Last I checked, my uterus was in a jar in Schenectady. An ignoble end for a thing that was once burdened with glorious purpose, like an old prizewinning racehorse going off to the glue factory. It’s been 17 years since it last had a job that needed doing. It’s been three months since it was in my body.
I’m grateful to have been born with it. I don’t miss it.
To write her recent book Get It Out: On The Politics of Hysterectomy, Andréa Becker talked to a lot of women like me—and a lot of women not very much like me, and for that matter, a lot of men and other people caught in the peculiar dilemma of not being women but having been born with uteruses anyway. It’s a good read, and a great title.
Get It Out is also vital recon for navigating the increasingly fraught landscape of US reproductive medicine and the Trumpian war being waged on reproductive choice on all fronts. Becker includes a timeline in her book that takes us up to 2022, with the US Supreme Court’s overturning of Roe v. Wade. There are surely more distressing milestones to come that might make it into a future print edition. Some—like the case of Adriana Smith, a Georgia woman who is currently brain dead and required under state law to be kept on life support as an incubator for her preterm fetus; like this administration’s failure to expand IVF access while IVF clinics are under attack—are unfolding now.
While it’s tempting to see the Trump administration’s all-out assault on reproductive choice as a new phenomenon, Becker argues that it’s of a piece with who we’ve been all along: a society that relentlessly polices uteruses wherever they’re located, and uses the levers of both soft and hard power to enforce decisions about who ought to keep theirs.
In her introduction, Becker explicitly declares allegiance to the principles of reproductive justice, which center bodily autonomy and the freedom of all people to choose whether or not to have children. Fair enough. Get It Out features the personal stories of dozens of uterus-havers, chosen from a hundred interviews conducted by Becker, and they span a wide range of experiences. The book holds up a mirror to the ways social forces shape all our choices about hysterectomy. Some of her interviewees have been pressured to have hysterectomies. Others have had much-wanted surgery withheld.
The common thread running through all of these stories, Becker argues, is a society that seeks through both coercion and persuasion to press younger white cis women into the work of reproduction, and steer other uterus-havers away from it. She asks us to consider: What does it mean to choose hysterectomy? Is choice even possible under all this pressure?
Presented with Becker’s diverse array of uterine narratives, it feels only natural to both notice that the terrain of reproductive medicine is wildly uneven, and to want to level the playing field. Why should a young Black woman be pressured to regard a hysterectomy as her only option? Why should a white woman the same age be denied a surgery that would spare her decades of pointless suffering? Why should a doctor assume that a trans man with a uterus doesn’t care about preserving his own fertility? For fuck’s sake, why aren’t we studying endometriosis harder? One can imagine us collectively doing a lot better at this.
I admit to being eternally frustrated with sociology. It’s the annoying former philosophy undergrad in me. The Greeks ruined me. [Editor’s note: this explains a lot about Harris, actually.] I can’t read words like “justice” and “choice” without wanting to know what they, like, mean, bro. Reading this book, which is sort of about uteruses but is really about things like choice and justice, I want to grab Becker by the shoulders and shake her til her a priori commitments fall out of her pockets. If she’s going to write around the topic of human flourishing and how the practice of medicine can help bring it about in the world, I want her to deploy a big loaded word like ‘eudaimonia’; to ask: what would it mean for us to truly thrive?
Where my own imagination struggles to envision justice is in the places where the constraints imposed by all-too-human doctors and politicians give way to the cruder, and no less terrible, constraints of being made of meat. Medicine has developed many tools to help us live longer and happier lives as animated meat sacks. The law can broaden our access to those tools. But neither can liberate us from being embodied.
The average human uterus is two ounces of weapons-grade tradeoffs. Its host is endowed with the awful power of creating new human life, and that power is viciously constrained by pain, uncertainty, time, and the formidable physical, financial, and social costs of both pregnancy and menstruation. Even the choice to give up that power, by physically having one’s uterus removed, involves its own sobering risks and a long grueling recovery.
What are the conditions under which someone can truly make a free choice to get rid of such a fraught organ? Good God, what does a free choice about anything look like? Maybe there aren’t any.
I’ve been both lucky and purposeful in dealing with the humiliations of meat-based life, and I have a good track record on getting doctors to listen to me. If you think doctors are frustrating, try arguing with a uterus sometime.
Whatever else this organ has been to me, it hasn’t been a free choice. If it could speak—to use the winsomely earnest language of 70s second-wave feminism—it would tell a personal history of choices made in extremis. It would talk about imperfect decisions flattened into two-dimensionality by the weight of time and trauma and bodily decay, and by the inescapable material logistics of reproduction. Those choices were heavily constrained. But to Becker, who declares hysterectomy to be “unchoosable, stratified, and burdened by history,” I would say: they were choices nonetheless, if anyone’s are.
These days, with my own hysterectomy in the rear-view mirror, I have a newfound appreciation for how much my uterus has been costing me all along. They’re pretty high-maintenance.
Almost 20 years ago, I had surgery to excise the aggressive endometriosis that was slowly gluing all my internal organs together. For years, it grew back while I dithered about whether to go under the knife again. Endo is hell, but like my mother before me, I learned to live with it. Ultimately, it was iron deficiency driven by increasing blood loss that pushed me toward a more radical intervention.
Now, three months past hysterectomy, I’m beginning to love not having a uterus. The iron deficiency has reversed dramatically. My energy is improving. Even my eyesight is better. I no longer feel like a feeble ghost tethered to my own degrading body, weakly piloting it around. (Check your ferritin levels, menstruators.) I am gleeful over the work of my surgeon, who is a skillful specialist and a trans woman with immaculate eyeliner game, and who’s now operated on enough of my friends that we could all play doubles tennis once the last of us gets the six-week greenlight for exercise. Along with the fibroid-riddled uterus, she got nine horrible specimens of endometriosis out of me, one of which had infiltrated my rectum right down to the muscle. She sewed me a new vagina, and it works. What a time to be alive.
Along with narratives of frustration and medical bigotry and physical debilitation, Becker also writes about this joy—the kind of joy made possible by exercising agency over one’s own body. “My quality of life has improved like 1,000 percent,” one interviewee says—and, girl, yes. It is breathtaking that it’s possible. We have medical tools our ancestors could barely dream of. We can and should work toward a future that extends to more uterus-havers the joy of choosing at least some of the conditions of their own embodiment.
But to be made of meat—meat that can make new meat—is to be constrained. We are already, as the late, great Judith Jarvis Thomson might have put it, in bed with that violinist.
Becker cites the case of Girls creator Lena Dunham, who at the age of 31 made headlines by fighting a very public battle with her doctors for a hysterectomy to treat her excruciating endometriosis, as a turning point in the US national conversation about hysterectomy and who is allowed to choose it. Dunham won her fight, and in doing so, offered up a morale boost to young endo sufferers everywhere. Hers was a victory for reproductive choice, and for tearing away the veil of secrecy that surrounds all things uterine.
But choices can only take you so far. A nuance I didn’t encounter much of in Get It Out is that hysterectomy is by no means a surefire cure for endometriosis, a disease that’s both depressingly common and distressingly mysterious. In a stubborn minority of cases, removing the uterus—even along with both ovaries—does not put a halt to the disease’s relentless infiltration of organs throughout the abdomen, or the life-warping pain it causes. If there’s a path to more and better choices here, medicine hasn’t found it yet.
Becker writes that the statistics she often quotes to people—one in five people born with a uterus has a hysterectomy by their 60s—are widely thought of as shocking. I suppose it is shocking that so many of us eventually embrace a surgery that was unthinkable not too many generations ago. Some people worry that having a hysterectomy will rob them of some existential femaleness. For others, that’s kind of the point.
I don’t feel like my own surgery made much of an impact on my gender, but it has made me feel thrillingly unnatural. To choose a hysterectomy is to embrace the unnaturality of health. It requires putting aside the dream that there is a nature that we can be in balance with, a nature that will stop hurting us if we can just unlock the right combination of diet and exercise and hormones and antioxidants and mindfulness and yoga and so on and so forth. It’s a beautiful kind of freedom to set all of that down.
Becker’s book does an excellent job of reminding us that medicine embodies history. I owe my joy in this new body to Jane Crawford of Kentucky, who in 1809 sang hymns to endure the first recorded abdominal surgery without anaesthetic, and to three Alabama slaves named Betsey, Anarcha, and Lucy, who were subject to horrific experimentation by the pioneering gynecologist J. Marion Sims. I owe my joy also to the butchers and the eugenicists, and to the generations of less depraved surgeons who sought to do no harm.
I’m part of the timeline now too. The next time my surgeon cuts the uterus out of someone’s body, she will have practiced beforehand on me.
If that person is you: I wish you joy, too.
