I sat on the paper-covered table in a sunny exam room, trying to hold back tears. The young doctor across from me gave a sympathetic smile and tilt of the head, her perfectly smooth, lustrous skin glowing in the golden afternoon light. I apologized and wiped a few tears off my cheeks, careful not to rub off the makeup devotedly hiding the war zone underneath.
This dermatology office is supposed to be the best in San Francisco. It doesn’t accept insurance, requiring all costs to be covered out-of-pocket, and so its main business is zapping off the wrinkles of its wealthy clientele. I was there because after having an IUD inserted a year ago, my skin devolved month by month into an increasingly horrific exposé of the fickleness of female hormones. In the process, it unearthed an unexpected fragility in my self-esteem.
The pretty doctor’s impeccable complexion was both a beacon of hope and a mocking cruelty. With her heat-wand curled hair and starched white coat, she seemed to embody some long-internalized gatekeeper to woman-dom. Through this door is clear skin and true love, or at least an updated profile picture and some decent Bumble dates.
After giving her a too-intimate medical history, I teared up in frustration as I explained that I had no idea what caused my acne. She nodded wisely, and simply said, “I would bet it’s the IUD.”
At first I protested.
“But my skin was fine for six months, it got better, even. I only started breaking out a few months ago.”
“Yes,” she said. “That’s common. I’ve had a lot of patients who experienced the exact same thing.“
“But the doctor who put the IUD in told me the hormones only absorb in the uterus. He said it doesn’t have the same side effects of the pill.”
I felt my uterus shrug along with her, as if the two of them exchanged a glance that said, “I dunno what to tell ya, babe. But here we are.”
I had to laugh a bit at the irony. Getting my IUD had buoyed me up in a flurry of Friedan-esque euphoria. I was heeding the feminist imperative to take control of my reproduction, and damn did it feel good. Although having the IUD inserted was a pain in the ass—or uterus, as the case may be—the discomfort felt like a rite of passage, yet another endurance of pain that marks the milestones of a woman’s life. And yet here I was, having tried everything to take back control of my face, from cutting out dairy to lathering on an ever-evolving routine of potent topical prescriptions, to no avail.
The cost of the appointment and bevy of new skin products tallied up to a painful sum. The doctor put me on a daily pill that blocks the body’s absorption of androgen hormones. The medication is supposed to protect my skin from the progestin leaching from my IUD, which while dutifully thickening my cervical mucus, is also giving me the skin of a pubescent boy who never washes his sheets.
I carried the prescription to the pharmacy clutched firmly in my hand, and approached the counter as Dorothy approaching the gates of Oz with an out-of-pocket password written in loopy doctor script. Thirty minutes later I placed the small paper bag on the passenger seat with care. I took it home and placed the bottle next to my perfume, where it sits sentry, containing the intoxicating promise of a possibility I have chased since childhood in so many different ways: Tomorrow, I could wake up prettier.
Almost two months later, my skin is little changed. In the meantime I have adjusted to the medication’s side effects: slight nausea, dizziness, needing to pee every half-hour. Skin-care, however, is a waiting game. I bolster my patience by scanning the internet for success stories, of which there are reassuringly many, and which all pass on the same advice from beyond the misty veil: Wait. Just wait. Maybe three months, maybe six. Be still and trust in the lord of pharmacology. Thou shalt wear sunscreen. Thou shalt not pop thy blemishes.
While my skin continues to wait for deliverance, I can attest to the effectiveness of the IUD—although perhaps not for the reason one would expect. Turns out, being too afraid of your makeup rubbing off on some dude’s scruffy hipster beard is a bible-camp approved way of preventing pregnancy.
From time to time I silently marvel at the ridiculousness of it all. I had a piece of plastic stuck inside me because it’s convenient and carries less chance of user error. Then I started medication to fix my skin problems caused by the IUD because I want to be attractive, to myself and to those very same men who I found unreliable in the first place. Now I eat take-out in my pajamas on a Friday night and see it all rendered, in the end, moot.
I bite down my anger and shame when I hear a male friend say, “Nothing against it, I just like girls who don’t wear makeup. It’s attractive that they’re confident without it.” Yes, it certainly is. I’m annoyed that he said it, but I’m guilt-ridden that I care. What have I learned from feminism or Beyoncé if I allow men’s imagined opinions of me to so thoroughly affect my life?
What’s next in my skin-saga? Maybe my persistence will pay off and I will wake up and look in the mirror without trepidation. Maybe I’ll give up and get the IUD removed, or replaced with the copper one that doesn’t have hormones but makes cramps worse and periods heavier. Maybe I will flee into the wilderness and live a blessedly peaceful existence without mirrors, or men, which have turned out to feel disturbingly like the same thing.
It’s early in the morning, and I stand in my small blue bathroom with icy feet, performing these daily rituals with deference. Foamy cleanser, moisturizer, weekly-cleaned brushes. The foundation I spread on smells vaguely of citrus. I force myself to perform other unseen rituals as well. Remind myself I am happy. Remind myself I am whole. With any luck, tomorrow my skin will be better. With any luck, tomorrow I won’t care.