The Intrauterine Device

I’ve got a poster in my examining room that captures a lot of interest; I call it my pasta poster. It’s a picture of a random assortment of interesting IUDs throughout history -including a couple of stones (Yes, stones have been used!). It often serves as a springboard for discussion of contraception back in the consulting room. Of all of the paintings, diagrams and anatomical pictures I have hanging on my walls, it seems to be the most popular -or at least elicits the most comments. Perhaps it’s the poster equivalent of an accident at the side of the road slowing traffic: morbid curiosity. And yet it seems to get patients thinking about birth control.

Inevitably, the stones at the very bottom of the picture get the most questions -or should I say incredulity. “I thought those were only for camels, doctor.” is a common observation, referring I suppose to the apocryphal use of stones as contraception for camel caravans crossing the desert. “I have no idea if they ever used stones in camel uteri,” I usually reply, and then, depending on the level of interest, go on to tell them of my own experience with them.

“Many years ago,” I often start, lapsing into my best story-telling voice, wondering if I should actually say ‘Once upon a time’. I half expect them to sit cross-legged on their chairs and fold their hands on their laps. “Many years ago a middle-aged woman was referred here to remove her IUD. It had been inserted several years before in a country somewhere in East Africa. She’d already had a few children and had been desperate to prevent any more until she and her husband had the means to support them properly. They’d moved to Canada shortly thereafter and only recently had decided to try for another child.

“She didn’t know the type of IUD that had been inserted, but had not experienced any problems with it over the intervening years. She was told it contained some sort of mineral, though, so I assumed it was a copper IUD. There are various types of IUDs that use copper -usually ones that are T-shaped (the inside cavity of the uterus is also T-shaped so the IUD conforms and is retained in a relatively stable position). She’d never been able to feel a string, and when she’d gone to her family doctor to have it removed, he’d been unable to see a string either. The doctor had felt I might be able to retrieve it.

“IUDs have strings attached to the shaft of the T -typically monofilament nylon so it doesn’t act like a wick and draw moisture (and bacteria) from the vagina into the uterus- and the strings are usually trimmed to stick out of the cervical opening  just enough for a patient to feel them and know the IUD is still in there, but not too short or her partner might be annoyed by the ends… But if the strings are not visible to the doctor using a speculum in the vagina, the IUD has to be removed with special instruments that actually go into the uterus to retrieve it.

“So I discussed this with her and prepared her for the possible cramps that inserting an instrument through the cervical opening and into the uterus would cause. ‘Just get it out, doc,’ she said. ‘Never mind me!’ She had clearly gone through a lot in her life, and when compared to that, nothing I could do in the office was likely to impress her.

“So I took her into the examining room, gave her something to cover herself with, and told her to call me when she was ready. When I came back into the room, I saw her looking at the IUD poster and smiling. ‘Sure a lot of those things, doc,’ she said pointing at the poster. ‘Which one you figure I got?’ I shrugged and pointed at one of the traditional copper T’s. I really had no idea.

“When I got her ready for the examination and inserted the speculum into the vagina I could see that the GP had been correct: no strings were visible. But maybe because of the light source I use to illuminate the cervix, I saw something else that he had apparently not noticed: a faint blue opalescent glow coming through the cervical canal from the uterus. And I knew what had been inserted those six long years ago in the little East African village health center: a semi precious stone.

“I have no idea how they did it, or whether it was pre-sterilized or maybe chosen off the beach, but there it was. I removed the speculum and when she sat up, pointed again to the poster but his time to one of the rocks at the bottom. You’ve got one of those, I said. I can’t remove it here in the office; I’m going to have to remove it in the hospital.

“I noticed she was smiling and nodding her head as I talked. ‘They told me it would be permanent,’ she said, ‘And they charged me extra…’”

In fact, I did eventually remove it under an anaesthetic in the hospital. I asked the pathology department to save it for me so I could give it back to the patient -or at the very least, put it on display near the poster to show other patients. But you know, I never got it back. Is it now a legend in the Pathology department and enshrined in a little glass box in a special corner? Or is some pathologist wearing it around her neck as I write?

I must visit the department again some time… Or would the presence of a gynaecologist -or any non-pathologist- arouse too much suspicion? After all the intervening years, though they’d probably think I was merely lost.

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