I went on a field trip to get a pap smear and asked my doctor about IUDs

“What brings you in today?”

“It’s been five years since my last pap smear,” I explained with a tinkling laugh. “I figured it was time.”

“The good news is that guidelines are now to have them every three years,” she replied very seriously. “So you’re not that far off.”

This was my first appointment with this doctor. My previous OB/GYN ,Dr. Z,was a Jewish man from Atlanta who immediately put me at ease with his self-depreciating humor and warm handshake on our first meeting. Dr. S offered neither: 1) because COVID protocols forbid the shaking of hands (even though she would soon be shaking something else more intimately), and 2) because she had a much cooler demeanor. I adjusted my enthusiasm about our meeting to match hers. Still, I couldn’t help but remark on the surroundings in which I’d found myself. There was an accent wall painted a calming shade of purple, adorned with an abstract metal shaped, and the black examination gown I’d been given was made of good cotton and had her practice’s name embroidered on the front. A far cry from Dr. Z’s faded green gowns.

“This is the nicest hospital gown I’ve ever worn…”

Seriously. I felt like a sexy smear model in that gown. It looked a lot like this! (Image source: Cotton On.)

“Thank you,” she said, smiling for the first time. Then Dr. S parted my legs, inserted a swab on a stick, examined my breasts and left me to get changed. It was so quick ang gentle that I wasn’t sure it had happened. Dr. Z’s examinations were always very rough and left me feeling gassy…and a little violated. I never knew it could be a different way!

Dr. S was typing away when I sat across her desk again, barely acknowledging my presence. “I’d also like to ask about IUDs.”

Her rapid, nonchalant typing stopped, and I swear I saw a hint of sunshine burst through her skull. She asked me about my family’s medical history and then hastily scurried to a cabinet from which she pulled out a to-scale silicone mold of a uterus and 4-5 examples of contraception. She looked at me with the kind of half smile, half serious gaze my son gave me before he was about to explain his latest LEGO build.  

“This is the patch. It works like this. *Explains* The injection works like this. *Explains* And this is the implant…”

“Not a fan of the implant,” I interject.

“Me neither. And these two are your IUDs: Mirena and Kyleena. Are you familiar with them?”

“Only Mirena,” I said. I hadn’t heard great things about it, but I couldn’t recall WHAT those things were. “And I thought there was another type of IUD: the copper?”

Dr. S nodded, but told me she didn’t have an example of that one handy.

“Why are you interested in IUDs?”

I’d heard that outside of pregnancy prevention, IUDs could be used to shorten and/or lighten your periods. I’m turning 43 in a few days, and I could think of no better gift to give myself.

“Mirena can actually eliminate your periods,” Dr. S said, almost conspiratorially.   

“No way…” I gasped, eyeing the contraption enviously. I felt like I was on the verge of signing my soul away to the devil. “Are there any side effects?”

“You may feel some pain at insertion. I recommend my patients take Ibuprofen before the procedure. And you may have some spotting in between periods, but that’s it.”

“Have your patients had any complaints, or reported back with negative effects?”

“No. None. In fact, all of my patients are delighted to have gotten rid of their periods completely.”

I knew that had to be categorically untrue. There is NO such thing as a 100% satisfaction rate for any service in South Africa. If there’s one thing the citizens of my host country thrive at, it’s to complain. I didn’t say this to her.

Some reading material provided by my interim doctor

“Here is some information on IUDs,” said Dr. S., sliding me two pamphlets and a print out. “I should warn you: the copper IUD is an effective spermicide, but will lead to heavier periods and cramping.”

“Well, I don’t want that…”

“But it’s cheaper. It’s R500 (+\- $35). Mirena and Kyleena are R2000 each. Yes, it’s expensive upfront, but they last for 3-5 years.”

“So you save in the long run.”

“Exactly. Also, the copper IUD is covered by Medical Aid. The Bayer contraceptive products are not…unless you say it’s (Mirena) for the treatment of abnormal bleeding.”

“…so, is that what you put in your patient notes when you write the prescription?”

The doctor only bowed her head, neither verbally confirming or denying the query. But we both knew. Times are hard for everyone abi?

At her instruction, I took the reading material home and said I would be in touch with my decision. What would I choose? Would it be the device that gave me a lighter period, or the chance to get rid of my period altogether? What are the implications of either? In the days that followed, I would down a path of discovery that would shock, thrill – and at times – horrify me.

Join me tomorrow for Chapter 2: The Findinz.

NB: When was your last pap smear? If you can’t remember, it was too long ago! I know we’re in a panoramic, but it’s important to keep your punanic healthy too…

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