Birth Control Mythbusting Sex Ed

What’s REALLY Up With the IUD?

Welcome to part two of “Birth Control Beyond the Basics,” a series of guest posts written by a dear friend of mine who knows a whole lot about sexual and reproductive health. Click here for the first entry, Birth Control Beyond the Basics: Pill Power!

Are you thinking of getting an IUD? Great! Intrauterine devices (IUDs) are low-maintenance, long-lasting methods that are highly effective at preventing pregnancy. And they’re often covered 100% by insurance, even if you have a deductible! (Always call and check—IUDs are expensive, so you don’t want to have a claim rejected.)

An IUD is a t-shaped device that goes inside your uterus. It’s placed there by a provider and lasts for 3-12 years, depending on which model you select—you can get it removed sooner if you want, though. Once it’s time for it to come out, a provider will remove it using the strings that hang outside of the cervix.

Even if you already know the basic spiel about what an IUD is, you might have some questions or concerns that are making the decision difficult. Here are the most common questions I was asked as a birth control counselor, as well as some questions I had myself when I was deciding to get an IUD.

Animation: Visuals of different birth control options. Text: "What are these?"

So. Many. Options!

Is there any difference between the types of IUD? Yes! In fact, the Paragard and Mirena, the two IUDs commonly used in the US, are so different that they usually appeal to completely different demographics. They aren’t interchangeable at all! The Paragard is the only pharmaceutical (non-barrier) method that is non-hormonal. For that reason, it tends to appeal to people who have had bad experiences with hormones in the past or who prefer not to use any unnatural substances in their bodies. people who get Paragard are often switching from a barrier method, like condoms or a diaphragm, or are looking to get off of hormonal birth control.

The downside of the Paragard is that some people get heavier periods with worse cramps, so providers usually won’t recommend it to people who have heavy periods already. Although periods might be heavier, you’ll still experience the highs and lows of your body’s cycle unadulterated, and for a lot of people, that’s worth it. (It is for me! I’m a Paragard gal.) The Mirena, on the other hand, contains a low dose of progesterone and reduces period bleeding by about 90%. (You might still get a regular period, but it will usually be much lighter.) The Mirena (and the new similar but smaller Skyla) tend to appeal to people who enjoy the positive side effects of hormone use and are looking for something easier and longer-lasting than pills or Depo shots.

Is the IUD easy to use? Yes! It’s a very low-maintenance method. Once it’s in place, the only thing you need to do is check the strings each month. You’ll reach up, locate your cervix, and make sure the strings are still present.

Wait, how will I be able to feel the strings? How freaking short is my vagina? The really cool thing about the vagina is that its length varies A TON! Your vagina gets shorter at certain times of month—the cervix typically descends a lot during your period. Your vagina also gets longer when you’re turned on sexually. That’s why you’re able to feel the cervix with your fingers (sometimes only at certain times of month) but are also able to have vaginal intercourse.

Do I need to be on my period to get it? Not really, but some healthcare providers prefer it if you are. If you can conveniently schedule it during your period, do so. Your cervix will be more open, and that way you can be certain you’re not pregnant. However, there’s no real reason the IUD can’t be inserted at any point in your cycle—as long as your provider can be CERTAIN you’re not pregnant. A pregnancy takes 2 weeks to appear on a pregnancy test, so if you’ve had any unprotected sex in the last 2 weeks, you can’t get an IUD that day (unless you’re using the copper IUD as emergency contraception). If you’re using a birth control method like condoms or pills, and have consistently been using it, your provider will likely be able to do the insertion that day.

So how much does it hurt, exactly? This is a big one! It doesn’t do anyone a service to downplay the possibility of pain during an IUD insertion. The reality is, the tool that measures your uterus (the sound) and the tool that comes with the IUD both need to go through your cervix, and that will be painful. Don’t downplay or dismiss your body’s experience of pain—if you’re not comfortable with the idea of the insertion, the IUD may not be the best method for you. That said, there is a huge variance in experience.  Some people who have given birth say it was nothing compared to childbirth. Some say it was worse. Some people who have never given birth say it was minor. Some are in agony. You can make a big dent in any pain you might experience by taking 800 mg of ibuprofen an hour before the procedure. Once it’s over, a heating pad works wonders (or try an ice pack). The type of pain you’ll experience will feel similar to bad period cramps.

Okay, but how much does it REALLY hurt? I’ll share my anecdotal experience: I have a history of vasovagal syncope (that means “I faint when I get shots and once I vomited into a trash can after a finger prick”), and I also find a basic pap smear very painful, so I was concerned that I would become light-headed, throw up, or be unable to tolerate it. When the time came, it ultimately was not as bad as I expected. I didn’t faint or throw up. I did get shaky and had a pins and needles feeling in my hands and feet. The pain was somewhere in between bad period cramps and the worst period cramps I’ve ever experienced. It was WAY LESS PAINFUL than getting my belly button pierced. It was less painful than dental surgery, but more painful than a tonsil biopsy. A heating pad helped more than ice for the cramps afterward, even though I usually prefer ice. I recommend taking a day off if you can, and just lying around and taking it easy. Watch a long movie, heat up leftovers, have a cookie, and just pamper yourself. Getting an IUD is a mature act of self-care, so reward yourself! Let a partner, family member or close friend know that you’re down for the count and let them pamper you, too. (And if possible, see if someone can give you a ride back from the clinic. Definitely avoid biking home if you can.)

Not you after getting an IUD.

Not you after getting an IUD.

Will I be able to feel it after it’s inserted? In theory, no. You definitely shouldn’t have any discomfort or pain with the IUD, other than normal cramping in the first days after getting it. However, the reality is, there’s a foreign object in your body, and that can take some adjustment. Personally, I wish someone would have told me before I got it that I might be “aware” of the IUD’s presence sometimes, but that I would get used to it over time. The first week I had the IUD, just being aware of it made me feel a little light-headed. I didn’t have any discomfort, but I felt like I could sense the strings, and I was moving gingerly for fear of knocking something out of place. It was not fun. But this is normal and it passes! If your IUD is placed correctly, you should feel comfortable doing all your normal activities within a week or so. It is an adjustment, so as long as you’re not experiencing any pain or major discomfort, give yourself time. If you do have pain, let your provider know—something might be out of place or it might not be the best method for you.

Will my partner be able to feel it during penetrative vaginal sex? Unfortunately, a lot of answers you see to this question are very dismissive. “Probably not,” “HOW FREAKING BIG DOES HE THINK HIS DICK IS LOL NO,” and “Who cares if he can?” are sadly common responses. So let’s back up here a bit. Many people do care about their partner’s experience of their birth control method—and indeed, some couples have a discussion about a birth control method that works for them as a couple. (You should always make the best decision for YOUR body, but it’s also okay if you would like to include your partner in the decision!) Also, if IUD strings are causing sex to be painful for a man, that IS real and important—men’s sexual pleasure matters too!

So here’s the real answer. IUD strings hang down low enough that you’ll be able to feel them with your fingers, so yes, it is totally conceivable that they might be reached by a penis. Sometimes people with penises can feel them. That being said, the strings are usually subtle enough that partners won’t be able to feel them at all or won’t find it uncomfortable. If they experience discomfort, the strings may have been cut too long or too short (too short means stabby). Talk to your provider if you feel the string length is wrong. If sex with an IUD is something that’s weighing on your mind, here’s my advice: just be honest with your partner. The first time you have vaginal sex with your new IUD, just say, “Hey, I’d love to stay in communication during this rumpus. Let’s start slow and build up speed when we’re comfortable. Let me know if anything feels weird or different, and I’ll do the same.” Most likely, things will feel just like normal. If you or your partner have any pain, get in touch with your provider—something might be out of place.

How does the IUD work? The truth is that we don’t really know. We know that the copper IUD (Paragard) is safe and highly effective, but we don’t have a specific explanation for exactly how it prevents pregnancy. It’s thought that it creates a hostile environment for sperm and for implantation of a fertilized egg. The hormonal IUD (Mirena or Skyla) also releases a low dose of hormones, which generally stops ovulation. Is it weird that we don’t have a perfect explanation for how IUDs work? Yeah, it kind of is. Hopefully, we’ll get there in the next few years. In the meantime, we do at least know that it is safe and highly effective.

Animation: Dad from TV show Modern Family shrugging.

How the IUD works.

“The IUD sounds awesome! Are there any downsides?” Yep. Sad face. Unfortunately, there is no perfect birth control method. Like with most methods, the major possible downsides of the IUD are side effects. With Paragard, you might have heavier periods and worse cramps, especially in the first few months. With Mirena, you usually will have lighter periods or no periods, but you might have constant spotting in the first three months. The other downside is a little more nebulous and personal. The IUD is a low-maintenance method, but that also makes it a low-control method. It’s rare, but IUDs can end up in the wrong place, or sometimes they “expel” (come out on their own)–and it’s something that you can’t always avoid by “doing everything right”. As long as you can feel the strings, your IUD is most likely in place and therefore is working. However, some IUD users can never feel the strings—your provider can check to make sure it’s in place, but if you can’t feel the strings, you don’t have a regular reassurance that your method is still working. For some people, that’s hard. Basically, it’s not for everyone. However, for a lot of people, the benefits of not needing to deal with birth control on a daily basis outweigh the downsides.

“The IUD sounds terrible! What are my other options?” If you are looking for long-acting contraception but get wigged out by the idea of something sitting inside your uterus, you’re in luck! There IS another option for long-active reversible contraception (LARC). It’s called the Nexplanon, and it’s a small plastic rod that is inserted under the skin of your arm and prevents pregnancy for 3 years. It’s even lower-maintenance than the IUD, because you don’t need to check strings and it can’t come out on its own under normal circumstances. (The main downside of the Nexplanon is the chance of irregular periods. Some users will get their normal cycle with no changes, some users will get no periods, and around 1/3 of users will get irregular periods—which could include spotting, and is usually lighter than a normal cycle, but may be constant.) It’s a good option for those who aren’t too keen on the IUD, and LARCs in general, including the IUD, are very freeing for many people!

Disclaimer: This information is not intended to simulate or replace the advice of a physician. Always talk to your doctor about your birth control options and how to best use them. Intrauterine devices or systems and contraceptive implants are not safe for everyone; only your doctor can help you decide if they are right for you! Always take a test or contact your healthcare provider if you think you may be pregnant or are unsure of a side effect from your birth control.

Annie spent a year working as a birth control counselor at a monolithic nonprofit women’s health clinic. She did the counseling, memorized the stats, and gazed into the vagina. She’s now a freelance writer and spends her free time obsessing about the Civil War to anyone who will listen. She writes the popular blog, Bras I Hate and Love, about tackling life with boobs you didn’t bargain for. She lives in Baltimore with her boyfriend and her cat, Gremlin.

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