The first time I got a coil fitted, I vomited on the nurse. Horrified and full of apology, I told her I didn’t know what had happened. “Don’t worry,” she reassured me, “it’s perfectly fine and normal.”
I had no idea what “perfectly fine” or “normal” meant, because I had no idea what the procedure actually involved. I didn’t know what a speculum was, or even what my cervix was (thanks, UK sex education system of the early 2000s). So, I laid back and spread my legs.
When the pain came it was intense, moving from gentle cramping in the taxi home to full-blown contractions which lasted for two weeks and eventually stopped me from going to work. By the end, I was begging the doctors in A&E to take it out. As it transpires, the device hadn’t quite taken properly and I’d developed an infection. The pain stopped as soon as it was out and I took a course of antibiotics. I thought to myself, ‘I guess I’m just not built for coils, then.’
Maybe I never would have tried again, had I not accidentally fallen pregnant a few years later. I needed a more reliable form of contraception – something that wasn’t the pill or condoms. The next time was much easier. A few years older, and much more clued up and chilled out about people digging around in my vagina – both the result of the aforementioned pregnancy (and abortion) – the coil “took” a lot better. A few days after the procedure, the cramps subsided.
Coils have been hitting the news of late, but not for a good reason. After BBC presenter Naga Munchetty shared her experience of having one fitted, calling it “one of [her] most traumatic physical experiences”, a conversation started about the varied experiences that people have when undergoing this procedure.
In response to a tweet of mine, many shared horror stories. Twenty-nine-year-old Lexie said she “screamed the surgery down when they inserted it and had full contractions for the next 24 hours”, while 61-year-old comedian Jenny Eclair said she “ended up in hospital with pelvic inflammation and [the] coil trying to eject itself” – a similar experience to mine. “My fitting was only attempted because I almost fainted and hyperventilated,” said 29-year-old Georgina. “I couldn't feel my hands or legs for about ten minutes after they stopped.”
It’s easy for the experiences of individuals to cluster together online and resemble a definitive conclusion. But according to Dr Jane Dickson, Vice President (Strategy) of the Faculty of Sexual and Reproductive Healthcare (FSRH) – and a practitioner who fits “maybe 300 to 400 coils a year” – these experiences are more like the exception than the rule.
“At least 90 percent of women aren’t going to have any problems,” she tells me over Zoom. She believes that increased anxiety will only make the experience worse, and has already noticed many people arriving in her clinic terrified of the procedure after reading about bad experiences online.
So what is going on? Let’s start with the basics. “Intrauterine devices [IUDs] are extremely effective and safe forms of contraception that have enormous gynaecological benefits,” says Dr Dickson. She reckons a lot of the bad experiences people are describing are likely due to a trend she’s observed in recent years: an increase in younger people who haven’t had children having coils fitted.
Fitting a coil involves pushing it through the cervix (the opening of the uterus), where the little T-shaped device will sit, with strings hanging down into the top of your vagina. “The resting diameter of a person’s cervix opening who has not had children is probably around 2mm,” explains Dr Dickson, “whereas for those who have given birth, this is more like 4 to 5mm.”
The average coil is around 4mm, which explains why someone who has given birth might find the process easier. The good news is that “the cervix is made of enormously stretchy tissue”, says Dr Dickson, “so is easily manipulated.” But as you might expect, this has the potential to cause pain for some people.
According to Dr Dickson, potential points of pain during the procedure occur when the speculum (the instrument inserted into the vagina to help the practitioner see what they’re doing) is inserted – “If you have any pain at this point, or suffer from issues of tightness related to vaginismus or a hypertonic pelvic floor, then smaller speculums are available” – when a clip is placed on the cervix to hold the uterus steady and avoid damaging it during the insertion – “this feels like a sharp pinch” – and when the cervix itself is opened, which, as described, causes pain in some and not in others.
The level of discomfort you may experience is dependent on many factors, including your level of anxiety, as well as any normal anatomical variation, such as the positioning of your uterus (mine points towards my bum, for instance). It’s also important to remember that many women have a coil fitted with little or no complaint. “I think because I was expecting it to be so awful, I was pleasantly surprised – it was uncomfortable, like having bad cramps, but not unbearable, and I was lucky enough to have a trainee nurse in the room alongside the doctor, whose sole job was to talk to me and distract me,” says 27-year-old Meena.
Dr Dickson says that if you feel anxious, you should definitely tell the person fitting your coil. “There are many things we can offer to help to put you at ease, such as a chaperone, who can talk to you during the procedure to help you relax. In non-COVID times, you could also bring a friend or partner along into the room.”
Another option is a local anaesthetic injected into the cervix directly. “I’ve seen a lot of people talking about numbing gel online – but this is mainly used as a lubricant to help get the device in, rather than for pain relief,” Dr Dickson says. If you are worried about pain, Dr Dickson says: ask for the injection. “People are often put off by the idea of the needle, but it’s like when you’re at the dentist: briefly uncomfortable, but you’d never have a tooth drilled without it.”
Dr Dickson says a good practitioner will pick up on your anxiety and offer the injection straight off the bat if they perceive you to be struggling. But given the immense pressure the NHS is under, because of chronic underfunding, clinicians are often overstretched, particularly in a GP surgery. “If you feel in any way nervous, I’d recommend going to a dedicated sexual health clinic if you can,” says Dr Dickson, where practitioners are more likely to be fitting ten coils a week, rather than ten a year like in a GP surgery – and are therefore experts.
Although not everyone experiences pain, Dr Dickson says that cramping for a few days after the procedure is to be expected. If it is extremely severe, prolonged or seems to be getting worse, though, she says you should contact the clinic that put it in for you, as it may mean something isn’t quite right. She recommends taking painkillers a couple of hours before the insertion to help to reduce discomfort, and to make sure you eat and drink something beforehand to minimise fainting spells and nausea. These, she says, are down to the “powerful nerves in your cervix”, and in particular the overstimulation of the “vagus nerve”, which can make you feel woozy or nauseous.
None of this is a given, of course. Thirty-three-year-old Olivia says that while she’d “heard some horror stories” she found it “totally fine”. “I went in on my lunch break and was back at my desk in an hour,” she says. “For me, because I had some really awful experiences with hormonal contraceptives, it’s been a positive change.”
For 25-year-old Lauren, it was the same. “I got it in when I was 22, 23, and it’s been a godsend,” she says. “I was lucky in that the initial insertion pain was very brief and momentary for me.” Although Lauren later experienced “extreme cramps, like I was being punched in the belly over and over”, these subsided after a few days. “For the first time in my life,” Lauren says, “my periods are like clockwork and never heavy or painful. Hormones made my anxiety a billion times worse, so the non-hormonal IUD has significantly improved my quality of life.”
It’s clear that the experiences of different women are extremely varied. This boils down to a couple of different factors: a lack of comprehensive research into women’s health (the UK’s Department of Health recently launched a strategy calling for evidence to try to address this, but progress remains to be seen), and a pervasive shame around our bodies that means many of us either feel ashamed to ask questions, or to tell one another what we’re going through for fear of judgment.
This must be addressed through improved education, more open conversations in medical settings and a commitment by the government to close the gender health gap. While we wait for that, resources like The Lowdown – the world’s first contraception review platform – have popped up to help to improve our access to knowledge so we can make more informed decisions about our bodies and know what to expect.