Happily Barren

I first got on the pill when I was fifteen (shout out to Planned Parenthood!); I finally stopped twenty years later after ingesting approximately 5,500 bits of estrogen and progestin.  Not wanting to go back on hormones once I stopped using them, I had a tiny copper IUD placed in my (apparently) tiny uterus, which promptly rejected it.  I thought the expulsion was due to my menstrual cup, so I got a new IUD placed, bought a lighter and more flexible menstrual cup, and started to be super careful about breaking the seal and watching for my IUD strings.  Despite my caution, as I squatted to pee in the middle of the night in a completely dark outhouse in the middle of rural Uganda this past April, I could feel my IUD strings poking out – seven months after I’d had it placed… almost as if my uterus didn’t want a foreign body lodged inside of it.  As I pulled an IUD the rest of the way out of my cervix for the second time in one year, I sighed, thinking: “Now what?”

Months away from coming back to the US, I knew I’d have to rely on condoms (which I usually use, anyway) and withdrawal for the rest of my trip and potentially for the rest of my life.  It was then that I started thinking about a more permanent option.   I’m not afraid of having babies (though a LOT of what Livvy wrote resonated with me) – I just don’t want them.  I love the idea of fostering or adopting an older child at some point, but I decidedly do not want to grow or raise infants.

Shortly after I came home this year, I went to my local STI clinic to get some routine testing done; while talking to a medical assistant about contraception, I casually mentioned that someday when I do have insurance, I sure would like to get a tubal ligation.  “Oh,” she said casually while typing my information into a spreadsheet – “In that case, let me sign you up for family planning health care.  It’s covered.”  I was incredulous and overjoyed; she made it so easy.  I signed some documents, called around to clinics to make an appointment, and finally got in to see a doctor in mid-November.

He asked, in short: Why do you want a tubal?  I told him my contraceptive history and my very strong desire not to breed.  Okay, he said.  No argument.  No “Are you sure?  You’ll change your mindWomen are made to reproduce and your life will be incomplete without a baby.”  None of that.  He just listened to me, trusted me, and said, “Okay.”  There was a month waiting period before I could have the procedure done; I had to sign a waiver saying the state of Wisconsin wasn’t asking me to get sterilized (there is a long and terrible history in this country of people living in poverty, people of color, prisoners, and folks with mental health issues being sterilized against their will), and I had to get the surgery done in a suburb because the Catholic hospital he works for doesn’t allow tubal ligations to take place there.  Because of course they don’t.  I’m lucky I had transportation to get out there in the dead of winter; a lot of women don’t.

It ended up being a short outpatient procedure; I came in at 6:30 in the morning, was on the table by 8:00 am, came out of anesthesia by 9:30, and was home by 10:30.  I met with the anesthesiologist, the nurses, and the doctor to ask questions before the procedure, which was very simple: he made a small incision in my belly button and inflated my abdomen with gas, then inserted a small camera called a laparoscope; he made another small incision in my lower abdomen and inserted the surgical instruments through that incision, placing plastic clips on my fallopian tubes.  Everything out, all stitched and bandaged up, and presto!  No more need to weigh the pros and cons of various methods of contraception.

Check out the sweet mesh panties they gave me to wear home…

Before I left, I had to ask in my very groggy state: How long before I can have sex?  For how long do I need to use a backup method of birth control?  I had to ask these questions because no one bothered to tell me.  When I asked the last question, the nurse responded, “Oh, you have a boyfriend?”  Last time I checked, I didn’t need a long-term partner in order to have sex, but hey – it’s Wisconsin?  They gave me a prescription for a few Percocet and sent me home, where my mother literally tucked me in and made me soup.

My mom is amazing.  She desperately wants grandchildren; all of her siblings and friends have them, and she has no children to spoil.  My sister doesn’t want kids either, so my mom is left wanting to smell baby scalp and looking at Facebook photos of other people’s babies.  I was so scared to tell her that I was getting sterilized – but she had the best reaction I could ever hope for.  “There are too many unwanted children in the world,” she said – “So if you don’t want one, you shouldn’t have one.”  She was so supportive and respectful of my choices.  I found it strange and ironic that she was the one to care for me after my surgery, but I’m glad, too – I feel lucky to have a mom I can trust and enjoy spending time with.  Also, I can’t imagine a better place to be while letting my body heal.

I spent the day of the surgery sleeping; the cramps were terrible, and I bled for three days.  Now, four days after the procedure, I’m still a bit crampy and sore, but I can be out in the world.  I can’t exercise or lift heavy things for a couple of weeks, but I finally got to shower and get all that iodine off my torso, which felt like a small victory.  The incisions are small and healing nicely, and I can’t wait for The Engineer to pump me full of jizz.

I’ve spent the past ten years having some variation of this conversation:

Me: “I don’t want kids.”

Other person: “Don’t worry; you still have time.” / “You’ll change your mind!” / “But you’d be such a great mom.” / “What if your future partner wants kids?”

Me: *silently rolls eyes, frustrated not to actually be heard*

I am pro-choice; for me, that means that women should not only have the right to terminate a pregnancy safely, but that they should have the right to prevent pregnancy in a way that feels right to them and ALSO that women should be able to have as many children as they want in a safe and healthy environment.  I’m a nomad who doesn’t find babies cute or understand the way that people fawn over them; they’re just not for me.  And I’m so grateful to have a doctor and a family who understand that enough to say, “Okay.”

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Cu T

Late last summer, I made an attempt to get an IUD placed as I’d recently stopped using condoms with The Texan; things didn’t work out so well.  I wanted a copper one, but the office I went to didn’t have any, so I opted for the Mirena instead – but when my gynecologist tried to place the IUD, my cervix was so narrow that she couldn’t get the tube in.  She said I had two choices: come back again when it was a better time in my cycle and my cervix was more open and malleable, or sit around and get my cervix dilated.  I hightailed it out of there and said I’d come back later.

 

During that appointment, she said I should go off the pill; I never asked why.  Instead, I kept taking them until The Texan left in December, after which I finally went off after twenty years of hormonal birth control… and I waited.  I wanted to get my IUD in during a period when I knew I wouldn’t be having sex (the highest risk of infection comes in the three weeks after placement), so I waited until one partner was gone for the summer and another one was leaving Korea AND timed it so I was both off work that day and in a place in my cycle that would be conducive to a slightly more open cervix.  Sheesh.

Women who have IUDs have lots of feelings about them; some love them and some hate them.  I did as much research as I could[1]; determined not to go back on hormonal birth control, I found a hospital that had a small copper one and set a date.  It was my first time seeing a male gynecologist; I thought that would make me nervous, but it didn’t.  What did make me nervous is when he showed me a uterine sound and told me he was going to insert it to check the depth of my uterus.  And after that hurt like a son of a bitch, he then told me that he was going to need to dilate my cervix a little with bigger sounds to get the insertion tube in.  Eek!  I consider myself a strong person, but that didn’t stop me from crying a bit and saying “OwowowowOWOWOWowowow” over and over.  It made me feel completely in awe of any woman who has actually pushed a human baby out through her cervix.  He told me to relax.  Ha!  “I’m going to put this metal stick into you – so you know, just relax.”  That being said – it worked this time!  Hurrah!

 Image result for uterine sound
“It can’t hurt that much, lady.”

Day one was pretty awful, not gonna lie – lots of bleeding and cramps.  Days two and three involved lots of bleeding and almost no cramps; days four and five were reversed (the worst cramps I’ve ever had, but very little bleeding).  So… we’ll see.  Is it worth it as a backup method?  I’m still using condoms with my partners as I have more than one, but I really don’t want babies.  I like having a just-in-case birth control method.  And who knows?  In a year or two I may end up with a partner with whom I decide to bond fluids.

 

Oh, and that whole gynecologist wanting me to go off birth control pills thing?  I asked this doctor about it and he said, “Yeah, you shouldn’t be taking the pill for more than two years at a time.”  WHAT.  Thanks for telling me that, no gynecologist I’ve ever had.  He then said gravely, “You should probably get a mammogram – extended pill use is linked to breast cancer.”  “But I’m only thirty-five,” I said.  “Do it before you leave Korea,” he retorted.  (Korea has amazing health care – the kind where you can just walk into any office any time without an appointment and it’s cheap AF.  My copper IUD was only $100; in the US it could easily be $500.)  So it looks like I’ll be getting a mammogram this year… at thirty-six. 

On a complete tangent, I found this amazing website where someone documented his partner’s cervix through actual pictures the first month after she got her IUD in; it’s completely fascinating!!!  It made me feel better knowing that other people have experienced the same things I’m experiencing (and likely will be for the next month or two… ugh).  I’ll make a full report on my first post-IUD penetrative sex later and I promise it will be much hotter than talking about mammograms and sounding.  


[1] A note on the articles I read while researching: IUD placement seems to be quite different in the US than here. I got no Misoprostol, no numbing agent, no prior STI tests or pregnancy test… pretty sure my gynecologist didn’t even wear gloves.  

On Becoming Friends with my Gynecologist

I have heard and read a lot of horror stories about visiting the gynecologist in Korea during my five years here.  Because of this, I’ve saved my visits for back home, even though it’s more expensive since I don’t have insurance in the US.  Most of my female friends and acquaintances in Korea have told me that there is a curtain placed between the doctor and patient so they can’t see each other and that the doctor will often do things without first getting the consent of the patient, like an ultrasound or a biopsy.  This would be totally unheard of in the US, where malpractice insurance costs an arm and a leg and there are entire classes taught in medical school regarding consent and liability.  In the US being able to see your doctor and ask her (or him) questions is comforting; perhaps in Korea, because sexuality isn’t really talked about, it might be embarrassing to be able to see your doctor’s face while she’s looking at your vulva.

I’ve also read stories about women being asked to recount their entire sexual histories aloud in a waiting room full of other patients, or doctors calling a woman’s boss to report her pap results.  Because individuality permeates US culture so thoroughly, complete privacy is expected in a medical setting, but the concept of privacy is much less important in communal cultures.  Visiting the doctor here often involves getting on a scale, having blood pressure checked, or even getting blood drawn in a public area.      

I found an English-speaking gynecologist through an expat website and was elated that her office was only a short bus ride away from my apartment!  What I experienced there was astonishingly different from what I’d read and heard.  There’s one doctor in the clinic; she’s retired, but still practicing privately.  I was called into her office and had a conversation with her beforehand, specifically telling her that I didn’t want an ultrasound or a sonogram – just a regular old pap smear and STI panel.  The receptionist took me into a changing room to put on a skirt with an elastic waist (no giant, awkward paper cover!  This might freak out people who are germaphobes, but it’s definitely more environmentally-friendly…) and then called me into another room where I sat on a chair that was much like a dentist chair but with a super short seat.  The back of the chair could be electronically raised or lowered.  Instead of heel stirrups, there were thigh stirrups and a flat place to put your feet underneath them. 

The doctor, who did not put a curtain between us, did a normal speculum / swab routine, but then she surprised me by telling me she was going to take a picture of my cervix.  “Oh!” I said… “Okay.”  Suddenly, a full-color picture of my cervix popped up on a monitor across the room, which was pretty rad.  However, I then felt a sudden, slight, sharp pain.  “What did you just do?” I asked.  She told me that she had applied an acidic solution to my cervix to check for HPV, which I thought was kind of neat at the time, until I researched it and found out that not only does it not really test for HPV, but the CDC recommends against having it done.     

Afterward, the doctor took out the speculum and she and the receptionist (who had been next to her the whole time taking notes!) lowered my feet onto the floor so I could go change.  I went back into the doctor’s office, and this is where it got good.  We talked for at least thirty minutes about which STIs she tests for on her STI panels, the prevalence of HPV in South Korea and how it’s changing, the HPV vaccine and how guidelines for who should receive it and when are changing, and the various types of abnormalities that can be seen during cervix photography.  Her medical English was incredible, but that’s not what impressed me.  What impressed me was that she treated sex and sexuality as a normal part of the human experience — basically, she was sex positive.  She treated me as an educated person who was fully capable of discussing my sexual health.  She even gave me her mobile number and invited me to drive around the coast with her so I could see parts of Korea that I normally don’t have access to while she practices her English!

It was a visit to the gynecologist that left me feeling confident and comfortable, which is a rare and beautiful thing.  She called me yesterday to report my test results (all good – yea!) and reminded me to come hang out with her.  And I actually want to.