Monday, July 06, 2009

I-U-Don't? I-U-Do!

Hi Dr. Kate!

I can't take hormonal birth control; I've had terrible side effects and I just don't like it! My question is; what is the best non-hormonal option? My doctor will not give me an IUD because I've never been pregnant. How effective is coupling condoms with a diaphragm or the sponge? I've read that The Sponge increases the risk of contracting HIV, but I've been with the same guy my entire life, so I don't think this is too much of a concern for me. Thanks!

No Pills for Me!

Dear No Pills,

My first thought is...find a different doctor! There's no reason that you shouldn't be able to get an IUD before a baby, that's outdated thinking. And a copper IUD will give you 99+% effectiveness for up to 10 years, so it's hands-down the best non-hormonal option. Condoms plus a diaphragm should get you over 90% effectiveness, especially if you use spermicide with the diaphragm (available as creams, suppositories or film). And condoms plus the sponge should be about that good as well.

The sponge - like other spermicides - may increase your HIV risk if you're having intercourse, and using the product, multiple times a day, every day. (The studies that showed us this were conducted in sex workers in Africa.) Since this isn't the sex pattern of most people in the world, spermicides are still a good option, when used in conjunction with a barrier method (condoms, diaphragm) for greater effectiveness.

But my guesstimates on effectiveness are based on PERFECT use - using both products, every time, with no spillage. And that can be tough to do, long-term. I'd still think about seeing another gyno to get the IUD, then going back to your guy for your check-ups, especially if you know you don't want to be pregnant for awhile.

Have you been told you couldn't get an IUD? What was the reason?

Photo credit: Liz Henry


Scout said...

I've considered getting an IUD, but I've been scared off by the idea of an even worse Lady Time and by the fact that my mother is absolutely 100% positive that I would become infertile if I were to choose this option. IUDs were once really bad, right? What's the difference now?

Also, my doctor said she wouldn't give me one because I've never had a kid and also because I'm pretty "small" down there. While giving me my exam she had to use the "Huffman" which I believe she said was the smallest size speculum available. The upside is I have a cute new nickname for my bathing suit area.

To make a long story short, I would LOVE to have an IUD. I'm in a monogamous relationship, I don't like hormonal birth control and I certainly don't want a baby, but there are a lot of obstacles in my way!

Dr. Kate said...

Scout, some IUDs used to have a string attached that increased the risk of infection. But the biggest problem was never the IUD - it was undiagnosed STDs (especially chlamydia) that got pushed into the uterus at the time of IUD insertion. The infections spread to the tubes, and caused infertility for some women. So if your gyno checks you for infection before insertion, there's no reason to worry.

Love the nickname "Huffman" but most women with petite uteri can still get an IUD! Your gyno would measure the length of your uterus at the time of insertion to make sure you're not too small (pretty rare, even without having a kid).

So find yourself a gyno who's willing to talk to you about an IUD - I think it could make you really happy!