IUDs have been a promising breakthrough in birth control, offering both convenience and effectiveness, and their use has exploded over the past few decades. But that progress has often come with some (painful) trade-offs. Vox senior reporter Allie Volpe has been digging into why medicine has been slow to catch up to the pain that IUD insertions can cause and doctors’ plans to make the process for more palatable for patients in the future.

It is a big reproductive rights story, at a time when those rights are increasingly under threat. I sat down and chatted with Allie about it.

Allie, are IUDs becoming more popular? What do people like about them?

They’re definitely more popular. Just over 6 million people, or 8.4 percent of contraceptive users between the ages of 15 and 49, use IUDs. It’s actually the fourth most popular form of birth control. No. 1 is tubal ligation or, as people refer to it, getting your tubes tied. The pill is No. 2, condoms are No. 3, and IUDs are No. 4. That’s a huge increase from the mid-‘90s when just 1 percent of birth control users used IUDs.

People really like the IUD. It’s a set-it-and-forget-it kind of thing. Once you get past the act of placing it, you have it for anywhere from three to 10 years, depending on the type you have. Both do the same thing: They prevent the sperm and egg from meeting.

A lot of people report less cramping on their periods, lighter periods, or even no periods in general. That’s a huge draw for people who often have painful periods or endometriosis. It’s a good way to treat those things.

I think a lot of people have the perception of IUDs as a quick, painless insertion that’s not really a big deal. Is that accurate?

It depends on who you talk to, right? It is quick. It is all over within a matter of minutes unless you’re getting anesthesia, which would make the process longer.

And for some people, it’s historically not been all that uncomfortable. But for others, it’s really uncomfortable. Pain is very personal, and it’s hard to pinpoint what pain actually is. Some people are like, “Yup, didn’t really feel it.” Others are like, “I’ve had multiple children, and this is more painful than childbirth.”

What we’ve been seeing over the last couple of years is those people coming on social media talking about their experiences with painful IUD insertions.

Why do you think that misconception persists? Why do even doctors misunderstand the pain that their patients are going through?

Women’s pain in medicine has long been minimized. There’s been reporting over the last couple of years about medical gaslighting, not just in gynecological procedures but across the board. Women will come in with a problem. And for decades, centuries, they’ve just been written off as being hysterical.

Specifically, when it comes to IUDs, as more people got them, you started to hear more stories about these being very painful. It’s a numbers game — more people get them, more people are going to have problems — but also a medical history game.

You’re writing about this now because things do seem to be changing. What’s going on?

One of the OB-GYNs I talked to said, “I’ve been placing IUDs for like 37 years. It’s not like I didn’t mention that it would be painful, but I just tried not to bring it up. Because if a patient expects something’s going to be painful, it’s going to be more painful than they really thought.” These conversations about pain were not really happening until recently.

Within the last year, the CDC and the American College of Obstetricians and Gynecologists both released recommendations telling doctors to talk to their patients about pain management during IUD placement.

For a while, there just wasn’t really good research that pointed to methods that might help during this procedure because the pain can come at multiple points. But these groups are urging doctors to talk to their patients about not only taking ibuprofen to manage the pain after the procedure but also using topical creams or an anesthetic shot during the procedure to reduce discomfort.

What questions should patients be asking their doctor?

All of the OB-GYNs I talked to really stressed this: Talk to your doctor before your appointment. Because if you walk in the day of, there’s not really a lot they can do. So, as you’re making this appointment, discuss your concerns with your doctor. Tell them if you’re concerned about pain or if you have any past history that might make this procedure more difficult for you. Ask, “What can you offer me?” Ask as many questions as you want.

If you don’t feel satisfied with the options they have — like if you really want a paracervical block but your doctor doesn’t offer it — ask if they have recommendations for another provider that will. Then start to talk through a plan with your provider. What medications will they give you pre-appointment? Some doctors now are giving people Xanax to chill out before the IUD insertion. They will probably often tell you to take ibuprofen beforehand. Ask what they will use during the procedure. Make sure you have that clear plan written out ahead of time.

If your doctor isn’t taking your concerns seriously, they’re blowing you off, or they don’t offer pain management that meets your standards. Some of the experts I talked to recommended reaching out to a hospital affiliated with a university. They have a higher chance of having a provider that uses some of these pain management methods. Others recommended searching for someone who’s trained in complex family planning. That means they have received additional training in abortion and contraceptive care, so they might also have more pain management options.

An Amazon-branded palm scanner greeted me at my last doctor’s office visit a few weeks ago. I’m not sure what I’d call the experience. Unnerving? Orwellian?

Amazon One is a relatively new service from Amazon that lets businesses verify your identity after you wave your hand over a sensor. The technology first rolled out in the short-lived Amazon Go convenience stores in 2020 and is now a way to pay for groceries at Whole Foods. It’s also used for payment and age verification at a few sports and entertainment venues, including at Coors Field in Denver. And as of March, you can also scan your palm with Amazon One to check in at NYU Langone Health locations, which is where I encountered it. So far, you won’t be forced to scan your palm to get a beer at a Rockies game or see an NYU doctor, but it’s an option.

In addition to its experiments in public venues, Amazon One is marketing its scanners as an alternative to the fobs and codes that let employees into their office buildings. Amazon is also working with hotel companies and manufacturers that make security doors and safety deposit boxes to incorporate its palm scanner.

Biometric scanning refers to the process of capturing your unique physical characteristics in order to confirm your identity. Whether it’s your palm, your fingerprint, your eyeball, or your face, the concept can feel creepy or invasive to some. Biometric scanning can happen without your consent, as was the case with Clearview AI, the company that built a massive facial recognition database from billions of publicly available photos online. There’s also a permanence to the collection of biometric data. Once a company has the details of your face, you don’t have much control over how that data is used. After all, you can’t easily go out and get a new face.

Millions of people volunteer their faces or fingerprints, nevertheless, as a quick and convenient way to verify their identities and make life a little easier. With Apple’s Face ID or Google’s Face Unlock, you can keep the contents of your phone from prying eyes but avoid typing out an annoying passcode every time you want to check your texts. With Clear, you can skip the line at airport security. And with Amazon One, you can save a couple minutes of waiting at the doctor’s office by scanning your palm instead of talking to a human.

Nevertheless, something seems fundamentally threatening about a future in which big tech companies use biometrics to serve as the gatekeepers of our digital identities.

What’s especially disconcerting to me about Amazon One is that your biometric data is just another source of data that the company has about you. The tech giant, after all, is a massive enterprise whose businesses span from its eponymous marketplace to a health care company to a multibillion-dollar advertising network. It’s not always clear how engaging with one Amazon-owned entity affects your experience with others.

AWS, the Amazon division that operates Amazon One, specifies in a supplemental privacy notice that it will not share your palm data — effectively, the image of your hand — with third parties, although it also collects other data, including your phone number and your PIN, when you sign up. AWS, meanwhile, is clear in its broader privacy policy that it can share data about you with third parties, including advertisers. Then there is Amazon.com, which is governed by its own separate privacy policies.

When I asked Amazon about all this, spokesperson Alison Milligan said that your Amazon One profile is separate from your Amazon.com profile, and that Amazon One profile data is not used for marketing or shared with advertisers. “​​Amazon One palm data is not accessible to Amazon business units outside of Amazon One,” Milligan said.

Meanwhile, NYU Langone Health spokesperson Arielle Sklar told me, “We do not share personal information with Amazon One, and Amazon One does not store any protected health information.”

Still, privacy watchdogs caution that when it comes to massive tech companies, it’s best to proceed with caution — the capabilities are enormous, and privacy policies can change. “Amazon likely can infer unbelievably sensitive health care data about people, partly because they have so many different programs and so many different services,” said Calli Schroeder, senior counsel at the Electronic Privacy Information Center, or EPIC. “All of this stuff gets tied together and can be incredibly revealing.”

Amazon calls its biometric offering a “palm-based identity service.” You might call it the Everything Scanner.

The key of the future is your body

The concept of a digital key isn’t all that different from physical locks that have been around since ancient Egypt. A password, in theory, is a key that lets you into a website or an account. Credit cards are a type of key too, since they unlock access to a bank account to make a purchase. The big change with biometrics, however, is that you no longer carry a key around. You are the key.

The core argument in favor of biometric scanners is that they’re more convenient and more secure than the old carry-the-key method. An Amazon One scanner works in less than a second, while tapping your credit card and entering a PIN can take several seconds. Those seconds add up, not just for you, the customer, but also for the business. Both parties also have to consider that credit cards and numbers get stolen with startling regularity.

“It’s a lot harder to steal somebody’s fingerprint or face print or palm print than it is to steal their cards out of their wallet or their pocket,” said Ash Johnson, senior policy manager at the Information Technology and Innovation Foundation, or ITIF.

But it’s not impossible, and when biometric data is stolen, it’s incredibly valuable to hackers, because unlike a password, it cannot be changed. There was a major breach of biometric data in 2019, for example, when security researchers obtained the fingerprint and facial recognition data of over a million people. Had they been bad actors, they could have used the data — the code that represents real fingerprints and faces — to break into office buildings.

Amazon also says it chose palm-scanning over other biometric approaches because palms don’t reveal as much about a person’s identity as a face scan would, and because a palm scan “requires someone to make an intentional gesture,” which protects against unauthorized scans.

I actually believe biometric scans are largely secure and the convenience is worth it for certain uses. I’m an outspoken fan of Apple’s Face ID technology, and I’ve allowed Clear to scan my eyes in order to get through the airport security line faster. It’s possible that my biometric data will one day end up on the dark web, but I was willing to take that risk when I was about to miss my flight. At the time, I hadn’t considered whether I’d make the same trade-off in order to save a couple minutes at the grocery store or in a waiting room.

It’s not the idea of palm-scanning at my doctor’s office that bothers me. The new system gives me pause because it’s powered by Amazon.

Like the vast majority of Americans, I like Amazon. I’m an Amazon Prime member, and a regular Amazon Fresh shopper. I visit my local Whole Foods at least once a week, and just as often, I watch movies on Amazon Prime Video. Thanks to all of these touch points, Amazon knows a lot about me, and I continue to be surprised by the ways Amazon combines my data in different ways — like the time Amazon recommended prescription medication based on my grocery order.

It wasn’t immediately clear to me what would happen when I put my palm on an Amazon One scanner at my doctor’s office. Would basic details of my visit, like the time and location, get logged somewhere in my main Amazon account? Would I get ads for Ace bandages after visiting a sports medicine doctor? Would I get deals on heart-healthy options at Whole Foods after an appointment at a cardiologist? And what if Amazon changes its mind about protecting my biometric data or goes bankrupt, like 23andMe? Amazon denies that it’s sharing data across its businesses this way, but it’s hard not to feel wary.

After winding through the labyrinths of Amazon’s various privacy policies and even talking to the company, I’m still not entirely confident that I know exactly how it all works. I definitely don’t believe that Amazon has access to my health records, and it’s very clear that the image of my palm — my “palm data” — is well protected. But the uncertainty surrounding any other metadata is enough to steer me toward a human receptionist for my next doctor’s appointment.

I also can’t escape the implications of all this. Tech giants, like Amazon, only know growth, and so they continue to reach into new industries. That’s business, sure, but it starts to feel overwhelming when a website I signed up for 30 years ago to buy cheap books now wants details about my body in order to verify my identity.

Time is long, and once Amazon has my biometric data, it’s out of my hands.