Sense and Sensitivty: Birth control and the future

[cereta]

DEAR HARRIETTE: I am a 28-year-old woman who is in a steady relationship. I am currently on birth control (an IUD that lasts three years at a time). I am due to have it removed next month. I have discussed it with my partner, but I have not asked him if I should be getting another IUD that lasts three years. I don’t want to assume that we will be having a child anytime soon, but I also don’t want to automatically throw it off the table by getting another birth control device put in. Should I discuss this with my boyfriend, and if so, how? -- Birth Control Confused, Charlotte, North Carolina

DEAR BIRTH CONTROL CONFUSED: Given your age, the status of your relationship and the parameters of your birth control method, it is time for you to have a serious talk with your boyfriend about the future. If you get the IUD now, you will be 31 before you remove it. Do you want to wait that long to consider having a child? Decide for yourself what you think about your future, and then broach the topic with your boyfriend.

Birth control can sometimes make a couple feel like the pressure to make decisions about the future has been removed, but that should not be the case. Now is a perfect time for you to talk about your plans. What do the two of you want for your lives? This should include whether you think you are in the relationship for the long haul, whether you want to have children and, if so, when. If your boyfriend gets agitated when you bring this up, remind him that there is a natural reason for it. You have to decide about the IUD.

Comments

[cereta]

The IUD is not really the issue, here, although the fact that neither you nor Harriette seems to know that it can be removed before three years if you wish is a little worrisome (it's in the commercials, for heaven's sake!).

The issue is that you want to know where your relationship is going, and some kind of timeline for when things like marriage or kids might happen, if they are in fact going to happen. That is a perfectly reasonable clear-your-calendars, turn-off-your-cellphones, let's talk about this discussion. If you want to use the IUD as a way of bringing it up ("You know, now that I'm scheduled to have it out and have to decide about replacing it, I've been thinking about the future.") But please don't wave some kind of three-year commitment to the new IUD at him. Neither of you needs to be making decisions under that kind of pressure, and luckily, you don't have to.

[the_rck]

Given the upfront cost of an IUD and getting it put in/taken out, my first question would be whether or not the letter writer has insurance coverage for it. If the LW doesn't have coverage, then it's a financial decision on the order of replacing two or three major appliances. If the LW has coverage for getting an IUD, then I'd want to know the terms under which removal of an IUD is covered.

My primary insurance requires a $50 copay for seeing a gynecologist (or a dermatologist or anyone who isn't my primary care doctor).

But if the money aspect isn't a concern, I agree with you completely.

[lilysea]

I had an IUD, and the gynecologist said it had to be inserted under a general anesthetic, because I'd never had children - apparently most women who've never had children find an IUD insertion too painful to tolerate while conscious.

So, while it can be taken out, most people want to avoid a general-anesthetic procedure if they can, because time off work/energy/unpleasantness/$$$$...

[ambyr]

This is not standard practice in the US, FWIW. I know probably a dozen nulliparous women who have IUDs well enough to have heard them talk about the insertion, and in no cases did the doctor use local anesthetic, much less general. Mostly doctors just suggest you take ibuprofen.

[ellen_fremedon]

Yeah, I didn't have any anaesthetic for mine and it was a really short outpatient procedure; I think I stayed home from work the rest of the afternoon but that was it.

[kaberett]

Not standard practice in the UK either, as a datapoint.

[malnpudl]

Oh, for heaven's sake. I had mine inserted at age 21 (no pregnancies) without any pain remediation at all. It was significantly painful, but couldn't have been more than 10 percent of the pain level of childbirth. It wasn't fun, but it absolutely was not traumatic. Had heavy ache for a few hours afterward, then life went on. I've known at least a dozen other women who've had one, and not one of them had unmanageable levels of pain. (USA, age 59)

[ayebydan]

Your experience. Each person with a uterus has their own. For the dozen you know in your sphere I know people who passed out when a nurse tried to do it under general.

[cereta]

I don't think we need to be dismissive of others' experience to point out that said experience is not universal.

[ayebydan]

Nipping in to say it can and IS really painful for some. No need to scoff it off as some comments are here. I have tilted cervix and endometriosis which was why the damn thing was going in so I was put under and waddled like a duck for days while bleeding. Every uterus owner to their own.

Each patient will be judged on their own needs I'm sure.

[ambyr]

I’m not commenting on level of pain; I know people for whom it’s hurt like hell, people who took unprescribed opiates to deal with the pain. I’m talking about medical practice. I don’t think you could find an insurer in the US willing to cover general anesthesia for the procedure, and even if you were willing to pay the thousands of dollars to cover hospital admission and general anesthesia out of pocket, you probably couldn’t convince a US doctor to do it. At best and in extreme circumstances you might be prescribed twilight sedation.

I haven’t had an IUD inserted, but I have had Essure. No anesthesia or painkillers were offered. I spent about twenty-four hours curled up in agony afterward. The procedure is billed as “go on your lunch break, go back to work after!” I don’t think it’s invalidating other individuals’ experiences with pain to say that the US medical system is often dismissive of individual needs and particularly tends to discount women’s pain.

[cereta]

Oh, God, I am so sorry they did that to you! I was lucky enough to be getting an ablation (the Essure was actually secondary to the ablation), so I was put under for mine. But I've certainly had experience with pain being dismissed and suspecting there was a gendered aspect.

[rosefox]

That's absolutely incorrect, and I'm so sorry your gynecologist gave you false information and possibly unnecessarily subjected you to general anesthesia! Some people experience that level of pain, yes, but most do not, and general anesthesia is not standard practice for IUD insertions.

[amireal]

This is a thing that kills me, children or lack thereof should be addressed relatively early on if only because it is a make or break issue. And IF the answer is eventually but not ready, it's a conversations that should naturally come up at various points, like when you are getting your IUD updated.

Seriously, this whole letter could be solved by literally just having a basic and honest conversation.

NOW, PERHAPS she is worried about either sounding like she's giving an ultimatum or receiving one, I'm not seeing much of anything to actually worry about? Unless she's looking for help on how to express what she actually wants vs how to express anything at all.

[cereta]

Seriously, this whole letter could be solved by literally just having a basic and honest conversation.

That could be said for so many letters ;).

[minoanmiss]

... this was a wild ride.

[cereta]

I was honestly not expecting that.

[redbird]

There's something about that "have not asked him if I should" that bothers me, and that Harriette seems to have missed: maybe it's careless phrasing, but the implication is that the boyfriend would get to make the decisions. Decisions, plural, because "do we want to have children, and if so how soon?" and "if the answer is anything other than 'Yes, and we'd both be happy if LW got pregnant two months from now,,' what birth control should we use?" are different questions.

[cereta]

That bothered me, too.

[eleanorjane]

Was it just me or did anyone else find "if you get the IUD now, you will be 31 before you remove it" a bit weird? Like, "oh god you will be a barren old hag by that point. YOU ARE ONLY FERTILE BEFORE THIRTY JESUS WOMAN PUMP OUT YOUR BABIES NOWWWW WHILE YOU CAN!"

31-32 is a perfectly reasonable age for a first pregnancy, especially these days. There's absolutely nothing wrong with putting it off for another three years if you're not ready to think about it. (Except the potential ructions it will cause in your relationship if you only find out after multiple years that you have different desires around having a family. That shit should be on the table by date number three IMO.)

[cereta]

There are so many things wrong with both the letter and the answer that I don't even know where to start. Except, well, where I did ;).