The Politics of Hysterectomy—and the Normalization of Women’s Pain

Why are we still in the "dark ages" when it comes to treating endometriosis, debilitating periods, and chronic pelvic pain?

“Stacey’s” first period lasted for 90 days, but when she sought treatment for her debilitatingly painful menses, her gynecologist told her it was normal. “Sweetie, just take ibuprofen,” she said.

Stacey’s story is one of many that Dr. Andréa Becker shares in her new book Get It Out: On the Politics of Hysterectomy, where we learn that it takes someone seven to 10 years on average to receive a diagnosis for endometriosis. The painful condition—in which tissue similar to the uterine lining grows outside the uterus—can derail someone’s life, preventing them from working or having relationships. Ten years for a diagnosis.

Get It Out is the product of interviews with over 100 women, trans men, and nonbinary people who had, want, or are considering hysterectomy. The book explores why patients are either denied or pressured to have hysterectomies along lines of race and gender identity; the lasting impacts of eugenics and medical experimentation; the emergence of solidarity movements among patients who have been forced to advocate for themselves within an indifferent, even violent medical system; and the consequences of an NIH research budget that largely shrugs off women’s pain.

As I read the book, I was reminded of a 2019 report showing that women are diagnosed years later than men for the same—and sometimes life-threatening—conditions. That’s often because their pain or discomfort aren’t taken seriously, or it’s accepted as fact that pain and discomfort go hand-in-hand with inhabiting a female body.

“There’s such a normalization of women’s pain, especially pelvic pain, that’s not just in the doctor’s office, but in how our entire culture normalizes it—if you have women’s organs, you’re supposed to be in pain,” Becker told Abortion, Every Day.

In fact, doctors only start to care about chronic pelvic pain and related conditions when patients start trying to have a baby. Get It Out points to the NIH’s research budget that allocates just 10% to “women’s health”—and of that, just 2% to health issues like endometriosis, fibroids, and uterine prolapse. Compare that with 80% dedicated to pregnancy and childbirth.

“We’re still in the dark ages” when it comes to basic medical research, Becker said. “Most doctors aren't even trained in diagnosing even obvious symptoms.”

Get It Out also presents the jarring statistic that 90% of hysterectomies are classified as “elective”—even though hysterectomy can sometimes be the only treatment for debilitating conditions like endometriosis.

“Across the medical field there’s this horrible binary between ‘elective’ and ‘essential’ that really dismisses women seeking to live without pain,” Becker said.

“Our culture only cares about women and women’s bodies when they’re having babies. Anything else that contributes to their wellbeing is ignored.”

When doctors’ “recommendations” verge on coercion and eugenics

Becker shares parallel case studies of two 20-year-old college students—one white and one Black—who sought treatment for debilitatingly painful endometriosis. The white woman was strongly discouraged from having a hysterectomy, while the Black woman was encouraged—and even pressured—to have one. She recounted being shocked by how flippantly doctors told her, at just 20-years-old, to have a hysterectomy, seemingly without a second thought. Meanwhile, the white student was told to try pregnancy as a treatment.

This happened constantly, Becker found; several white women were asked by doctors whether they had their male partner’s permission, and some had to cite their male partner’s vasectomy to prove they were serious about not wanting children. White women seeking hysterectomies are often told they’re too young—even well into their thirties—that they’ll regret it, that they’re not sick enough, haven’t had enough children, or that their future husbands wouldn’t approve.

One white, lesbian woman who lived with her long-term female partner was denied a hysterectomy, told by doctors that she might change her mind and fall in love with a man who would want to have a child. Meanwhile, Becker writes:

“Many Black women I interviewed experienced doctors recommending a hysterectomy before they ever desired one. This recommendation was often framed as their only choice and frequently verged on coercion.”

All of this builds on the United States’ dark history of eugenics: From 1909 to 1979, thousands of women—disproportionately women of color, poor women, and disabled women—were sterilized without their consent by the government. And that ‘history’ remains an ongoing reality: close to 1,400 people may have been subjected to forced sterilizations in state prisons between 1997 and 2013.

In 2022, the National Women’s Law Center published a report showing 31 states and D.C. continue to allow nonconsensual sterilizations for disabled people, incarcerated people, and immigrants—through policies that offer judges significant leeway to decide whether someone can or can’t consent to being sterilized.

Endemic medical mistreatment of people with uteruses has driven patients to band together for the support they know they won’t get from doctors—sharing information about their conditions and teaching one another how to advocate for themselves in social media groups like “Endo-sisters” and “Hyster-sisters.”

Becker endearingly refers to them as “rowdy patients”—those who defy traditional power dynamics between provider and patient as a survival mechanism, after years of dismissal, gaslighting, and abuse in the medical system.

“Vulnerable communities and communities of color have long known the medical establishment is letting them down and known to spread knowledge among and support each other.”

A female fertility-obsessed culture

Get It Out exposes just how obsessed our culture and health system are with female fertility. Again, when many of the patients Becker interviewed first asked for hysterectomies, they were repeatedly denied—what if they changed their minds and wanted kids down the line?

“Over and over, [doctors] invoked this invisible man, this future male partner who they’d want to have kids with,” Becker said.

Consequently, women are disbelieved or dismissed—not just about their pain, but about their stated desire to not have kids.

While doctors tell certain (white) women to “treat” their endometriosis through pregnancy, Becker reports, trans men were often encouraged to have hysterectomies—or it’s automatically assumed they’ll have the procedure as a natural step in their transitions. Once doctors perceive a patient as masculine, fertility is no longer a paramount concern.

One eyebrow-raising example? As trans men who Becker interviewed furthered in their transitions, and their providers started to view them as men, “doctors became less obsessed with their fertility and believed them more about their pain.”

The hysterectomy procedure is the same for a cis woman or trans man, regardless of age. But a patient’s identity—and the reason they’re seeking it, whether to treat a painful condition like endometriosis or as part of a transition—can determine whether health providers are willing to help them.

“Zero trimester” and fetal personhood

Get It Out highlights the term “zero trimester,” coined by sociologist Miranda Waggoner to describe how all women, girls, and people with uteruses are viewed as “one-day mothers.”

I’m reminded of how since the end of Roe, women and girls of reproductive age—including children—are sometimes denied desperately-needed medications deemed “abortifacients,” or those that may impact their fertility, even if they’re not pregnant or never want children.

Even before Dobbs, in 2016, the CDC advised “pre-pregnant” women and girls who weren’t taking birth control to refrain from drinking—even if they weren’t pregnant and didn’t plan to be—to protect their fertility and hypothetical embryos.

There are alarming parallels between how abortion bans and the humanization of fetuses infringe on the rights of those who are pregnant—or merely capable of pregnancy—and how hypothetical fetuses are invoked to deny someone a wanted hysterectomy. Get It Out draws strikingly clear connections in both cases to fetal personhood—the effort to grant fetuses citizenship rights—which dictates how women’s behaviors are policed both when they’re pregnant because they’re pregnant, and also, increasingly, to protect their future, hypothetical pregnancies. Becker said it best here:

“When you see women as forever being on a zero trimester of pregnancy, you end up not able to fully treat their whole bodies as whole people.”

Buy Get It Out: On the Politics of Hysterectomy here.