception. Basically, it’s a little T-shaped piece of plastic that’s inserted into the uterus by a trained professional. The IUD is not to be confused with Implanon, the progestone-based contraceptive method that is inserted under the skin of your arm.

There are two kinds of IUDs available for your uterine enjoyment in the US. ParaGard is copper-based and has no hormones in it. It works because copper somehow retards the movement of sperm so that they never make it to the egg. Because ParaGard can also be used as emergency contraception, there’s a thought that it also disrupts implantation. OK, so its mechanism is not totally understood, but its failure rate* is 0.6%, which is substantially less than that of “typical use” of birth control pills (8%) or condoms (15%). Once it’s in, it’s good for twelve years. The side effect that most women experience is that for the first few cycles, they have heavier, crampier periods; this usually levels off after about six months.

Mirena uses progesterone to keep you from getting knocked up. Progesterone does a couple of things: it keeps you from ovulating, and it also thickens your cervical mucus, so even if by some fluke you did release an egg, nothing could get through the cervix and into the uterus to fertilize it.** This dual function makes it slightly more effective than ParaGard. Because there’s a finite amount of hormone in it, it’s only good for about five years. Most women stop having periods altogether with Mirena, because of the progesterone, which is a bonus for some ladies. The main side effect is that up until their periods stop, a lot of women have some spotting and irregular bleeding.

So, on to the misinformation that seems to be out there:

1. IUDs can totally be used by women who have never had children. It did used to be pretty standard (and still seems to be, in some places) for healthcare providers not to put IUDs in women who hadn’t had children. This was partly because there was a suspicion that a nulligravid (never been knocked up) uterus would be more likely to expel the IUD somehow. Studies have shown that this is absolutely not the case. There were also some studies of older models of IUDs that suggested that they could lead to infertility, which has also since been proven to be untrue. The cervix of a woman who has already given birth is also a little bit more open, so maybe that was part of the reason too. Whatever. The cervices of menstruating women open and close a couple times a month for ovulation and menstruation; some providers tell women to have their IUDs inserted when they are on their periods because the cervix is a little more open, which makes insertion a little easier. But seriously, the tools that go through the cervix when you’re putting in an IUD are just not that big.

2. IUDs don’t cause pelvic inflammatory disease (PID). The only time that an IUD can increase your risk for getting PID is at the time of insertion, and this risk only exists if you are actually infected with an STI when the IUD is put in. To prevent PID, every good healthcare provider will test your cervix for gonorrhea and chlamydia beforehand. She will also swab your cervix with iodine to kill any cooties that might be hanging out. Sterile tools and sterile gloves are also standard. I mean, duh. Your risk for getting PID is based on behavior, not on the apparatus you have in your uterus, so even having a history of PID doesn’t rule you out as an IUD candidate.

3. Sluts can totally use IUDs. There are still a lot of healthcare providers out there who will give you grief if ask for an IUD and you’re not in a longterm monogamous relationship. This is associated with the outdated thinking that IUDs increase your risk for PID if you’re out there slutting it up, which we know is incorrect. PID happens when you contract an STI, like chlamydia or gonorrhea, and never get it treated. So, if you’re being an irresponsible slut (as opposed to a responsible slut who uses barriers, has the cooties talk with her partner(s), and gets screened for STIs), you’re putting yourself at risk for PID, but it has nothing to do with having an IUD. This reminds me of that bizarro reasoning that girls who are on the pill or who have had the Gardasil shots are more likely to be slutty because they feel like they’re protected.

4. IUDs don’t increase your risk for ectopic pregnancy. An ectopic pregnancy is one that implants somewhere other than where it’s supposed to, like in the fallopian tube (between your ovary and uterus) or in the cervix. Because IUDs decrease your risk for pregnancy altogether, they decrease your risk for having an ectopic pregnancy.

The labeling on the ParaGard was changed in 2005 so that it no longer says it’s only recommended for women “who have had at least one child, are in a stable, mutually monogamous relationship, and have no history of pelvic infection.” Mirena’s labeling still says something along these lines, although studies have shown that these are not necessary criteria. Now it’s just time for healthcare providers to get with it, and make sure to include the IUD in their contraceptive counseling. Don’t assume everyone wants the pill or the ring, and certainly don’t assume that condoms (or, OK, other barriers) are the only answer for ladies who aren’t interested in taking hormones.

*Failure rates are sort of an interesting concept. Basically, what these percentages mean is that in the first year of using the contraceptive method, 8 out of 100 women who use the pill will get pregnant, 15 out of 100 women using condoms will get pregnant, and only 6 out of 1000 women using ParaGard will get pregnant. “Typical use” also assumes that you’re slipping up here and there; with “perfect use” the failure rates are obviously lower.

**Progesterone actually does this in the second half of your menstrual cycle too! After you ovulate, your progesterone levels rise, and your cervical mucus thickens, preventing any cooties from ascending into your uterus and disturbing a potentially newly implanted pregnancy. SO COOL.

{ 2 comments… read them below or add one }

Redd Delicious February 10, 2011 at 11:42 pm

Dear Lady Perv,

Are there any issues with the IUD and a solid deep-dicking? I just keep imagining it (a) poking some unfortunate swain or (b) getting dislodged during a particularly vigorous episode of sexing. Eh?

Also, with the spotting, for how long? Weeks? Months? Inquiring minds want to know.



Lady Perv February 11, 2011 at 12:02 am

Oooh, girl, I have so much more to say about IUDs! I’ll have to write a follow up post for all the stuff I missed.


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