Lucy was always a good kid. She worked hard in school and stayed out of trouble – her parents hardly had to worry about her. Sex, though, was her one act of rebellion.
“My older sister would go out and party,” Lucy said. “That could get her into trouble with more than just our parents. She could have lost scholarships, it could have affected her schooling. For me, sex didn’t do any of that, it just ruffled some feathers, and I felt like it was something I could control.”
Lucy became sexually active when she was fifteen years old. She had been interested in sex from a young age; it was something she saw often on TV, she heard about it in music, it was alluded to in magazines and advertisements. At the same time, no one spoke openly about sex. This created a sense of mystery surrounding the act that drew Lucy’s attention.
“I realized that my parents couldn’t control whether or not I had sex,” Lucy said. “I realized relationships could be very focused on sexual acts, like giving and receiving, and it's within the privacy of two people. When I was young I was really interested in that dynamic, and as I grew up, I realized that no matter where you go, people are gonna be having sex. It’s something that happens everywhere, just like everybody eats, everybody has sex. So if you know a lot about it, or if you are good at sex, you can use that to your advantage. I got smart early on as a woman knowing how powerful sexual attraction is. Sex is a very powerful tool.”
The first time Lucy had sex, her and her boyfriend used a condom. It was not his first time, so he provided the condom and knew how to use it. Lucy asked him once about STDs, and he said he was “clean,” meaning though he’d never been tested, he exhibited no symptoms. And after the act, Lucy felt guilty. For the first time in her life, she had broken the rules. While she was growing up, at home and in school, there was no positive conversation surrounding sex; there were conversations about unwanted pregnancy, and conversations about sexually transmitted diseases, and conversations about abstinence. She had done the one thing of which no one had ever spoken fondly, and she couldn’t undo it. She confided in her older sister, who told their parents soon after.
“It was really hard for my parents when they found out,” Lucy said. “I remember my dad not really talking to me, he felt uncomfortable and disappointed. So I ended up just talking to my mom about things. The conversations were mostly about abstinence, like, ‘You could still not have sex, try not having sex.’ Eventually we talked about getting on birth control when they realized I was gonna keep having sex.”
Lucy lived in a small rural town – population: 3,000 people – and the gossip among community members was ruthless. She did not want word to get around that she was having sex, and her biggest fear when she thought about going on birth control was that if she went to the clinic in town, people would find out. So Lucy went to Indian Health Services (IHS) on her reservation to get her first prescription for the pill. At the time, the pill seemed like the obvious choice.
“I remember a lot of girls at school got on the pill for acne,” Lucy said. “I thought, prior to getting on birth control, that it was a magical fix for acne. It was maybe a secretive way of preventing pregnancy, using acne as an excuse to get on it. Maybe it didn’t actually help. I remember the popular girls being on birth control and not having acne, so maybe it did work, or maybe they just had really good skin care routines.”
Lucy had trouble with the pill, though. She struggled to remember to take it every day, and she felt constant paranoia that she was pregnant. She remembers taking a lot of drug store pregnancy tests as a teenager. She also took a Plan B pill once, without thinking about the side effects – she didn’t know beforehand that it would make her feel sick to her stomach. Eventually, she switched from the pill to using a patch. It was less maintenance – she only had to switch it once a week – but it gave her rashes. So she eventually had a Nexplanon implanted in her arm, which was, again, even less maintenance.
“[My doctor] said it goes into my arm, it’s a small procedure, and then I could maybe just forget about it,” Lucy said. “With each step, I kept advancing with birth control so I wouldn’t have to be as paranoid because their effectiveness scientifically increased.”
She could not forget about the Nexplanon, though, because it caused her to bleed and spot constantly – like a never-ending period. She hated it. But through all of this, there was never a point where Lucy felt as if birth control was more trouble than it was worth. She was still so young, and she remembers feeling optimistic.
“I had all of these options, so going through them was like, ‘Oh, this is the next best thing. I'm gonna get on the next best thing and it’s gonna work for me,’” Lucy said. “I think I also felt mature. It was something I was taking to prevent myself from getting pregnant. It was responsible, and I liked feeling in control of my body in that way.”
When she had her Nexplanon removed, Lucy had her first overtly bad experience with a healthcare provider; she had the procedure done at IHS, which is where she’d always gone. She got checked in and went to a room to wait. When her doctor entered, the first thing he asked was, “Are you able to get care here?” Lucy is white presenting, but she thought it was a silly question, because she couldn’t have made it past the front desk if she wasn’t eligible for care at IHS. At first she laughed it off, and made a joke about being pale. He didn’t laugh with her.
“He was just short with me because I was a teenager getting birth control,” Lucy said. “I’m sure he had preconceived notions of what that meant on the reservation.”
It wasn’t until Lucy mentioned that she was going away to attend Dartmouth College that her doctor warmed up to her. He became kinder, more talkative. He told her that he was from Boston, and his son was attending Boston College, which is within driving distance of Dartmouth.
“He was basically trying to pair me up with his son,” Lucy said. “He was trying to appeal to his son’s attractiveness and proximity to me, and he couldn’t get the birth control out. He was digging around in my arm, and I was starting to feel it because the numbing cream was wearing off. And I remember feeling frustrated. I was in pain, and he’s talking about his son.”
Lucy began to worry. She thought, maybe he wouldn’t be able to get the Nexplanon out, then what? Maybe she’d end up with a big hole in her arm. Finally, he did remove the Nexplanon. But Lucy was annoyed with him.
“It was rude,” Lucy said. “He was inside of my arm. It doesn't tickle.”
Lucy went back on the pill for a while after that. Being older then, she was better at taking it consistently. When she went away to college that fall, she broke up with her boyfriend of five years and, for the first time in her life, felt free to have sex with whoever she wanted.
“There were so many different people and sex became more fluid,” Lucy said. “In high school, people were keeping count. It was a small town so everybody knew everything. At Dartmouth, people cared less that you were having sex and who you were having sex with because it was just a moshpit of new experiences and people, there was no body policing relationships. That was really liberating.”
At the time, Lucy assumed that most women at Dartmouth were sexually active and on birth control.
“I just thought, these were really smart people, and if they wanted to prevent pregnancy they could take that into their own hands,” Lucy said. “In high school, there was this connotation of shame attached to sex. It wasn’t an empowering feeling to be on birth control in a communal way. For me personally it was empowering because I wasn’t getting pregnant and it was a way to rebel against my parents. But I didn’t want everyone to know I was having sex, whereas in college I just assumed everyone was.”
Lucy had one particularly memorable encounter with a boy regarding birth control during her freshman year. One night, while she was out, she met a boy and went back to his room with him. Before they had sex, he asked her if she was on birth control. Lucy decided to joke around with him, and told him she was not. He didn’t think she was funny. He got very serious all of a sudden, and explained to her the importance of being on birth control. This was the only time in her life Lucy ever fought with a stranger.
“I was so mad at him,” Lucy said. “I was like, ‘You don’t think I don’t know about these things?’ He was being condescending, like I didn’t know about my options. Like somehow he knew that’s what’s best for women’s bodies and I should have it because he said so. He was making this judgment about what I should or shouldn’t do about my body. It set me off.”
Towards the end of her sophomore year, Lucy decided to get an IUD. One of her sorority sisters had recently gotten one, and told Lucy it was basically painless, that she loved it, it works for five years at a time, and that she had gotten it done at Dartmouth Hitchcock Medical Center (DHMC), just a little ways off campus. Lucy made the appointment and took a public bus to DHMC by herself.
“I didn’t know what I didn’t know,” Lucy said. “I didn’t know what kinds of questions to ask. I didn’t know what the procedure was physically going to look like, I didn’t know the tools that were being used or what they were doing during the procedure. When I went into the room there were a bunch of things that looked foreign to me, and I remember feeling scared because those things were gonna go inside of me.”
On top of her anxiety about the procedure itself, Lucy remembers feeling rushed. Her doctor was forceful rather than gentle with Lucy’s body.
“She was like, ‘Oh I’ve done hundreds of these,’” Lucy said. “So she probably [inserts IUDs] all day long and just tries to get through them. There was not a lot of care taken to make me feel comfortable, and afterwards I think I was as white as a ghost. I was sort of, like, a little bit traumatized. So they went and got me juice and snacks, the nurses were really kind. I was just like, that really sucked. I wish someone would have told me that it really sucks. I remember feeling really… hurt.”
Lucy left the hospital shortly after the procedure – she had to make it on the last bus to go back to campus that day. She got off the bus and walked to the CVS in town to buy a heating pad. Then she went to her boyfriend’s room and spent the rest of the evening in his bed with the heating pad on her stomach.
"I felt angry for the next couple days about the procedure," Lucy said. "I was walking around campus thinking about how I’d given this health provider consent to do this thing without really knowing what it was that they were doing, and without really being told what it would feel like. It felt like I was deceived, like I was just another girl in this factory line getting this thing done that was supposed to be 'so great' for me. And I was thinking about how my boyfriend at the time didn’t have to do anything like that, and I was also thinking about my uterus. It’s a part of my body that I could never get to, I could never touch my uterus. And I was thinking, how the fuck did they get that up there? It’s not supposed to go there, and they took something and shoved it in a place where it’s not supposed to go, in a place you can’t even see. And I remember feeling weirdly invaded, even though I had given consent to have this procedure done. Even though I had said, even though I thought, 'This is what I want.'"
This was the first time Lucy felt completely out of control of her body. The procedure forever changed the way she thought about birth control. She couldn’t stop thinking, what is this thing that’s in my uterus? What is it that it does? The experience set her thinking for the first time about some of the negative impacts of birth control. For a long time, this made Lucy feel isolated. She thought she was an outlier – it seemed like every woman she knew loved their birth control, and she was the only person for whom it didn’t work properly. She didn’t talk to any of her friends about what she was feeling. About a year after she graduated college, she started having conversations with her new roommates about what she had gone through, and realized for the first time that other women could relate to her experiences.
When Lucy was 24 years old, she went to a new doctor in the city where she worked and told her what had happened when she got her IUD.
“I realized I was almost crying,” Lucy said. “[My doctor] was like, ‘I’m really sorry that happened to you. That must have been really traumatizing.’ And it was the most validating thing I’d ever heard from a primary care provider.”
When she had her IUD removed, her doctor went slowly and talked Lucy through the process step by step.
“She treated me like I was a person that has a body,” Lucy said. “Knowing what was going on, even though I was in pain, alleviated my fears. The better informed we are, the better we’re going to feel about the decisions we’re making. When you’re having those procedures done, you are completely relinquishing control over your body. I can’t see what’s happening, but when they tell you what’s going on, I think it gives that control back.”
After having her IUD removed, Lucy decided to stop using birth control. She wanted to know what it would feel like to be “unregulated.” For the first couple weeks without her IUD, Lucy felt terribly depressed. She has since learned that is a common side effect of the sudden drop in hormones in the body, but no one had told her at the time she was going to experience that. Eventually she began to feel normal again, and has not used birth control for about two years now.
“I don't have anything controlling my hormones anymore. That’s a good feeling,” Lucy said. “My body is being its authentic self. Before, [my body] was being controlled in some ways. I’d been on birth control for so long, but now I don’t rely on anything synthetic just to have a functioning body.”
After all of her trials and tribulations, Lucy has learned that ultimately, the most important thing is to have real conversations with healthcare professionals about birth control.
“It’s one thing to be handed a pamphlet about my options and how many milligrams of whatever,” Lucy said. “I think that’s great, that’s one thing. But we should also have a conversation about what women actually experience. Treat people like people.”
Lucy is 26 years old now, and though she no longer has sex with men, she is considering going on birth control again to help with the migraines she experiences each month while she’s on her period. They’ve gotten so severe that they are beginning to affect her ability to do her job. Her health care provider suggested that birth control could help with that.
“What do you think doctors do for men who get migraines?” I asked her.
“I’m not sure,” Lucy said. “Probably suck their dick?”
Interview conducted September 27, 2022 by phone.
"r/Nexplanon – Dizziness?"
When Sloan was seventeen years old, she had a Nexplanon implanted in her arm. Shortly after, she began experiencing random fainting spells.
When Melissa started dating her first boyfriend, she decided to get on birth control. She wanted to use hormonal birth control as contraception partly because she’d heard it could help with acne, but also to spite her conservative Christian mother, who had forbidden her to use birth control. Melissa was eighteen years