IUDs are Painful

IUD insertions are probably super common procedures for med students. But I guess I'm unique, because I'm in two particularly painful positions.

Position One

For the first three weeks I shadowed here, Dr. D didn't insert a single IUD. However, I knew she prescribed them because during the first few days she recommended one and we discussed it. Dr. D is pro-life; however, she read some research long ago that showed her IUDs don't carry a higher miscarriage rate than normal, healthy young women. Thus, she believes they are not abortafacient.

I searched for the article and I think I found it, but I can't be sure, since Dr. D only remembers that it was published about twenty years ago. I contacted the second author on a similar paper. This author wrote back:

Bottom Line: IUDs work by inhibiting sperm transport but all these methods have back up mechanisms, just like hormonal contraception - - interfering with implantation should ovulation / fertilization occur.

And am I the one to call this to Dr. D's attention? "Dr. D, you know you've been inserting abortafacients all these years, right?" Boy, would it strain a so-far pleasant mentor-mentee relationship. Is it my place? Is it my duty? I get a headache and a heartache just thinking about it. 

Position Two

I'm a Catholic and morally opposed to contraceptives whether or not they are abortafacient. Thus, I'm wearied watching all of my mentors prescribe, recommend, endorse, encourage, and expect contraception and perform sterilization.

This is not usually a problem when the contraceptives are pills, rings, patches, condoms, caps, implants, shots, etc because I am not capable of being involved. (The story was a little different when I used to work at a pharmacy and had to decline ringing people up for birth control.) However, as a medical student learning in small steps to participate in procedures, I am definitely vulnerable to participating in an IUD insertion.

Thus, if there hadn't been any IUD insertions during my externship, I could've avoided asserting my right to conscience. Alas! 'Twas not to be...

The Story

As soon as I saw "IUD insertion" on the schedule I called the NCBC hotline, asking what to do. I remembered awkwardly excusing myself from Dr. C's tubal ligation, but some intervening reading and conversation (especially at IBPCA and with my mom) gave me cause to think I could watch if I didn't do anything. This was confirmed by the ethicist on call.

I still hoped I wouldn't have to assert my right to conscience. There was a slim possibility I wouldn't have to do anything: in minor procedures like colposcopies, Dr. D's medical assistant helped her by default, and I only helped when there was a staff shortage. I hoped that the medical assistant would do the same. I approached her and asked about the procedure.

"So, what's an IUD insertion like?" She described it briefly, and I asked, "so, do you usually help?"

"Oh no, Dr. D does it all herself; the tray's all ready."

My heart plummeted. If Dr. D did it herself and it was only she and I in the room, I would have to explain my conscience beforehand to avoid awkwardly being unable to squirt betadine on a sponge.

So, I explained myself. "Because I'm Catholic, I can observe, but not assist," I told Dr. D when she came in.

"Oh, okay," she replied, and added that I didn't have to watch if I didn't want to.

"No," I said slowly. "Knowledge is good." It was important that I know all I could about this procedure in order to present it accurately to my future patients...the truth isn't served by coercion and misinformation.

If IUDs were for something besides contraception, I'd easily think IUD insertions are nifty procedures. The insertion device is so well built and the site is accessible, making the process in-office and quick....

So I watched the insertion. The patient experienced pain (she wasn't given any analgesia) and had a vasovagal reaction afterwards although there were no serious complications. I felt a little disgusted that anyone would put a woman through pain like that for no good purpose (in fact, to evil ends). It was hard to watch, and weird to think that all the people in the room were cooperating in evil (to one degree of culpability or another) except me, who stood there in the middle of everything.

It's a painful experience that I often have...to be in possession of the truth and be unable to provide it to others who are so close! I know what you want, I know what would make you happier than you could imagine. I know the source of peace. I know where healing lies. Let me tell you! But I cannot: they would not like to hear it, it would ruin a relationship that I should continue to build, I don't have the words, etc.

I guess this doesn't make a very good blog post; there's no beginning, middle, or end. When will pain end and our Master come to relieve us unendingly?