What Getting A Contraceptive Arm Implant Is Like

by JR Thorpe

Don't want a baby and won't for a while? We're in a lucky position these days: women have a variety of choices for contraceptives that last beyond day-to-day use, from the ever-popular IUD to the contraceptive implant. The second option, which is marketed under the name Nexplanon or Implanon, was my chosen contraceptive choice when I decided early in 2016 to look for a more long-lasting baby-preventing alternative to the Pill. (I forget to take it. I've thrown it up and had pregnancy scares. It's a pain in the neck.) So what's the procedure actually like, and is it fundamentally bizarre to have a small matchstick-sized piece of plastic inserted into your arm casually at your doctor's office? Answer: yes, but it's also AWESOME.

The implant was right for me for a number of reasons. One was that while copper IUDs are very effective, I don't particularly like the sound of having one; I have to grab a painkiller and a hot water bottle if a cramp so much as looks my way, because I am a grade-A abdominal pain wuss. Another was that implants are free in the UK, low-impact, and after testing the hormonal combinations, seemed to be ideal for my body. The third, frankly, was that I've always wanted to be the Bionic Woman. I now have an invention in my arm two inches long that prevents me from getting pregnant; it's so science-fiction it's barely credible. I will be talking about this at cocktail parties for months.

If you're hesitant about the procedure or a bit mystified about what it involves, here are the details, complete with my original photographs, to show exactly what happens. The pain involved is minimal, with a small pin-prick and bruising, and it takes a maximum of half an hour. Overall convenience score: 10/10. Overall awesomeness score: 20/10, will likely do again in three years when it needs replacing. Here's what getting a contraceptive implant was like for me.

1. The Prep Stage

Yes, that is my bicep. Wonder at it. The contraceptive implant is a low-hormone birth control option, so to test my tolerance for the hormones in it, my nurse switched me from my combined pill to the mini-pill, which is progesterone-only. I was on it for three months, to give my body time to adjust to the hormone levels, and was warned I might experience spotting, pimples, weight gain, unpredictable periods, and everything up to and including a head explosion. (OK, no, not that last bit.)

It is incredibly difficult to predict how female bodies will react to hormonal shifts, so it was with great relief that I could report that I was fine, had no real side effects, and had a gleaming bicep (captured here in a cafe bathroom before the procedure) just ready to be filled with the anti-baby stick.

2. The Appointment

Nexplanon is the name given to the contraceptive arm implant in the UK; in America, it's known as Implanon. It's much more popular in Britain and Australia than it is in the U.S., so finding a healthcare professional who can do it for you may be tricky depending on your location. It's called a "subdermal progesterone-only implant," and is classified as hormonal contraception because it uses progesterone to thicken the mucus lining the womb. It lasts for three years, and requires only local anesthetic and an appointment with a nurse to apply. It's also radio-opaque, which means that it can be picked up on X-rays; if it slips out of position, you can check it without needing your skin opened.

3. The Location-Marking

The nurse, who by this point had sort of come around to me photographing everything and had clearly decided I was just a genial sort of nut, marked out exactly 8 cm from the end of my arm, to avoid bone and potential nerve problems. It was done with a ruler and a marker, and felt curiously like a grade-school project. The jaunty imprecision of it all made it seem a bit unreal to me.

4. The Anaesthetic

This is the only part of the entire procedure that hurts: a local anesthetic was applied to the area, and it took at least 15 seconds to fully empty the syringe. I had no problem with this and happily chatted throughout, which made the procedure easier, but did deeply bemuse the nurse.

5. The Insertion

Once the area was fully numbed (which we tested, very scientifically, by poking various bits of my arm with a small needle and seeing when I said "ouch"), out came the hero of the hour. My Nexplanon was contained within its own disposable application gun, and at the purple point of application, the nurse made a very small incision with the razor at the top of the gun, then slowly worked the rod under the skin. When I say "under the skin" I mean "you can feel it sitting there". It is a spectacularly weird feeling; you feel faintly as if you should be able to press it and produce some Tony Stark-style hologram out of your elbow.

The actual insertion was mostly ... peculiar. The nature of local anesthetic meant that I could feel the pressure of the implant going in, but no pain whatsoever. As a non-squeamish individual, I was a bit annoyed that the positioning of the nurse's hands meant I couldn't actually see it going in. (This is likely not a common reaction.)

6. The Clean-Up

If you're getting this done, be reassured there are no stitches; the entry wound is so tiny it only needs to be held down with a suture bandage, otherwise known as a "butterfly closure," or a small adhesive strip for tiny wounds. But there will be a charming purple bruised bit where the razor insertion was actually made, and some blood, and it will look as if something with one large tooth has ineffectually tried to get at your arm.

But in my opinion, it's all worth it. You will have a small stick of plastic that will prevent you having babies. It's basically modern witchcraft.

7. The Finished Product

Yes, that is a very fashionable accessory I'm currently wearing. And after the implant's insertion, you need to wear it for at least five days, which means I'll be running around town in short sleeves for the next week looking as if I'm about to run an '80s marathon. It's a pressure bandage, and there's a lot of protection underneath it: sterile gauze, and beneath that a giant band-aid, and under that the butterfly closure. My bicep aches, but far less than it does after vaccinations, and I'm reliably informed that I'll have an impressive temporary bruise to flaunt as a sign of my commitment to a no-baby life.

The next three years will, according to the nurse, likely be quiet ones. Unlike with most other contraceptives, I'm not supposed to have the implant checked regularly; I only need to bring my arm in for examination if something peculiar happens (it somehow moves out of position or breaks, for example, which is rare), or if the wound gets infected. And then, in 2019, I have the option of getting a new one. And so on, and so on. I've only had it for five hours, but I may already be a lifelong convert.

Images: JR Thorpe