Thursday, September 23, 2004

The IUD: Last But Not Least

Apropos of this post, Anne has two very good questions:

Q: Isn't the Pill the most popular method of birth control in the United States?

A: No. Female sterilization (tubal ligation, or "getting the tubes tied") is. This is the ranking for all the methods. To give you an idea, out of 60.2 million women age 15 - 44, about 64% use birth control; of the 64%, the percentage of women using a particular method is:

  • Female sterilization 17.8%

  • Combination birth control pill 17.3%

  • Male condom 13.1%

  • Male sterilization (vasectomy) 7%

  • Withdrawal 2%

  • Injectable (the shot) 1.9%

  • Periodic abstinence 1.5%

  • Diaphragm 1.2%

  • Other* 1.0%

  • Implants** 0.9%

  • Intrauterine device (IUD) 0.5%

  • * spermicides, cervical cap, sponge, and other methods not shown separately

    **list was compiled when Implants were still available in the U.S.

    Q: Would the IUD be a good option to consider if it becomes more difficult to obtain birth control pills?

    A: Unfortunately, no. The IUD is an outstanding method of birth control. For many women it's the ideal method. The problem is there are approximately 60 million women of reproductive age in the U.S. Over 10 million women use the Pill. Take away the Pill option from these millions of women and, for some, the IUD will be a very good substitute. For others, it won't. Not only that, but even for the women who'd be able to use, and would love using an IUD, as they go through life, their reproductive needs, and thus their birth control needs will change.

    As good as any individual method of birth control is, it's never the best method for all women. This is why it is essential that women have access to all the available methods, throughout their reproductive lives.


    At 2:44 PM, Anonymous Anonymous said...

    I'm getting ready to get an IUD (if my doctor lets me - another story) and only have only a few concerns: Can you feel it once it's in? Can it or the string be felt during sex? How often does the string need to be checked?


    At 4:38 PM, Blogger ema said...


    Can you feel it once it's in? No, you can't.

    Can it or the string be felt during sex? Neither you, nor your partner can feel the IUD (during sex, or at any other time). You don't feel the string during sex. It's possible for your partner to feel the string during sex, if the string is too long. Solution: ask ob/gyn to shorten the string by cutting it.

    How often does the string need to be checked? Once a month, but this is not written in stone (whatever you feel comfortable with).

    Here's a very good illustration of an IUD (not the same type as the one you'll get) in situ:

    It's a pathology specimen (uterus cut half-way down the middle, to expose cavity), so don't look if you don't like graphic images. If you do look:

    --notice the thickness of the uterine wall, in particular from the bottom of the IUD to the bottom of the uterus (the cervix); you/your partner won't be able to feel the IUD. (The only part of the uterus that protrudes into the vagina is from the narrowed area down.)

    --notice how little of the string protrudes from the cervical canal inside the vagina; as a rule, the cervical secretions act as a "glue" and keep the string flush with the cervix. You won't be able to feel the string, even when it touches the cervix (not enough nerve endings on the cervix; it's not sensitive). When you check for it, you'll be able to feel the string either between your fingers, if it's not stuck to the outside of the cervix, or by running your finger over it.

    Hope this helps.

    At 1:55 AM, Anonymous Anonymous said...

    I've had an IUD since 1988. I am post menopausal and want to have it removed but my HMO (that paid to have it put it) now will not cover to have it removed. What will happen it my appeal is denied and I just leave it in forever?

    At 2:39 AM, Blogger ema said...


    Most probably nothing will happen if you leave it in. However, you need to consider the risk/benefit ratio. Although the IUD is an excellent method of birth control, using one does have some risks (e.g., perforation). Since you're postmenopausal, you're not really deriving any benefit from using an IUD any longer, yet are still exposed to its risks. Based on this, having it removed would be the better option.

    Now, I don't know what will happen if the HMO denies your appeal, but you might want to consider these alternatives: A) Just ask your Ob/Gyn to remove it during a routine physical (basically you'd be asking him/her to do this for free); or B) Your Ob/Gyn could designate the removal as medically necessary--e.g., something along the lines "I'm considering local HRT for this patient, to be delivered via a hormone-releasing IUD, so her current non-hormonal IUD needs to be removed, in order to be replaced with a more appropriate model."

    Hope this [educational information, not medical advice :-)] helps.


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