Scarleteen

Hello! I have some concerns about having an IUD placed soon -- I probably should've voiced them sooner, but I suppose "better late than never" since I still have a few days yet until my appointment. (trigger warnings: sexual abuse, graphic description of anatomy)

I started seeing a new GYN in Dec 2014. She is AWESOME. I'm very comfortable with her. One of the things I wanted to discuss with her during my appointment (which was my annual check-up) was birth control options to address the heavy and painful periods I deal with. We did a lot of talking about the options, and after doing lots of research (from credible sources) and reading the literature she provided me with, I decided that the best birth control method for me -- one that would help with my dysmenorrhea and consequent anemia; wasn't super-costly like my previous method, the pill, had been for me; and didn't necessarily have to have a high rate of efficiency at preventing pregnancy since I'm not and don't plan on becoming sexually active any time soon (although the very high rate is still nice in the unlikely event that I do!) -- would be an IUD, namely, Mirena. It was also appealing because since I already am on several prescription medications for a variety of medical problems, I wouldn't have to worry about taking yet another pill or if my current medications would affect the efficiency of my birth control (since I have to make sure my medications don't interfere with one another each time my prescriptions/dosages change).

I personally feel that I've got a pretty good grasp on how Mirena works and its side effects. I'd been told when I called to make an appointment for insertion to take ibuprofen before the procedure and how much I should take to help with cramping. I've heard "horror stories" about the cramps that say the cramping that insertion can cause is comparable to the pain associated with labor, and how the equivalent-to-labor pain can last for weeks, but I take those stories with a grain of salt and keep in mind everyone is different, especially when it comes to bodies and pain thresholds. Also, I know that my periods could be heavier, more painful, etc. for a few months or so after insertion as my body adjusts. All this being said, it isn't actually the insertion-associated cramps and the aftermath that worries me. I've decided that Mirena is worth a try at helping with my periods. It's the insertion itself that has me worried. And that would be because of my cervix. *sigh*

As I've mentioned on my previous original post (the archived one, not the updated one on here), I've dealt with vaginismus, which was worsened by a history of sexual abuse, since my preteens. For reasons of simple curiosity about what my own internal anatomy/cervix looks like, I purchased a medical-grade speculum to do some looking with. The speculum is a Pederson model in size small, and even on my 1st attempt at inserting, I found it was super-easy to insert and that my vaginismus didn't even really interfere with it. I was really happy! Before I got out my mirror and light source, though, I realized I hadn't even felt my cervix. So one day I sent a (cleaned, lubricated) finger on a...search mission. What I found out about my cervix is what concerns me about having my Mirena placed.

Firstly, I happen to have a very high cervix. I've checked during several points in my menstrual cycle and found that even during times when the cervix is said to be lower in position, it's still pretty high-up. Also -- and I don't know if this is even something I should be worrying about since I don't know if it's common, not frequently heard of, etc. -- my cervix seems to be off to the side. Like, waaay over. (warning: this next part is graphic and contains way tmi!) When I feel with my index finger (the finger I always use to feel for my cervix), I find that I can insert my entire finger, almost to the point where it feels like I'm going past the knuckle where my finger and hand join, before I reach the end of my vaginal cavity. I've got pretty long fingers, which is what has me believing my cervix is very high. When I reach the end of my vaginal cavity, though, I don't feel anything aside from the normal foldy tissue constituting the "end" of the cavity. I decided when I first tried feeling my cervix to feel around that area since I know the vagina actually extends a little bit past the cervix. Long story short, after lots of feeling around, I finally found my cervix -- to reach it, though, I have to reach my finger to the extreme left (extreme left meaning that even with lots of caution and gentleness, it hurts my hand/knuckle to get my finger to stretch far enough.) Even then, I can't feel the entirety of my cervix because it's impossible for my finger to contort itself to feel for it.

After I felt my cervix, I then moved on to inserting the speculum and looking. Like I'd feared, my cervix wasn't in the field of view. I tried a number of times over about 4 months to see it, and while I'm pretty sure that it's made difficult by the high cervix/small speculum combination, I found out not that long ago that it apparently isn't impossible because when I was just about to give up, it moved itself into view. So, since it isn't impossible but still difficult, I think my small Pederson speculum may be too small (i.e., too short) to help me be able to visualize my cervix with ease. My GYN showed me at the end of my December appointment the variety of specula she has, and she even said that I could bring my speculum in (I know how to clean and care for it, by the way! ), so my concern as far as the speculum is concerned is that even if it's small enough in that it's narrow enough to be inserted without triggering my vaginismus, it may not be long enough to make my cervix accessible for the procedure. So basically that would mean in order for the speculum to be long enough to make my cervix accessible, it may also be wide enough to trigger my vaginismus since an increased blade length would also mean an increased blade width. (ooh, and also, I didn't ask my GYN this during my last appointment, but I'm going to ask her if I can insert the speculum myself before the Mirena insertion -- I don't see why I couldn't, since like I said she's pretty awesome and sensitive to patients' needs.)

I feel like I'm rambling on here, so: I understand that I may be in for some cramps, but I'm prepared for that and have my ibuprofen ready to go (I plan on taking it about 30 min before my appointment). My cervix, on the other hand...not only am I scared it won't be accessible for the procedure, I'm also scared about the pain my cervix may be subjected to since, like I said, it feels like it's way off to the side. Having its os opened with a separate instrument is probably going to just exacerbate that possible pain. I'm not even sure that all this speculum talk I'm doing makes any sense! Like I said, I probably should've thought about this before scheduling for a Mirena insertion, and honestly I completely forgot to bring it up with my GYN during my appt. because we discussed a lot of things (and I also wasn't fully aware of my cervical position yet), so umm...help please? (for what it's worth I've heard a local anesthetic can be administered to the cervix before the insertion? and also my GYN said I could have the procedure done under sedation, but I want to avoid having the Mirena inserted under sedation as much as I can because like I said I have a sexual abuse history)

It really sounds to me like all of this is a conversation to have with your GYN, or at least have with them first before coming here to talk about whatever they have to say about this. There are just a lot of questions in here that ultimately, only she, as the person providing any if this care, can answer for you.

Because you did not ask this stuff at the consult does not mean you can't ask it. You can. Just put a call or email in, or figure you ask all or any of this before the insertion.

Hi Heather, and thank you for replying! (is it weird that I kind of had a "fangirl" moment when I saw the founder of Scarleteen had responded? )

If I may share tmi again (so once again, warning: graphic) I happened to take a peek a few minutes ago, and I think I might've figured out what was the cause of my trouble.
I positioned the speculum a little differently (but not painfully) as I've tried during each self-exam, off to the side, and I also tried a light source that was a little different than what I usually use in terms of positioning the light, etc. I think that, while my cervix is definitely off to the side, high-up, and a little elusive, what's been happening is I've been seeing it this whole time and didn't realize that's what it is. If this is what's happening after all, my cervix isn't very "prominent" (I keep forgetting that the photos over on BeautifulCervix's site are that -- photos -- meaning the camera had to use special settings and whatnot to make sure the cervix was "large enough" to be seen on photo) and kind of blends in with the vaginal tissue, and also since my os apparently falls into the "slit" category, I've been ignoring it because I just thought it was a fold amongst the tissues there. I've seen photos of cervices similar to mine (either on BC or a similar site) where you have to look carefully to make it out amid the rest of the tissue because it isn't a prominent knob-looking structure. It's kind of hidden amidst the vaginal tissues. I'm now wondering if that time I saw it perfectly (and it looked more knob-like and not hidden by the vaginal walls), it was because I was around my ovulation phase because I don't remember where at in my cycle I was during that self-exam. So, if this is indeed what's happening after all, I'm less nervous now because I "found" my cervix and know even with my considerably small speculum, it isn't as difficult or elusive as I thought.

I think I'm going to hold off until the actual appointment to ask if I can insert the speculum (regardless of whatever speculum ends up being used), but I'm going to call my GYN's office to inquire about a local cervical anesthetic being administered. Also, now that I think about it, when I go for my appointment, I'm going to ask my GYN if a mirror can get involved so she can point out my cervix to me. So thank you, Heather, for helping me sort this out and figure out what to ask my GYN and when. I'll come back if I have any additional concerns to discuss (and also maybe after my appointment, after my GYN examines my cervix, so that if there's anyone else who feels they have a cervix like the way I described mine, I'll say whether or not I've been looking at it all along or if it's as elusive as I initially thought). Also I apologize for a potentially pointless thread since I really might have been looking at my cervix all along and thinking it was hiding -- who knew posting on Scarleteen and then adjusting the light ever so slightly could convince your cervix to quit hiding?

Hello again. As you can see, some time has passed since I expressed my anxiety over having an IUD insertion procedure. Long story short: it wasn't as bad as I anticipated. Really, it wasn't.

I asked as soon as I checked in if I could have a localized analgesic injected into my cervix, and my GYN had the injection prepped before I was taken back to my room. She permitted me to insert the speculum myself and warned me the analgesic injection would probably be the worst pain I'd feel. She described it as being similar to having a piercing done, though some have described it as being similar to an insect sting. Maybe I lucked out and my GYN found the "right spot," but I hardly even felt the needle go into my cervix (which she had an easy time finding, by the way), and even then it wasn't in the least bit painful -- just an annoying little "poke" of pressure. The analgesic took effect quickly, and I didn't feel much of anything aside from a few more annoying "poking" pressure sensations here and there. That said, I hardly even felt anything when my GYN found my cervical os was particularly narrow and struggled to pass the sound through before stopping her attempts and dilating my cervix (med-free). Once again, I didn't feel anything. By the time my IUD was inserted, the only real pain I'd felt was discomfort from the speculum, which my GYN was very sensitive and respectful of, and that big cramp I was supposed to feel upon the insertion of my Mirena was nothing more than a bit of a burning sensation at the top of my uterus that went away within seconds.

Now of course, this was just my experience; unfortunately, I know others have had experiences far less positive than mine. But I wanted to say what ended up happening, and also recommend to anyone considering an IUD to inquire about having a cervical analgesic put in place before the procedure begins, as I can say it helped me tremendously. But in the meantime, thanks for everyone's support

So glad to hear everything went well for you (your GYN sounds fantastic).