Monday, 29 June 2009

The journey (or, my sterilisation story)

Non-crafting, very long, personal, me me me post.

Warning: this post deals with matters relating to female biology, including menstruation, and contains one photo (work-safe) that some may find icky. If you are squeamish, or don't wish to read about such things, please come back later when I'll have a crafting post or two. And thank you for visiting. :)

I am childfree, not childless. I don't want kids, never have done. I was always an odd child and I sought out adult company, and was horrified if I was expected to play with other children beyond my very small circle of friends. I have photos of me as a young child clearly trying to avoid being made to 'hold' my baby cousins. As a teenager, years before I entered a relationship, I became acutely aware that I could become pregnant, and wondered if having a relationship was worth the risk. At the age of 24 I entered my relationship, but one contraceptive failure/morning after pill event had me researching and then running to the family planning clinic for an Implanon implant. I had a hard time persuading the FP doctor that I wouldn't want to try to conceive in the next three years - "I'm in the first year of my PhD" did the trick.

Despite gaining three stone in weight (42 lb) within the first year of having the Implanon (I also started anti-depressants during that year, which contributed to the weight gain), my periods stopping and the reliability of the Implanon trumped the fat and misery. Was my depression also caused by the Implanon? I don't know.

I was finishing my MPhil (no longer a PhD sadly, due to circumstances largely beyond my control) when my Implanon was up for removal/renewal. We had decided two years previously that sterilisation was the best option, however with the stress, my on and off depression, an impending house move and knowing no-one would take me seriously if I asked to be sterilised because I was only 28, I went to student health and mumbled a request for my Implanon to be replaced. It duly was, and the weight I'd finally managed to lose in the third year of my previous Implanon went straight back on although I continued with the same diet and exercise regime.

A house move later and with rising weight, depression and anger, I decided that when the second Implanon 'ran out' I wasn't going to bottle out of asking for sterilisation. It took a lot of plucking up courage as I have several medical phobias thanks to previous bad experiences, some worse than others - the worst are needles, cannulae and loss of control, but I also have fears of gases, tubes and doctors . The coil also sets off a deep disgust reaction as in my mind it too closely resembles the fish hooks I desperately tried not to impale myself on as a fishing teenager. And having no children is a red flag for requesting sterilisation. My partner and I went to the GP to get the referral. Here I was really lucky and I wasn't patronised or told I'd change my mind. My pre-prepared ten minute monologue of my reasons for why I wanted sterilisation proved largely unnecessary as my GP said I seemed well informed and we had clearly thought it over in depth. Since this was so important, we were running out of time (6 weeks to end of Implanon), I had researched local NHS waiting lists (possibly a year) and we were able financially, we decided to go private. This confused my GP somewhat but I gave her the list of consultants at the Spire Hospital in Edinburgh, and she recommended one as 'very good' and 'socially, the nicest.' I couldn't believe it had been that easy as I've heard numerous stories of women pestering their GPs for years just to get a referral.

19 days later, I was sitting with my partner in the consultant's office explaining my reasons, providing a medical history etc., a phone call was made and I had a surgery date for the following week thanks to a cancellation! I spent the rest of the day in a state of disbelief, then the anxiety set in - firstly about undergoing surgery then about after effects of the anaesthetic. Thankfully a week wasn't much time to get stressed, and soon it was the big day.

I couldn't believe it was actually going to happen, even when I was shown to my room in the hospital. The anaesthetist put me at ease and certainly seemed to know what he was doing (my medical phobias have been enhanced in the past by painful cannulation and a physically painful, psychologically bad anaesthesia experience that ended in me becoming enraged and aggressive when I woke up, and still haunts me with nightmares and flashbacks). My surgery was scheduled for noon and the only delay was the consultant arriving late, racing into my room with the consent form, getting my signature then rushing off again.

And then it happened. Changed into undignified surgery gear (yeuch itchy paper underwear), led to the theatre ante-room (I refused to hold the nurse's hand - hate being touched by strangers), up on the table, felt like drowning in the gas, crying out, briefly (and feebly) struggling whilst my voice seemed to become detached from my body, heard someone shout 'someone from theatre!' then... hearing people talking, being aware of a slight ache in my lower abdomen, then at the feeling of a blood pressure cuff inflating my eyes popped open and I had a panic attack followed by feeling irritable but relieved. The mask and IV were removed and I was given a beaker of water. I immediately demanded to see my partner and was told that I'd be taken back to my room in a few minutes and could see him.

Sure enough I was taken back, and couldn't see him straight away. I'd been conned! "Where's Sam, I want Sam!" Of course he was promptly retrieved from the visitors' lounge. By this time I was shaking uncontrollably, especially my legs (I assume some side effect of the anaesthesia). I was very hungry and thirsty, so sandwiches, tea and water were brought. After about 30-45 minutes I'd stopped shaking, and having eaten felt much better. I got up, used the toilet and got dressed. By 3pm, the nurse and anaesthetist thought I was good to go and after the consultant approved my discharge at 3.45 I was heading home... until I fainted outside the hospital whilst waiting for my taxi. Sam got me back inside, nurses were summoned and I had a seat and glass of water. Taxi was reordered, although the nurses were hesitant at letting me go - it turned out the roads were congested with people heading to the Oasis concert at nearby Murrayfield Stadium.

The trip home proceeded without further incident and I was home by 5pm. I sat on the bed with the EeePC and managed to check my email and Facebook before falling asleep listening to Morphica (a former flatmate of mine is one of the 'voices' on some tracks). After pizza and a good night's sleep I felt much better. I had been equipped with loads of painkillers, but I didn't feel I needed them. I took the ibuprofen for the anti-inflammatory effect - almost because I felt obliged to. Then I sat and waited for the shoulder pain to begin (with this kind of surgery, the abdomen is often inflated with gas, and unless it's very well removed at the end of the surgery, it can irritate the diaphragm and cause shoulder pain), but it didn't. It was almost an anticlimax, although I'm glad I didn't experience it.

I consider myself extremely fortunate to have had a remarkably pain-free recovery. I did have some strange pains I wasn't expecting, and until day three post-op laughing was painful, then I got hayfever for only the third time in my life - and the sneezing, that was SORE!!! 13 days postoperatively I still get odd twinges which can be very painful, but mostly I'm pain free. Just have to be careful not to overdo things. I'm immensely relieved that despite my medical phobias, the experience hasn't exacerbated them as I've had no flashbacks or nightmares and I felt my phobias were handled sensitively. Sam noticed within two days that I seemed much happier in myself. I can't decide if this is because I no longer feel like I'm at war with my body, or because I confronted my phobias and had a positive outcome, or a mixture of the two. I have two incisions, one in my navel (see pic, ten days post-op, cunningly disguised as a vertical crease, right next to an actual crease - the faint right-left diagonal line is the loose end of the stitch) and one on my lower abdomen (no pic, that would be verging on pornography):


I could still be the unlucky one who has a failed procedure (1 in 200, to 1 in 500 depending on who you believe), but that's unlikely. I have no doubts I made the right decision. Of course, I was also very fortunate to be in a position where we could go private - but this also meant so much to me and I have had a terrible NHS experience in the past. Being sterilised is not an option to take lightly, particularly if you have any doubts, or the slightest inkling that you may want children in the future. Although type of procedure I had - laparoscopic sterilisation with Filshie clips - is reversible at a high cost as the NHS won't cover it, the chances of conceiving after a reversal are extremely variable, depending on damage to fallopian tubes, the age of the woman and so on.

The only hesitation I had in my mind about getting sterilised rather than getting another Implanon was:

The Return of the Period

Periods are yuck. I haven't had one in five years thanks to the Implanon. I was sent home from school several times as a teenager due to severe period pain (doubling up in pain, turning grey and almost fainting, having to be half-carried to the school nurse's office etc.). It settled down a bit in my early twenties, but periods are a source of nastiness for me, and together with the accompanying stomach upset it's all pretty grim.

However, with my post-sterilisation happiness level I have decided to take the plunge with a Mooncup and reuseable pads. Due to spotting after my surgery, I had to venture into the feminine hygiene section of Tesco for the first time in years, and it was just plain confusing - pads for thongs, regular pants and shorts, blue gel filled pads, with 'cotton', with 'silk', scented (?! That can't be good for the ladyparts)... - how it's changed in the last five years. I recycle, buy organic local and fair-trade, try to minimise packaging, grow my own veg as far as possible, compost etc. so I definitely shouldn't be using disposable sanitary products. I used to think mooncups and reuseables were disgusting, but now I'm willing to give it a go and thinking about it, disposable tampons and pads are horrid. My Mooncup and reuseable pads arrived in the post this morning and I'm impressed. The mooncup isn't as big and scary as I'd heard, and the pads are really nice - seems a shame to bleed all over them. I don't think it's smelly hippyish at all, though yes sometimes I think I was born in the wrong decade, and yes I sometimes smell of patchouli, so draw your own conclusions. But really... all that plastic and fibre ending up in landfill or the sea, plus the energy, resources, bleach etc used to make disposable sanitary wear; definitely time for a change. I'd much rather have a layer of nice fuzzy fabric next to my skin than that plasticky disposable stuff that gets hot, sticky, lumpy and scratchy.

Well done if you got to the end. I didn't intend this to be my memoirs, it just got longer and longer and longer... These are events as I interpreted them, and events around anaesthesia may differ slightly from my memories of them.

Don't ask me why the text formatting went wonky after the photo. I have no idea. Weirdness.


Zu said...

Wow what a story! I'm glad your surgery went well and can understand how scary it must have been.

I'm off to research mooncups. :-) Never heard of that before.

Laura said...

Thanks - I was actually a bit less sressed about this surgery than about my eye surgery 9 years ago, though I think the short wait between the initial consultation and the surgery helped (whereas for my eye surgery it was a 4 month wait as I was having implantable contact lenses which had to be custom made in Switzerland). Now I just wish the stitches would disintegrate but I think I'll need to get a nurse's appointment this week to get them removed. I'm all healed up but the stiches are making my skin pucker. :(

I think mooncups are definitely for people who have no problem 'rooting around' - I had a trial run with mine and it went well, so hopefully it'll work out when I actually need to use it. Apparently it can take about three cycles to get totally used to it. Thankfully my partner is less squeamish about things like periods than I am...

Zu said...

Oh wow I would have been freaked about eye surgery! I didn't even know you could get implantable contact lenses!
I'm really thinking about giving the mooncup a try. I would definitely feel sort of unprotected though. Maybe a bit gross for a while as well.
Mooncups would be a great idea for all those women in poor coutries that can't afford sanitary products huh?!

Carol said...

I'm planning on asking about getting snipped this year. Fingers crossed my doc doesn't give me a hard time.

I tried a Divacup a while back. Sadly, my parts aren't set up right and when I have one in, I can't pee! I had the same problem with a diaphragm years back and so it appears my urethra is too close to the vaginal wall. Damn, I really liked the idea...

Laura said...

Zu - yes, I'm worried about feeling unprotected and yucky, but we'll see when the time comes.

Laura said...

Carol - best of luck with your snip quest. I was really lucky with my referring doctor - as she was only a year or so older than me she couldn't do the 'you'll change your mind' thing, but what I think really swung it was that I had done a lot of research. I don't know if you have any academic training, but if so, treat it as a research exercise so you can go in there being prepared to discuss it in depth and with confidence - I have two postgrad degrees so I wasn't at all intellectually intimidated. Also make it clear it's a long term decision - they have to be convinced you've thought long and hard about it.

Too bad about the Diva cup - I had a practice run with my Mooncup and that same problem, so I hope it was just a case of bad positioning and I can sort it out. I haven't had a chance to try my Mooncup properly yet as I'm still trying to get my flipping Implanon removed (hopefully it will happen on Thursday but I'm trapped in some inefficient NHS bureaucracy).