Stuff You Missed in History Class — "The IUD: A History" (March 18, 2026)

Episode Overview

In this episode, hosts Tracy V. Wilson and Holly Fry explore the complex, sometimes controversial, and frequently misunderstood history of the intrauterine device (IUD). The conversation traces the evolution of internal contraceptive technologies from ancient lore and early gynecological devices, through medical advancements, global trends, regulatory crises, and social debates—including the role of contemporary pain management in IUD procedures. Rich in anecdotes, historical figures, and memorable asides, the episode balances scientific detail with sensitivity to bodily autonomy, social context, and lived experience.

Key Discussion Points & Insights

Early Claims and Ancient Lore (03:27–07:20)

• The episode opens with popular stories about IUD origins:
  • Legends of nomadic peoples placing stones inside camels’ uteruses to prevent pregnancy during journeys—a story lacking credible historical evidence.
  • References to Hippocrates having written about IUDs, which Tracy notes are based on vague readings of ancient texts. The actual passage in "Diseases of Women" describes opening the cervix, not contraception.

    “In these IUD discussions, nobody really cites a specific source for whatever it is that Hippocrates supposedly specifically said.” — Tracy (06:11)

• The discussion dismisses these as likely apocryphal and transitions to more substantiated origins.

The Pessary: IUD Precursor & Early Use (07:20–11:39)

• The pessary, one of the oldest medical devices, was originally for uterine support and later also used for contraception.
• Materials throughout history included hammered brass, waxed cork, precious metals, sponges, and even (possibly) pomegranate halves.
• Intracervical and intrauterine pessaries developed by the late 1800s; designs included stems, loops, and legs for retention.
  • Tracy interjects to clarify anatomical misconceptions about the cervix (10:22–11:39), explaining its tunnel-like structure and emphasizing the confusion even among educated adults.

Ineffectiveness and Discomfort of Early Devices (11:39–13:57)

• Early pessaries were uncomfortable, often ineffective, and made of hard metals or rubber.
• Removal and cleaning required frequent, often uncomfortable doctor visits.

  “Having experienced, like, the temporary sensation of an IUD insertion and the discomfort of many years worth of Pap tests, I just can't imagine that having a piece of metal going all the way into or through my cervix would be comfortable at all…” — Tracy (12:37)

Health Risks and Stigma (13:57–15:21)

• Notable medical texts in the early 20th century called these pessaries undesirable—citing poor contraceptive efficacy, infections, and even deaths due to the absence of antibiotics.

  “From a health viewpoint, this type of pessary is therefore undesirable.” — Holly referencing James Friar Cooper (13:57)

• The continued stigma and conflation with dangerous earlier pessary types affected the acceptance of later IUDs.

First True IUDs and European Developments (18:47–22:44)

• Richard Richter (1909): Published the first IUD description; loop of silkworm gut with bronze wire; reportedly effective and removable.
• Carl Poust (1923): Used a similar device with over 400 patients; a glass button prevented expulsion; claims no serious complications.
• Ernst Grafenberg (1920s–1931): Developed the "Grafenberg ring"; silver wire created issues (argyria/blue gums), shifted to German silver/copper alloy, likely contributing to efficacy.
• Grafenberg’s work intersected with Weimar Republic sexual reform movements, including connections to Magnus Hirschfeld’s Institute for Sexual Science.
• Rise of Nazi Germany stifled this research, destroyed critical archives, and forced Grafenberg’s emigration.

Parallel Developments in Japan (24:44–27:44)

• Shizue Kato and birth control activism inspired by Margaret Sanger.
• Tenrei Ota: Developed the "Pressia" or "Ota ring" in the 1930s; designed after trying gold balls as intrauterine contraceptives (inspired by livestock legends).
• Japanese government, influenced by eugenic logic, banned IUDs as "harmful contraceptives" in 1936, leading to Ota’s brief exile; IUDs weren’t licensed in Japan until the 1970s.

Post-War Research and Plastics Revolution (32:24–36:21)

• 1950s–1960s: Key papers by Willi Oppenheimer (Israel) and Atsumi Ishihama (Japan) established relative safety and efficacy.
• Lazar Margulies: Developed polyethylene spiral IUD—a precursor to modern designs.
• Jack Lippes: Introduced "Lippes Loop" (1962); shape improved retention; included retrieval strings—reminiscent of modern IUDs.

The T-Shaped and Copper IUD Era (36:21–37:37)

• Howard Tatum and Jaime Zipper: Developed the copper T200 in 1970, a landmark in IUD history; the T-shape improved comfort, copper improved efficacy.
• Antonio Scomegna: Created the first hormone-releasing IUD, "Progestasert," though its impact was limited by its short approved use period (one year).

Expansion and Disaster: The Dalkon Shield (38:42–42:36)

• IUD popularity rose after the 1970 Nelson Pill Hearings increased public wariness of oral contraceptives.
• Dalkon Shield (1968/1970s):
  • Designed for increased retention, but flawed multifilament strings allowed infection.
  • Led to at least 18 deaths, 300,000 lawsuits, and a $2.5 billion legal settlement.
  • Tracy devotes careful attention to the social and legal aftermath, which shaped both U.S. regulatory policy and declining IUD use for decades.
• The FDA gained authority over devices in 1976; all IUDs categorized as "Class 3" for highest risk.

Global Differences and Social Control (42:36–44:45)

• U.S. IUD use plummeted; elsewhere, especially in China under the one-child policy, usage soared, often through coercion.

  “If you live in a place where you have autonomy over your own body…that might feel liberating…But if you live somewhere where that is not true, or if you are in an abusive or a controlling relationship, an IUD is something that can be imposed on you or refused to you.” — Holly (43:15)

• Notable individual case: Britney Spears' conservatorship (2021), where she was compelled to retain an IUD against her will.

Internet Memes, Pain, and Modern Medical Guidance (45:06–49:06)

• Tracy reflects on how pain during IUD insertion is widely discussed and memefied online, sometimes in ways that deter individuals from pursuing IUDs.
  • Presents research that nearly half of patients experience intense pain during insertion.
  • Critiques outdated or insufficient pain management, noting that current best practices recommend paracervical blocks and other anesthesia options:

    “Doctors who are not discussing pain management with their patients beyond recommending over the counter pain relievers for an IUD insertion are not following the current guidelines.” — Tracy (46:19)

• 2025 WHO and 2016 CDC guidelines endorse person-centered, evidence-based pain relief and informed consent.

Notable Recommendations and Ethical Perspectives

• Emphasize the importance of counseling all patients about pain and options before placement (47:26).
• Discussion links medical evolution with gendered bias and the need for empowering information rather than fear.

Notable Quotes & Memorable Moments

• On Cervical Anatomy:
  “My mental image of the cervix does not line up with reality...The only person in the group chat who had a correct understanding was the midwife.”
  — Tracy (10:22–11:04)

• On Early Pessaries:
  “That seems large to me, unless it was a very small pomegranate.” — Tracy (08:22)
  “I'm also just thinking that, like, pomegranates have a lot of crevicey surface area.” — Holly (08:26)

• On Dalkon Shield Fallout:
  “The Dalkon Shield was blamed for at least 18 deaths and more than 300,000 lawsuits...Multiple other IUDs were pulled off the market in the face of the Dalkon Shield's bad publicity.” — Holly (40:37, 42:06)

• On Global Perspective:
  “China is one of the most populous countries in the world, which is part of the explanation for those numbers...But it's also because of the Chinese government's one child policy.” — Tracy (44:05)

• On Pain Management:
  “Here is a PSA to say at least in the United States, doctors who are not discussing pain management with their patients beyond recommending over the counter pain relievers...are not following the current guidelines.” — Tracy (46:19)

Timestamps for Key Segments

• Early History & Myths: 03:27–07:20
• Pessaries & Anatomy: 07:20–11:39
• Discomfort & Failure of Early Devices: 11:39–13:57
• First Modern IUDs (Richter, Poust, Grafenberg): 18:47–22:44
• Japan & Ota Ring: 24:44–27:44
• Post-War Research & Plastics: 32:24–36:21
• Copper and Hormone IUDs: 36:21–37:37
• Dalkon Shield Crisis: 38:42–42:36
• Global Use & Autonomy / Coercion: 42:36–44:45
• Pain Management, Modern Guidelines: 45:06–49:06

Tone and Style

The hosts balance humor, clarity, and empathy throughout, often breaking the "fourth wall" to clarify anatomy, revisit common misconceptions, and share personal perspectives. They neither sensationalize nor sanitize the bodily discomforts that accompany the history of IUD development, and they repeatedly center both individual autonomy and historical context in their analysis.

For Listeners Who Haven’t Tuned In

This episode is a thorough, unflinching, and ultimately empowering look at the IUD—touching on bodily autonomy, gendered medicine, scientific advances, and public perceptions. Whether you’re interested in history, science, or the intersection of medicine and social policy, Holly and Tracy offer context, candor, and compassion throughout.