are you monogamous enough for an i.u.d.?

About four years ago I had an Intrauterine Device (IUD) placed for 5 stress free years of fertility control.  I chose an IUD because it is more effective than condoms and the pill, there is almost no chance for human error in regard to using it (the doctor puts it in and it stays put for 5 years), and it pumps many fewer hormones through my blood stream than the pill (one form of IUD is actually hormone-free).  However, there were downsides: a bit of cramping the first couple of weeks, my insurance wouldn’t cover the cost (about $500) and I had to search to find a doctor to complete the procedure.  (Click here for a quick FYI about IUDs if you are not familiar with what they are).

I am due to have my IUD replaced in the next year and so the frustrations associated with having the procedure done have resurfaced. First, insurance not paying: I have little to say here. It is stupid, since in the long run the cost of the IUD is less than five years of birth control pills and much less than the cost of a pregnancy. But, insurance companies tend to be totally illogical and ridiculous so I expected nothing less. (If you want an entertaining distraction, here is a funny comedy sketch spoofing the illogic of insurance companies.)

The most frustrating and enraging part is that many (if not most) doctors refuse this service if a woman is single and has never been pregnant. I have been given two explanations by doctors and nurses as to why this is and I suspect they are both true. First, is that for women who have not had children, the procedure can be more painful. The device must pass through the cervix, which is much smaller if it has never dilated for childbirth. I also suspect that for some there is a belief that young women don’t really want to remain childless. (However, the device can be removed at any time and has no lasting effect on fertility after removal).  This is the reasoning behind why doctors almost unanimously refuse tubal legation (i.e. “getting your tubes tied”) to young women without children. The second explanation is that it harms a woman’s health if she is not in a committed monogamous relationship. For some doctors this means marriage. For other doctors this means a long-term monogamous relationship accompanied by a pattern of serial monogamy.

The reason for the unofficial relationship clause is supposedly for the health of the woman. Two strings descend from the IUD to the outside of the cervix so that the device can be removed. If a woman comes in contact with a sexually transmitted infection (STI), it can essentially travel up the strings to the uterus and ovaries, which allows a higher risk that an STI will be contracted and increases the likelihood that some STIs become cancerous.  The thought is that in monogamous relationships this risk is reduced. The problem with this logic is that it assumes 1) that single sexually active women are promiscuous 2) That if a woman does have multiple partners she doesn’t use forms of STI protection such as condoms and 3) that women aren’t responsible enough to make an informed decision about their own bodies.

I was in a long-term relationship (which, to the best of my memory, my providers assumed was monogamous without asking me) when I had my first IUD placed. My IUD now needs to be replaced and this time I am single so the relationship privilege is absent. I am a responsible adult with the ability to make my own decisions. Given appropriate information about all of the risks and benefits I can make my own decisions regarding my own fertility as can most women and I resent the fact that medical professions can “judge” whether I am monogamous enough to get an IUD.

Many doctors refuse at the get go based on marital status alone. This reasoning privileges marriage (which may or may not be monogamous) and monogamy over other lifestyles. If I find a provider who will accept my request for an IUD as an unmarried woman I will have to decide if I should lie about my relationship status or take a risk and make a case that I am monogamous and do not have sex outside of relationships. I could try to sell my sex life as safe and tell them the truth: that I never have sex with any partner who has not been tested for STIs. However,  that just may not be enough. But one thing is certain, if I remain principled and demand and IUD based only on the grounds that I want one, I am informed of the risks and I have decided it is the safest and best fertility control method for me, I can be almost certain that I will not find a provider to perform the procedure.