Wednesday, May 12, 2010

Disability and birth control: part three

This is the final part of a series for Blogging Against Disableism Day. Part one and part two ran previously. See more of BADD 2010.

After I tossed my birth control in the trash, things were pretty okay. My mind was in line, condoms and withdrawal (a tip from another friend) served me just fine, and when it didn't, Plan B didn't knock me too far out of line (at that point).

But after intercourse one night, I had some nasty gas. Or cramps. Something that made me double up next to my partner on the twin bed in his dorm room for an hour. It passed, I went to sleep, and didn't think about it much the next morning. The next day, at work, I doubled up again, on a couch this time. I could not walk it off. A student who had an appointment with me came in, and I had to beg off. I waited a few hours and then called my roommate to take me to the hospital.

After several boring hours at the hospital, pain going in and out, the verdict was returned: ruptured ovarian cysts.

"Could this be caused by birth control?" I asked a nurse. "Certainly, honey!" she replied. I was relieved - I threw that stuff away.


I recovered well and went to a male gynecologist whom I was comfortable with, even when he described the discomforting image of my ladybusiness filled with blood from the ruptured ovary. Months passed. In the late summer, I went back in for a check-up. Things were fine until Dr. Man called me into his office. "So, what are you doing about birth control?"

"Well, we've been using condoms and pulling out, but I'd really like to talk about maybe getting a diaphragm or an IUD?"

"Oh no. I only prescribe non-hormonal methods to people in stable relationships."

"Well, I've been with my boyfriend almost two years now, and we're pretty..."

"No, I'm talking like... mortgage, kids together. You're not ready for that yet. I think hormonal methods are much more appropriate for you." He smiled.

"Well, you know, I think that the pill might have caused the ruptures? - "

"Oh, no, that's not possible. This will actually prevent them!"

"But didn't like it that much the first time around, it didn't make me feel good, you know, mentally?"

"Sometimes you have to try several different kinds. It takes a while to get the right fit."

"But I'm not good at taking pills - "

He smiled, and pulled up a NuvaRing, and talked me into it.

Never mind that I said I was uncomfortable. Never mind I said I was looking for a non-hormonal method of birth control. Never mind the strife and pain and suffering that trying hormonal methods, of searching for the "right" (read: hormonal) fit. Never mind that I researched and requested specific other methods. Never mind that I already had a reliable and effective method of birth control.

I was judged too young, too immature, too unstable. I am a woman and a person with disabilities, and for that reason, my input on my own body was dismissed, and another method that had already proved harmful was pushed upon me.

Now, I should say this: I'm sure that HBC can help people with ovarian cysts. But they don't help me - every time I've taken and gone off HBC, I have had ruptured cysts within a few months. I had never had them before I started HBC, and I don't have them when I'm not on it. In some women, HBC and ovarian cysts are unrelated, or helpful. For my body, it's a causation.

Ruptured ovarian cysts are one physical, temporarily disabling ramification of hormonal birth control for my body. But the major tremors were, as I've belabored, mental.

In the month I was on the NuvaRing, I was anxious. I was angry. I was out of my head. I couldn't concentrate, on anything. My sex drive plummeted and I couldn't climax. I deal with OCD on a daily basis, but this was different, meaner. The obsessions and compulsions were full of rage. The trichotillomania was almost violent.

The tipping point finally came when I screamed at a close friend and broke my phone in a rage...brought on by a lost puzzle piece.

(I think this is funny, in retrospect.)

I took out the ring the next day.


Things were good, for a year or so. I wasn't on any kind of hormonal birth control, and I didn't get pregnant. I was busy. I wrote two honors theses, graduated with honors, got a temporary job with health insurance, found the perfect apartment with my partner. One afternoon, though, our usual methods malfunctioned, and I had to take Plan B. It most likely wasn't necessary, but my anxiety surrounding pregnancy was only relieved by being extra-careful.

A month later, I went into an anxiety tailspin - deep enough that I am still dealing with its ramifications. I had health insurance, so I got therapy and went to a female gynecologist who encouraged me to look into non-hormonal methods. Getting service from her was too expensive, but another friend recommended a local abortion clinic, who fitted me for a diaphragm for only $25.

I had to try two different sizes. Figuring out how to fit it was frustrating enough to inspire a tearful phone call to my mother. The tubes of spermicide are expensive. It's a pain to remember to take it out the next day.

But getting a diaphragm was the best decision I've made regarding my fertility.

For the purposes of curious readers contemplating different methods of birth control, I'll describe my system with my partner. After foreplay and before intercourse, I insert my diaphragm (it's easier when I'm aroused). We go for a while without a condom. I am comfortable with because withdrawal is 97% effective when used consistently and correctly, because we have both been tested and neither of us have STIs, because we have been monogamous and stable for four years and I trust him, because it feels pretty awesome, and because I have a diaphragm in in case of early ejaculation. When my partner feels that it is necessary and after I have climaxed, he puts on a condom, and finishes.

This is satisfying, exciting, and I feel comfortable and confident in my methodology. Mistakes are rarely made, and there is always a safety net in the case of an accident. We are able to plan our family and our life without worrying about unexpected conception. I have little to no anxiety, even when my (often irregular) period is slightly late.

This is the right method of birth control for me. It was hard won, but you know what? It's an accomplishment in self-care, and I'm proud of it.


In concluding this series, I want to reiterate that hormonal birth control can be wonderful and liberating and healthy for many women. This is not a diatribe against hormonal birth control in and of itself. If this works for you, I am so glad.

So, what are the lessons I want to communicate to readers facing choices about their method of birth control?

As with any other decision we make regarding our body, our choices are judged and policed. This is not okay. You should not have to use birth control. You should not feel that you have to use any particular method of birth control. While doctors and partners and friends and mothers are worth listening to, it is your body and your health, and you can do what you want with it. Your body and your reproductive system are yours, and you and no one else knows what is best for you.

Doctors are not the only source of information on the topic, and they cannot dictate what you should do. They are prone to bad advice. Doctors do not know everything and are subject to biases that can block you from finding the method that's right for you. Diaphragms are a valid choice. So is withdrawal. So are condoms. So is the sponge.* So are hormonal methods. There are other methods than hormonal birth control, and hormonal birth control is not right for everybody.

Only you have the right to make decisions about your reproductive health, but that doesn't mean that you don't need help. The words of other women are powerful. Your mother, your friends, your mentors, may very well have information and stories to share. Ask women you trust about their experiences, and talk to them about your options and feelings.

*Thanks to Liss for reminding me of this method!


  1. A week ago tomorrow (Thursday) I had my Paragard inserted. After years of being perfectly happy with NuvaRing, and hesitant to use a more permanent method of birth control when I was having infrequent sex, I've finally reached a point where I was comfortable saying "Baby-free till 2020!"

    Beyond that, I've started to wonder (largely in part to your story, RMJ, since I know you) if being on HBC has contributed to my anxiety and depression-- at least as triggers for conditions I am genetically prone to. Particularly in the last year I've faced a lot of trouble with those twin demons, and recently started trying to figure out how to get back to the okay I was years ago. Sure, the early twenties are a trigger time too, but I'm giving this a shot.

    And yes, I'm still cramping, but for the chance to be hormone-free and able to have a sex life without worry? YES PLEASE.

    One thing: I have an excellent, young female doctor who respects the fact that I worked in an abortion clinic, and know my way around birth control. I told her in no uncertain terms that I'm aware of the risks of having an IUD without having had children, and without having one partner (I tend towards polyamory)-- and I told her that I wanted what I felt was the best choice for me. I was lucky enough to find a doctor who respects that.

    So, just as a final word, keep in mind that Your Right Birth Control can change as your circumstances, your feelings, and your relationship with yourself and others change. And that's okay, too. We're human, change is what we do.


  2. I felt so lucky that I was able to get my Mirena without a headache - I'd done a lot of research, and after taking Plan B, I knew that I wanted the IUD both for itsself and for the extra boost of emergency contraception.

    Normally, I'm kind of a pushover with doctors, but I think I lucked out in getting a good guy (who was über-sympathetic when it came to insertion issues), and I avoided a ton of problems I never knew I might face. Other nulliparous friends got HUGE amounts of pushback when trying to get IUDs, and I've had a few NPs tell me that they were amazed I 'was able' to get one.

    These are medical supplies, not limited edition Fendi bags. 'Trust women' really needs to be taught, retaught and taught yet again as part of med school, because the paternalism than can show up when it comes to this stuff is crazy.

  3. I've read this series with interest. Thanks for it.

    My own experience with birth control was relatively easy. I knew nothing about it when going on it, and was a little ashamed of that since I was already in my twenties. However, my GP and one of my support staff educated me quite well about all options, including non-hormonal birth control, so that I was able to make an informed decision. I am one of those who is happy with the pill so far, but I know that I can switch if I need/want to.

  4. Great posts. I haven't had the best experiences with HBC, either. I had issues with Depo Provera, and Nuvaring appears to have been a contributing factor in the blood clots + pulmonary embolisms that I had in December. I'd been thinking about an IUD for a while, and after the blood clots I can't use any HBC that contains estrogen (and I'd rather not use any hormones at all), so finally bit the bullet when I got home from the hospital. Fortunately the gynecologist my GP recommended was great about the whole thing. I didn't get any flak (from either of them) about being unmarried--though I am in a going-on-five-years relationship, so maybe that helped.

    And I totally agree with Alice: "trust women" needs to be taught early and often.

  5. Hi, I came over from Shakesville, and wanted to thank you for this series. HBC can be a great option for a lot of people, but it's sure not for everyone. I used a low dose pill for years (often going on and off it because of mood issues) and then only quit for good because I had a blood clot.

    Now I'm using Mirena, which still has hormones in it but I guess they don't circulate in the system like the pill.

    We really need doctors to know about ALL the options, not just the ones they personally would like to give out.


  6. Hi, also here from Shakesville. Terrific series; thank you!

    This has made me even more aware of what a wonderful OB/GYN I have; at my most recent annual exam, I told her my new insurance was not covering the NuvaRing very well and would like to talk about other options, and she, knowing my previously-stated reluctance to rely on my ability to regularly take a pill, suggested an IUD. I was actually really surprised; those ridiculous tv commercials stop just short of saying "you have to have had a baby and be married to get this" so, silly me, I thought I couldn't get one. After she explained the whole thing to me, my first thought was "Wow, this sounds awesome; how come nobody talks about this?" She didn't even ask me about my relationship status; it only came up when I told her my misconceptions.

    It only recently occurred to me that my low sex drive could be because of HBC; I got on the NuvaRing before I was regularly having sex, so I can't really tell if it's the problem now.

  7. I came over from Shakesville too.

    One method you didn't mention is the rhythm method, which if used correctly has just as good a rate as others. I think this one isn't talked about as much because it relies on knowing your body (which hey, society doesn't seem to like) and having a very strong communication with your partner (something else not really promoted).

    I'm personally on yasmin right now, though I'm debating about staying on. I haven't had bad side effects *knock on wood* but it isn't going to be needed for the next few months so...

  8. this post was really inspiring to me. As someone with a mental illness, in a long term relationship, NOT having vaginal intercourse, I really dread going to the gyno and being pushed around. I track my periods, use a menstrual cup, know what different cervical mucus means, know what my cervix feels like. I need a doctor who can understand and respect my decisions without making judgments about me and my significant other. Its really nice to hear that it CAN be done!

  9. Just want to pop in and thank everyone for sharing their stories and ideas. ohands, yes, you're totally right, thanks for bringing that up :)


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