OP: Why are IUD/IUS so mistrusted?

I shall assume you live in the States. That is simply because that is where the epicenter of problems were in the 1980s with the Dalkon Shield. There were many styles and shapes and constituent additive IUDs about thirty years ago and one, the Shield, turned out to cause many problems. It seems that the U.S. market has yet to recover. In the U.S., there are two manufacturers; in Europe, over a dozen; in China, the IUD is the leading contraceptive for women in their twenties.

Both U.S. IUDs are the traditional T shape whilst in Europe they are available in a number of different shapes. The "one-size-fits-all" approach to IUDs is being seriously questioned. Some of our uterus are not a standard shape; some of us are tilted a bit. This makes the IUD more difficult to adjust to because the crossbar may irritate the side walls of the uterus. Alternative shapes compensate for this. A Belgian doctor has recently developed an IUD that attaches to the uterine wall and eliminates this problem completely. It is simply an attachment "hook" with a short string with a few copper balls on this string. It adjusts to any uterus shape. It is now available in most European countries and Canada. I do not know where else but have heard reports of American women going to a clinic in Vancouver for the GyneFix.

In the U.S., one of the products is coated with copper and the other with hormone (progestins, mostly). In the rest of the world, these two alternatives are available but women can also get uncoated IUDs. The advantage is that the uncoated ones last "forever." Hormone coated are recommended, usually, for five years and copper, seven years.

The IUD is as old as most techniques and it was common on the island of Taiwan for mid-wives to place pebbles in the uterus 1000 years ago. There reasons to believe that this practice spread Westward from there. The modern iteration arrived in 1960, the same as the pill, and initially had about the same acceptance. The effectiveness is the same as the pill and the side effects much less than the original pills. Over 95% of women acclimate to the IUD within three months and the incidence of perforation and/or infection is less than 2%.

I understand there are many horror stories "on the street" but few have any basis in fact. The Dalkon Shield was limited in distribution to the U.S., so the marketing effects were greater there. The rest is urban myth and a really good contraception system is being ignored by many who would find it acceptable.

IUDs suffer a bad rap.

Brandye

Posted: 30 Sep 03:58

Actually I'm in Wales!

I'm sure stories about that paticular device have contributed to women my age being warned off by their mothers not to get an IUD. But there does seem to be a lingering fear of putting anything up there. I remember being in junior school when girls were starting to get talks about their periods; they were absolutely convinced that tampons were super gross and would probably kill you. I've even heard people my age say "shove stuff UP there? ew no!" about tampons. The mind boggles.

Thankyou for your response; I want the IUS but I was told the one that's available (mirena?) might be too big so they want to have a poke around first and then presumably they'll give me the available options from there.

I'm aware some women are allergic to the copper; there was an interesting episode of House about it with a nun :D I'm not too worried about that.

llovell

Posted: 30 Sep 03:59

Living just across the pond from you, I think IUD's are much trusted here, particularly the hormonal kind. It's like the birth control of choice for moms who don't want any more babies, but don't feel ready for the permanent option (or hubby isn't yet ;)) I don't happen to know a young woman that has one. Doctors here are much reluctant to place them inside women who've never given birth. Apart from one woman who had it removed after constant belly-aches, the mothers I know who have one, all are much content with it. They've told me it's the easiest way they've ever practiced birth-control :) So I wish you happy times with yours, llovell!

I do think there is something about the vagina, cervix and perhaps even beyond that people still consider dirty or creepy or something. I mean; how often do women really wash their hands prior to changing/inserting a tampon? I can tell you; everyone looks at me like I'm daft when I enter the ladies room, wash my hands and then enter the toilet :rolleyes: Whereas given the many menstruating women who use tampons, it should be the most normal thing in the world. I've read that many women consider this hygiene-measure unnecessary, because they consider the vagina to be dirty in the first place! :eek: And even more so unclean while menstruating (which is definitely false). There are far more bacteria on your hands or inside your mouth, than there will ever be down there. Apparently women still don't realize what a lovely self-cleaning place it is.

RedRoses

Posted: 30 Sep 03:59

Toxic Shock Syndrome interestingly enough does tie in with tampon use. In September 1980, the CDC reported users of Rely tampons were at increased risk for developing TSS. It has since been shown that super-absorbant tampons, not just Rely, increase this risk. This was thirty years ago now but the mechanism of TSS is still not entirely understood.

Interesting to see, however, how "folk wisdom" works.

EvilEvilKitten

Posted: 30 Sep 03:59

EEK, that is true. But ever since those super-absorbent tampons have disappeared from the market, the syndrome has become rare. If my resources are correct, estimates are between 3-15 cases of TSS per 100.000 fertile women and 2-3 cases per million people, on an annual basis. And that is not to say it was caused specifically by tampon-use. Though it is the more reason for women to be washing their hands before putting it in there and changing regularly (don't forget to take out the last one!). Coincidentally; also men and children can experience TSS, caused by an infection gone wild with a bacteria everyone caries on their skin daily.

I'd doubt whether it's "folk wisdom" or simply the "eeeew!"-factor... Sometimes people can do things right for the wrong reasons. Which also makes it likely to back-fire in the end.

RedRoses

Posted: 30 Sep 03:59

This thread has taken on added dimensions. I'll try to address some of the stuff. Living in Wales, alternative shapes of IUDs are available to you. If not, take a holiday in Belgium. The given shape of the Mirena (T) may be too large. See my earlier post and other shapes of floating IUDs or the GyneFix may be better for you. They are equally effective.

Yes, some few women are allergic to copper and they should get a non-metallic IUD. The copper is spermicidal in and of itself and it causes the cervical mucous to be thicker slowing sown the sperm's mobility into the uterus. The hormone coating, on the other hand, is used to reduce cramps and flow during the period. The simple, non-coated IUD is equally effective but, for some women, increases cramps and the flow. See my earlier post on "one-size-fits-all," NOT. A different shape may get around this problem. The copper allergy is considered a minor one with infection and perforation being the big problems. This is affected by shape and insertion technique.

Toxic Shock Syndrome was "discovered" with the advent of high absorbancy tampons. It likely existed before but there were too few cases for it ever to be recognized and categorized. Menstrual cups and, even diaphragms and cervical caps, come with warning and time limits for their wear because of the possibility of toxic shock syndrome. I have worn my cup for twenty hours. It was effective but not too attractive when I emptied it.

As so many of you, I was warned against tampon use in my early years. My (three year older) sister was using them, against adult advice, so I simply got the thinnest available and used them as well. Very quickly, a candle had eliminated any need to stay with the thin ones.

Brandye

Posted: 30 Sep 04:00

True - I am just pointing out that such things remain in the 'collective consciousness'.

EvilEvilKitten

Posted: 30 Sep 04:00

I'm aware of TSS; but it's another one of those things you only ever hear about happening anecdotally, and yet everyone seems to be unreasonably terrifed of. Just... use the tampons properly and stop stressing :/

*waits for appointment*

One other IUD related question since we're here;

Are there normally any follow-up appointments to check on the thing? Or do they just give me instructions at installation and tell me to come back if there's a problem?

I'm starting to worry that I haven't left enough time between now and my upcoming holiday, if they want to see me again.

llovell

Posted: 30 Sep 04:00

O, no worries, they'd not refuse :) Maybe I should rephrase it to; our system discourages IUD's in women who have never given birth.

It is my understanding things work different over here than they do in other countries. I don't know if it's of interest to anyone, but to illustrate how this works in the Netherlands;

Procedures
Say I'm a perfectly healthy young woman and I want an IUD. First stop is my primary physician, who then has the birth-control chat with me. Yes/no questions leading through a map towards most suitable birtcontrol, giving me information, answering my questions, etc. Say I don't need any more time to think and decide immediately I'd like an IUD. Normal procedure is that the primary physician will place it for me in the next appointment. Which could a matter of days if my cycle allows. And I'd be happy on my way :)

Unless I'm considered "higher risk". Women who've never given birth are automatically considered of this category. This means I'll be referred to a gynecologist or a doctor at a hospital who is highly experienced at this procedure. Depending on the waiting lists, this could mean weeks passing by. Depending on the hospital, it may be that I have to go through the same talk with the gyn as I did with my primary physician, again confirming that I'm sure. Have exams, wait for results. Then (finally!) I can set the appointment to actually have the IUD.

On a side-note: because it is more painful to place an IUD for women who've never given birth, I could request for the referral to include a local anesthetic, tranquilizer or light sedation. It is best to request this at my primary physician or administrative procedures at the hospital may prevent me from getting it. If I'd insist on it, leading to a new referral and a new appointment (again: weeks). Hospital are highly procedural institutes here.

Attitudes
There is a thing you should probably also know about people in the Netherlands. We will never see the inside of a hospital, unless there is something "wrong" with us. The word "hospital" comes with a certain darkness. Faces of friends, family, colleagues get serious when you tell them you have to go there. Because a visit to a hospital immediately signals that it's serious, that it's wrong, that you're ill, that it's risky, etc. On top of that: doctors in hospitals over here are sadly not much famous for their caring and comforting attitudes like primary physicians are, but more so for their cold and distant attitudes towards patients.

Also realize: most women in the Netherlands will never see a gynecologist in our entire lives. Our primary physician does our first PAP-smear by the the time we reach the age of 30. Only when these results come back bad, we'll be referred to the gynecologist. Note that: women younger than 30 have never even removed their underwear in an examination room, unless health-issues or pregnancy made such inspection necessary. When we do this, it is usually with a trusted physician who we've know for many years, sometimes even our entire lives.

Easy choices
Now; go back to that very first visit at the primary physician and imagine this entire administrative circus and the weeks awaiting me. An IUD has suddenly become far less accessible to me. Intended or not; just the fact that I have to go to a hospital to get one, seems to imply this is not for my body. On top of that: I had expected the comfort of my trusted physician to do this procedure for me, but that is not possible. During this conversation my physician may have emphasized that 5 years is a long time and that it's quite an expensive procedure, particularly should I have it removed earlier. Which is not unlikely to happen in young women; developing a wish to have children. Logical result: even though I may have felt confident about this decision for an IUD, my feelings of safety and security now reduce instantly.

Instead of all this drama: my primary physician offers me alternatives. Like a recipe for bcp or a nuvaring. Right there, right now. I could pick it up immediately at the pharmacist -in the same building- and start on it. He could also give me a depo-shot; right there, right now. There's quite a chance the yes/no-map has even indicated those types to be the birth control of choice for me, making me feel more secure and safe about these options. Iow: the system in the Netherlands appears to be discouraging young women who've never given birth to have IUD's.

RedRoses

Posted: 30 Sep 04:01

For many years, the guidelines were "IUD for women who have given birth." These guidelines have been relaxed and doctors are increasingly willing to place them in non-parous women. The procedure is really quite simple and can be done on the same apparatus as a pap smear. Most physicians will insert in the office.

I smile and grimace at RedRoses post. Netherlands has among the lowest hospital admission rates in the developed world. Across the border, Germany the highest. And waiting until 30 for a gyn exam scares me. 16 is about the proper age. You need to know that is in the proper order BEFORE you start sex and not after you experience problems with your first few attempts.

Brandye

Posted: 30 Sep 04:01

It sadly gets worse, Brandye. Only 50% of all women who turn 30 actually show up. It's the lowest percentage of the age-group that gets an invitation (30-60). Women feel they are too young for this exam, thinking that cancer is a risk for those who are older. They do not realize they are statistically in the highest risk-group :eek: The government will be launching an awareness-campaign to clear up such wrong assumptions.

Doctors still do the "old standard" pap-smear, without HPV-testing. Though after a 10 year-research the scientists have advised the government in December to have the old pap replaced by an HPV-test. So this may change (let's say: by the time I'm 30 ;)). Thing is; they are actually contemplating on making this an at-home-test. After years of in-lab-testing, the home-test has been on trial throughout the country since 2010.

Research shows more women would participate with an at-home-test and it is considered more female-friendly. Ironically this would also mean that in a few years time it will even be more unusual for a doctor to ever check on the health-status of a woman down there.

RedRoses

Posted: 30 Sep 04:01

You have some very good answers from the informed women here which I could only echo. From a man's point of view: the strings or threads that are attached to those devices for easier insertion and removal which the gynecologists will tell you cause no discomfort--- many men find then extremely uncomfortable during coitus.

dlb

Posted: 30 Sep 04:01

The primary purpose of the strings is to allow the woman to check and be certain that it is in place. About 5% of IUDs (plus or minus) are expelled spontaneously during the first year of use. The woman should check frequently to feel the strings. The strings are not used for insertion and the device can easily be removed without the strings.

"many men" and "extremely uncomfortable" require definition and clarification. Those doctors who insert IUDs have techniques for wrapping the strings around the cervix and/or trimming them if they are noticeable in use. Some few couples do notice the strings in use and this is almost always correctable. Certainly those cases involving extreme discomfort can be made less uncomfortable. Work with the doctor.

Brandye

Posted: 30 Sep 04:02

Your original question: 'Where the deep-seated mistrust of IUDs ......"

The answer is in this thread. "A friend of a friend had .... " has There were some horrors thirty years ago with some poorly designed IUDs and those issues are still echoing around women's dorms, the internet and mom-daughter talks.

dlb is a sample of "1." Of 128 million women with god-knows how many men participating, this issue arises in an estimated three percent or so cases. He had it with four women. Considering that under three percent of American women have IUDs, his random chances of encountering four women with IUDs are somewhere in the neighbourhood of .00081. And to have problems with being poked by the strings of each of the four, you can add four more zeroes after the decimal point. Yet, his story is here and will be viewed by quite a number of women over the next few years. How many of those will file it away and randomly recall it in discussion a year later?

In China, this has not daunted women because in the 1980s, they were getting little outside news and were not given many choices. In Europe, there was demnonstrable reluctance but in the US, the recalls of the Dalkon Shield had every women with an IUD considering removal and that echoes on.

Go back to my original statement that the IUD is a good contraceptive solution for many women. This is especially true where she and the doctor have real choice in selecting an appropriate device. In the US, with only two choices and both of those being T-shaped, the resurrection of the IUD is difficult. In Europe, and most of the rest of the world, with forty-some designs from dozens of manufacturers, recovery is clear. The fact remains that you, in Wales, have encountered these rumours and the decisions made by your friends have been affected by them.

Perhaps I should have allowed this thread to die and allow dlb's statements to disappear in the bowels of the website. Even in trying to give factual, data based information, some will read this thread and only remember that sometimes the man gets poked. Regrettable but true. At least we got it from "many men" to one one man with four partners and have shown the likelihood of that repeating itself.

To see it again, I do not know how I shall react.

Brandye

Posted: 30 Sep 04:03