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Ask the Gyno: The Real Deal With IUDs

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Word around town (errrr…gyno conventions) is that IUDs are making a comeback. They’re safe for teens and leaders in the “set it and forget it” category of birth control (aka—get it inserted ONE TIME and you’re good to go for  three-12 years of protection!). So what’s the real deal with IUDs?  I put Dr. Kate White, Director of the Family Planning Fellowship at Boston University,  in the hot seat to shoot it to us straight. 

Amber: What is an IUD?

Dr. Kate: An IUD is a small flexible device shaped like a T that’s just a little bigger than a quarter. A provider inserts it into your uterus and it can stay there for three-12 years to prevent pregnancy. But realize that “three-12 years” doesn’t mean it has to be there for that long. If you don’t like it or want to take it out or switch methods you can go back to your doctor at any point and have it removed. 

Amber: The thought of a T shaped thing in your uterus can be kind of scary. And I know a lot of girls who are freaked out by the idea. Is it dangerous in any way?

Dr. Kate: There are a lot of myths about IUDs being dangerous, but they’re not at all. It doesn’t make you more likely to get UTIs, yeast infections, or an STI. And if you do get an STI or vaginal infection, you’re not going to have a worse infection because you have an IUD.  

Amber: Who is the IUD best for?

Dr. Kate: Some girls think that because they don’t have a regular boyfriend an IUD seems a bit dramatic since they aren’t having sex that regularly. But IUDs are perfect for when sex is irregular, unexpected, or spontaneous because you’re already protected from pregnancy—you don’t have to do or take anything and you’re covered. Also, some girls are worried you can’t use an IUD if you haven’t had a baby but that actually isn’t true. The tricky thing is that some doctors are actually misinformed about this as well, so we’re working to educate them. But if you want an IUD and your doctor thinks you can’t use one because you haven’t had a baby, be firm and tell them to look into the latest guidelines.

Amber: Alright, so walk me through the process of getting one. Because anytime you’re talking about a doctor and a uterus I really want to know exactly what’s going to go down.

Dr. Kate: That is completely fair! The first part is that your health care provider will give you an internal exam using a speculum to look inside your vagina and at your cervix. And honestly, that’s the worst part for a lot of people. If you’re freaked out by this, ask them to use a smaller speculum, lube, and to go slowly. 

Amber: Is the speculum just too big for some girls?

Dr. Kate: I usually say that an open speculum is about the same size as your boyfriend. And honestly, I’ve even put IUDs in virgins. It’s really more of a mental hurdle. 

Amber: So what happens next?

Dr. Kate: The actual insertion process takes about two minutes start to finish, and there are three moments of pain that can last about 10-15 seconds, with milder cramping in-between. If you’re in a lot of pain you can ask for a local anesthetic injection around your cervix—although, that idea can scare people more than the IUD insertion (but isn’t actually that painful). You can also take some Advil 30 minutes to an hour before your appointment to help with the pain of cramping.

Amber: What are the side effects associated with IUDs?

Dr. Kate: There are two kinds of IUDs hormonal and non-hormonal. Mirena and Skyla are hormonal and ParaGard is the non-hormonal, copper IUD. For all of these IUDs the biggest side effect is changes in your period (it could become heavier, lighter, or irregular, depending on which IUD you go with), but that tends to go away within 3-6 months. With Mirena, about one-quarter of women will end up not getting a period at all; this is totally safe, but can be scary for girls who want to see their period, so it’s something to keep in mind when you talk to your provider/research your options. With the copper IUD, periods can actually get heavier and girls can experience more cramping, but again, this tends to get better with time. 

Amber: What else is it important to know about IUDs?

Dr. Kate: If the IUD is inserted properly, you shouldn’t know it’s there. A guy won’t be able to feel it either. If he does feel something it’s likely the strings that need to be tucked or trimmed. Some girls worry it will fall out or get pushed up, or that they’ll pull it out when taking out a tampon. But this won’t happen, and you can use tampons just like always; you just remove them the normal way. An IUD is great because it’s a kind of birth control you can’t mess up. You get to set it and forget it, and not think about getting pregnant for years. 

Want to learn more about IUDs and all the methods out there? Check out our Birth Control Explorer and compare/contract each method. Ready to talk to a doc? Find a clinic or health care provider using our Find a Health Center feature!

Author: Amber M.
Teenagers sitting on a tree limb

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