IUD's - general anesthesia?

[kabith]

Hello!

I have been thinking about getting an IUD for years, but the procedure has stopped me from doing so. I have struggled with anxiety and panic in my life, but I have managed to cope pretty well 99% of the time without needing medication. However, certain medical procedures (IUD insertion as one of them) gives me some pretty extreme anxiety. Last time I asked my doctor about it, they described the procedure to me, and I passed out (which is usually what I do when overcome with anxiety since a small child).

I know that the procedure is very fast and that the pain lasts for less than a minute, but the whole thing really freaks me out. I can actually handle a decent amount of pain and I am used to hospitals and medical procedures due to a chronic illness, but this specific procedure really gets my goat!

I think the main problem is that I am afraid that I will go through this process, be traumatized from the level of anxiety I experience, and that it doesn't work. I hate the idea that I go through this whole ordeal and need to have it taken out a few months later. I know some friends who ended up having it removed because it did not work well with them.

To circle around to my main question: has anyone had experience with IUD insertion using either local or general anesthesia? I think I could cope if I came in, went under, and woke up with an IUD. I am not 100% sure how much it would cost to add anesthesia to a procedure that does not require it, but I am willing to look at paying out of pocket for it. I also like the idea of local anesthesia, but I am pretty sure my anxiety will still be through the roof during the procedure, even if I do not feel anything.

When I explain my anxiety to my doctors, most of them just say that it may not be right for me, or to try and consider the benefits vs a few minutes of panic. I don't think that is necessarily fair- shouldn't I have access to this amazing birth control option, but not have to subject myself to days of extreme anxiety? Why is it that there are dental offices that offer general anesthesia for minor dental work to cater to the same fear, but I can't seem to find that option for something as important as birth control?

Thanks!
Kabith

[Karyn]

Hi Kabith. I currently have a Mirena IUD, and it was inserted using twilight sedation - I don't remember anything about the procedure. It's not quite the same as a general anaesthetic, but the effect is similar: you remember as much as if you had been put completely under. However, mine was done in Australia, where I was living at the time, and as far as I know it's a very common way to do IUD insertions there, so I didn't have to request anything special. If you've been asking for general anaesthetic, it might be worth inquiring about twilight or conscious sedation instead - it's less risky than a general so doctors may be more open to giving you that option.

If you don't mind me asking though, I am wondering what it is about the IUD that makes it an appealing birth control method for you? It's not a method I would suggest for someone who feels they absolutely couldn't handle the insertion. I'm also wondering, given how extreme your anxiety seems to be around this, if you're getting any treatment for anxiety in general, and if you'd be willing to talk to a mental healthcare provider about it?

[kabith]

Hi Karyn,

Thank you for the response, I will ask about that.

The IUD is appealing because I like the idea of not having to worry about birth control. I am currently on the Nuvaring and a barrier method as a backup, but when work gets super busy I know that I have messed up the timing on when to replace it before. Most of the time I am fine, but working 70+ hour weeks caused a few slip-ups. I also really dislike hormonal methods other than those that act locally, because I have had some negative side-effects. I also do not trust barrier methods alone enough to just rely on those. I am in a long-term monogamous relationship as well, so STI risk is minimal, making the IUD a good option. Plus, if health care goes totally sideways in the USA, I will be safe until the next election

Like I said, anxiety really does not affect me during my day-to-day life. It tends to latch onto something specific, and in many cases I can work through it on my own- this one is just much more stressful. I think the pain of insertion is what scares me so much, and the idea of inserting something through my cervix as it seems so unnatural and invasive. I am not currently seeing a mental healthcare provider, though I was interested in finding a counselor for sex related issues (which I posted about a few months ago). It has proven to be very difficult to find a provider in my area with hours that are flexible enough, as my work schedule can be pretty crazy. I am also planning my wedding, considering looking for another job, trying to be mindful of healthcare... so it has fallen lower on the priority list than it probably should be. It is something that I would like to do, but I have been having trouble making it happen at this point in time.

[Karyn]

Thanks for elaborating on why you're interested in an IUD - that helps.

It sounds like you've got a lot going on in your life at the moment on top of this specific worry, so what I would suggest first of all is bumping up finding a counselor/therapist on your priority list. I understand that with such a hectic schedule it can be difficult, but some mental healthcare providers are willing to do phone or Skype appointments, or work with you to find appointment times that are outside usual office hours. Having a lot on your plate can make anxiety around specific things worse, and a counselor or therapist will likely be able to help you develop some new strategies to help manage this specific anxiety and to hopefully deal with the other stressors in your life as well. (Looking at your past thread about finding a therapist specifically around issues of sexuality, it occurs to me now that background anxiety - even if it doesn't seem to be present - might be a contributor to your lack of interest in sex, so that's another reason to have another go at finding a therapist.)

As for birth control, if you are really set on the IUD, then asking your doctor about twilight sedation like I suggested before is one option. Another possibility is to ask for a dose of anxiety medication you can take on your own ahead of time. You might also want to take a second look at some other methods: I know you've had some issues previously with hormonal birth control and side effects, but I can't remember if you were ever able to get any solid information from your doctors about whether something like the implant would be a problem with your diabetes? Too, you mentioned in the past that something like the fertility awareness method (combined with barriers) wouldn't be a good fit for you, and I'm guessing given your hectic lifestyle that that hasn't changed, but I just wanted to check in and see if that would be a possible alternative.

[Siân]

Hi kabith,

I am currently on my second Mirena IUD, having had a replacement a couple of months ago when my first 5 years expired. Like Karyn, mine was done outside the US, in England.

You asked for some experiences with local anaesthetic. Both my initial insertion and replacement were both done fully conscious, which I believe is standard where I live, but for the replacement I was offered a local anaesthetic to my cervix. This meant that I could feel the doctor doing the initial examination, inserting the speculum and then the needle. If you have ever had a smear test the level of discomfort was about the same for this part. There was an assistant present to help the doctor and talk to me to make sure I was ok. The removal of my previous coil did give me some pain. The local anaesthetic to the cervix does not numb the uterus and I felt some pain and tugging during the removal part of the process, this was distinct from the insertion but is worth bearing in mind as you think about what is right for you. Local anaesthetic also has the strange effect of numbing pain but not pressure, so you may feel some strange uncomfortable poking that is different from a sharp pain.

I hope that this helps you think about what is the best choice for you; Karyn is right that it is not for everyone. Your mental health is just as real as your physical health and is certainly a priority and could be discussed with your healthcare provider before taking the plunge.

[Heather]

(Just FYI, an IUD insertion when not done post-childbirth will typically involve a cervical local. That's a current basic standard for doing insertions.)