How to Get Down Without Getting Knocked Up

TW: Consider Yourself Warned

I love sex!

Hours-long, fully immersive, creative, mind-altering, transcendental play.

I’ve recently discovered (or been shown?) my body’s capacity for multiple orgasms. I’ve also achieved sequential waves of concentrated edging that felt like I spilled over into hallucinations. Which came as a surprise considering I’ve been stone-cold sober for years. I’ll write you a story about edging towards ecstasy in the future. But first, we need to cover some medical logistics.

To the select men who I’ve graced with mind-blowing orgasms; YOU’RE WELCOME! I spent a lot of time, money, effort, and bodily sacrifices ensuring that your ejaculation didn’t result in a lifetime of parenting and child support.

If you’re a dude who’s been granted the privilege of ejaculating into the body of a woman without having to pony up for half of the $350,000 that it costs to raise a child in the US, thank that woman and the availability of effective contraception.

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On to the Good Stuff…

I’ve spent my adult life having sex of variable but improving quality while avoiding pregnancy. Never have I ever looked at another human being and thought, “I want to raise children with this person.” Maybe that’s because I’ve seen firsthand the difficulties that parenting bring into a romantic relationship. As a pediatrician, I’ve witnessed the dissolution of countless partnerships and helped coach many couples through the process of uncoupling; including the transition into amicable(-ish) co-parenting.

More likely, my Herculean efforts to avoid pregnancy stem from the fact that I’ve simply never wanted to be a mother. After spending a significant portion of my 20’s being a primary parent to someone else’s child, my lack of enthusiasm for the work of parenting was solidified. In retrospect, I appreciate the clarity provided by my de facto step-parent experience.

In my calculated avoidance of childbearing, I’ve used a variety of different birth control methods. I was started on oral contraceptive pills (OCPs) as a teenager before I even became sexually active. I was told I had elevated levels of testosterone that needed to be regulated with estrogen and progesterone.

When I gained weight as a result of taking the Pill, my adolescent brain got the brilliant idea to take up smoking as an appetite suppressant. (Spoiler Alert: This is not an effective weight loss strategy! Plus, there is an increased risk of blood clots in smokers who take birth control pills). That stupid plan lasted for 8 years until I quit cold-turkey at age 24.

I switched from OCPs to medroxyprogesterone (Depo Provera) shots in my 20’s because I had a hard time remembering to take the pill. The shot, injected once every 3 months, didn’t cause weight gain and had the added benefit of halting my periods entirely. I stayed on the shot for most of my 20’s and early 30’s. Unfortunately, studies have shown that prolonged use of medroxyprogesterone can cause problems with bone mineral density. So in 2017, I switched once again. This time to a more permanent form of birth control: the intrauterine device (IUD).

The IUD is an increasingly popular method of long-term birth control that has many benefits over other methods. Once inserted into the uterus, it lasts for 3-10 years; depending on the brand. IUDs are more than 99% effective at preventing pregnancy. There’s no need to remember to take a pill every day; there are no increased risks of bone loss; no dealing with barrier methods during sex with trusted partners; no awkward hassles of implants, rings or patches. Short of surgical sterilization, it’s the most surefire way to avoid pregnancy.

But the insertion of the device can be gruesome! Especially if the people coordinating the procedure don’t adequately prepare the patient. When I had my first IUD inserted in 2018, I made an appointment with the academic family medicine clinic where I was a NICU fellow at the time. As so often happens when becoming a “New Patient” at a busy practice, I was assigned to “whoever is available”. In my case, a Physician Assistant (PA) who had less education and clinical experience than I had. No one bothered to tell me before my appointment that this procedure is exquisitely painful. If you’re a guy, the best comparison I can give you is having a metal rod shoved up your urethra (pee hole) without any lubrication or pain killer.

The nurse who checked me in asked if I had taken Motrin prior to my arrival. When I asked “Was I supposed to?”, she laughed at me. After giving me 600mg of Motrin and a paper cup of water, I was ushered into a cold procedure room and instructed to put on a paper gown with nothing on below the waist. Once undressed, my feet were placed in stirrups and I was instructed by the PA to “scooch” all the way down. Keep going. Keep scooching. Your butt should be falling off the exam table.

Once in the spread-eagle position, the PA inserted a cold, plastic speculum covered in medical-grade lubricant into my vagina. When done correctly, this technique causes the cervix to pop into view for the clinician. (You can learn more about the cervix and female pelvic anatomy here.)

Now comes the hard part. A long, surgical-steel rod is inserted through the opening of the cervix and pressed into the uterus to establish depth. But here’s the kicker: in a woman who’s never had a baby, the cervix has never been dilated. Which means this incredibly sensitive organ, laden with parasympathetic innervation and capable of visceral, excruciating pain, is being stretched out in a way that feels like being torn apart from the inside. Nurse Motrin held my hand while I screamed “MOTHERFUCKER!!!” and tears streamed horizontally down my face. There’s no doubt that the people in the waiting room heard my tortured swearing.

After the PA took the steel rod out of my uterus, she proceeded to make a second excruciating pass through my cervix to insert the plastic device that held the actual IUD. This second pass through the cervix allowed her to deploy the tiny, hormone-infused contraption into my uterus. The insertion complete, she removed the plastic rod from my cervix, removed the speculum from my vagina and chirped that she was “All Done!”

Again, no one bothered to tell me that I should probably take my time getting into an upright position. My heart racing, blood pressure dropping and tears streaming down my flushed face, the assault on my parasympathetic nervous system came raging into full awareness. I felt like I was going to vomit, shit my pants and pass out all at once. For better or for worse, all the clinicians had left the room. I rushed to pull my pants on and run to the toilet before my ass exploded. Which it did as blood tricked out from between my legs. It took every ounce of focus to keep myself from losing consciousness as my vision narrowed and stars began to obscure my visual field. I put my head between my knees and took several long, slow, deep breaths as I shoved down the powerful urge to vomit.

Once I was able to align my gaze on my shoes, I slowly lifted my head. From there, I returned to an upright, seated position; still on the commode but thankfully with only one gastrointestinal orifice having exploded. I got myself clean, pulled up my pants and hobbled feebly out of the stall. As I washed my hands, I wiped tears and mascara off my face. I still had a hard time standing up straight and was filled with rage that Nurse Motrin had the nerve to laugh at me because of their complete lack of preparation for this horrific procedure. I somehow managed to drive myself home and proceeded to spend the weekend curled up in bed. Fortunately, I had some left-over tramadol from a recent foot fracture that I took to manage the ongoing pain while passively wishing I were dead.

Several days later, I was back to baseline. And for the 8 years since having that IUD put in, I’ve never once worried about pregnancy.

Why am I telling you this horror story?

Because this week, I went in for my second IUD placement. This time, it’s been done by an experienced physician gynecologist who recognizes the importance of pain management. I made arrangements for a ride to and from the clinic so that I could safely take prescription medications to mitigate the pain. My schedule was cleared and close friends notified that I might be out-of-commission for a few days.

Only recently has IUD insertion been recognized as a procedure that warrants either local or systemic pain control; ideally both. I’m not sure why it took so long to acknowledge the suffering caused by this important medical intervention but it probably has to do with the fact that women’s pain has been systemically dismissed by the medical establishment for generations. Most women can tell you a story about having their concerns blown off by a healthcare provider. Many can tell you stories of abject medical trauma.

I’m grateful that I have the access and means to navigate the healthcare system and avoid pregnancy altogether. Not having children has been one of the most liberating and defining decisions of my entire life. Along with the decision never to marry.

But the fact is that many poor and marginalized women aren’t so lucky. Many women simply don’t have the education or financial means to secure effective contraception. One in four women/girls will be sexually assaulted in her lifetime. Some of those assaults result in pregnancy. In a growing number of states, these rapes will result in forced birth.

It’s bewildering to me that Americans are deprived of the basics of reproductive education. As of February 2024, only 18 US states required that sexual health education be medically accurate.

As the right to terminate a pregnancy is being stripped away in many parts of the United States, the timing of my IUD replacement is no coincidence. I want to continue having soul-nourishing, transcendental sex without the lifetime commitment of parenting another human being. For now, at least in Nevada, it’s my right to do so.

Afraid of commitment but value my unique perspective? You can make a one-time, commitment-free donation here.

Resources:

Many physicians decline to perform surgical sterilization on adult women who are unmarried and don’t have children. A crowdsourced list of US-based physicians who will sterilize women over 21 years of age upon autonomous request can be found here.

Hey Jane is an online resource for birth control, emergency contraception, medication abortion and STI treatment. State level restrictions on healthcare may apply.

Planned Parenthood: Adolescent patients can access information and treatment for sexual health concerns without parental consent in most states. Including HPV vaccination, birth control and treatment for sexually transmitted infection. Planned Parenthood remains a stalwart in the provision of affordable and equitable sexual healthcare.

State-level information on minors’ access to contraceptive services can be found here.

If you find this content valuable and know someone who would benefit from reading it, please click the tiny heart and share. This Substack is my irreverent little way of offering medically accurate sexual health education to the public (and maybe a few open-minded doctors as well).

Under the White Coat News:

• Male Anatomy 101: From Plumbing to Pleasure is now available to my paid subscribers! I put a lot of work into this and it’s far less expensive than what you’d pay in your doctor’s office.

• On Saturday, November 23rd at 1:00pm, I’ll be hosting a Book Club to discuss The Anxious Generation by John Haidt. We will do a roundtable discussion of the book, it’s critiques and the role of technology in the lives of children more broadly. You can purchase the book here and register for the book club here.

• I’m currently taking a Continuing Medical Education (CME) course on Sexual Health in Menopause. This work includes up-to-date information on topical and systemic Hormone Therapy. I’ll be breaking down what I learn and making it accessible to subscribers in the coming weeks.

• I’ve been invited to give a presentation at the joint conference of the International Society for the Study of Women’s Sexual Health and the International Society of Sexual Medicine. The topic is legal frameworks, human trafficking and equitable healthcare for sex-workers. My goal with this project is to give voice to millions of stigmatized and marginalized people around the world. I’ll share what I learn as I prepare for this important talk.

• In celebration of Sober October, I’ll be posting my interview with Sober Sexpert Tawny Lara, author of Dry Humping: Dating, Relating and Hooking Up without the Booze. Buy the book here and check out our talk about the role of liquid courage in human sexuality later this week.