The Freedom to Choose Hysterectomy

To read about hysterectomy in the news is to read about disaster: emergency hysterectomy after a denied abortion, deadly hysterectomies during war, coerced hysterectomies on detained migrants. A hysterectomy often signals multifold systemic and legal failures, which are then forever written on the body—a body forever changed.

Hysterectomy also often indicates a tragedy inflicted by external, malignant forces. Yet one in five people who are born with a uterus will have it removed by the time they are in their 60s, a statistic that was one in three when I began this project and one that never ceases to shock the person who asks why I study hysterectomy.

Hysterectomy is at once highly common and yet primarily discussed—if at all—as a devastating event that happens to you. While we rarely read about this in news headlines, many people want a hysterectomy, choose a hysterectomy, and are happy to have had a hysterectomy. People might want a hysterectomy for a number of reasons, whether to find freedom from one of the many illnesses that affect the uterus and ovaries or to affirm their gender. These stories contradict fundamental assumptions we hold not only about hysterectomy but about gender, bodies, and reproduction.

A pervasive idea within culture and medicine alike is that all people with uteruses will inevitably want to become pregnant and be mothers. Following this logic, choosing hysterectomy will almost certainly spark regret. And yet, as I found, a hysterectomy can elicit various emotional responses, ranging from delight to grief to something in between. 

While the assumption is that hysterectomy invariably causes grief, it is not the procedure itself that brings on this grief but rather the degree of agency afforded and the social context in which the hysterectomy is situated—the degree to which a hysterectomy feels choosable.

Hysterectomy stories lay bare the dangers of viewing “women’s bodies” as perpetually pre-pregnant, or as existing in the zero trimester of pregnancy, as the sociologist Miranda Waggoner aptly named it. As it turns out, this ideology can be used within medicine to prevent people from making informed decisions about their bodies, both in the realm of hysterectomy and far beyond.

Even opting out of one pregnancy, as in the case of abortion, contradicts central truths we hold about gender in general and women specifically. The abortion scholar Anuradha Kumar and colleagues theorized that abortion is so widely stigmatized because it violates cherished feminine virtues: perpetual fecundity, the inevitability of motherhood, and instinctive nurturing.

As an abortion scholar myself, the more I delved into the puzzle of hysterectomy, the more I realized the notion of choosing hysterectomy likewise causes fissures in how our culture understands gender and bodies, perhaps even to a magnified extent. If women are valued for being perpetually fertile, one-day mothers who are born to be nurturing, how could they ever be happy about removing the organ that is purportedly the source of these fundamental attributes? 

How could it be that some people would willingly have this organ removed to achieve happier, healthier, more self-actualized lives? Hysterectomy seekers must confront these questions and assumptions in their quest toward a hysterectomy. Ironically, the overemphasis on fertility promotion within health care simultaneously leads people to desire a hysterectomy while also making this surgery difficult to access for many.

The emphasis on fertility is even found in the way we refer to the uterus and ovaries (“reproductive organs”) and to the illnesses that affect them (“reproductive illness”), which erases the other functions these organs hold for bodily well-being. This emphasis is reflected in the financialization of health care.

Only 2% of the National Institutes of Health research budget is allocated toward understanding the various illnesses that impact these organs, many of which lead to a hysterectomy. Accordingly, despite how common these conditions are, patients often require seeing a specialist to receive proper diagnosis and treatment after years of neglect—that is, of course, unless the illness is causing fertility issues, in which case, time to diagnosis typically shrinks.

Within this system, people whose uterus is causing suffering might eventually come to desire a hysterectomy for themselves as a mode of self-care. Yet, these same people who wish to choose hysterectomy might then be told they are not sick enough, are too young, or haven’t had enough babies to warrant a hysterectomy. To have a uterus in a medical system built for cis women having babies often means being pushed to want hysterectomy and then being told to wait.

The freedom to choose hysterectomy is endlessly complicated by gendered reproductive politics as well as a health care system that does not invest in understanding and treating the uterus beyond its capacity for pregnancy. Hysterectomy access is stratified by race and gender, and more specifically by a proximity to white womanhood. Those who embody white womanhood are often paternalistically barred from choosing sterilization, typically due to a physician’s concern about anticipatory regret. Simultaneously, women of color—particularly Black women—are often pushed toward hysterectomy and are told it is the only option for relief from their symptoms.

Meanwhile, the reproduction of trans and nonbinary patients is often clerically forgotten altogether during clinical conversations about hysterectomy. Trans men as young as 19 are recommended a hysterectomy as part of their gender-affirming medical journey (often without counseling on fertility-preserving methods like egg freezing), while a white cis woman might be told she’s too young to choose such a “drastic” procedure at the age of 35. Of note, a wanted hysterectomy as part of gender-affirming care is considered essential health care, and is associated with improved psychological well-being, while a hysterectomy for a cis woman in chronic pain is often deemed elective. 

Across race and gender lines, the meaning of “medical necessity” for the same procedure shifts, as do concerns around fertility, age, and regret. While individual doctors might not be consciously acting out of malice—and some might even be motivated by a genuine desire to protect their patients—these individual encounters ultimately make up the fibers of stratified reproduction based on race, gender, and class.

To move forward toward a world where hysterectomy is choosable, then, requires viewing all reproductive health choices through the analytical framework afforded by this study of hysterectomy. This analytical framework is rooted in reproductive justice, is trans-inclusive, and accounts for the complex ways race, gender, history, and politics come together to stratify choice. It is imperative to examine not only who is being barred from the right to choose to parent and why but also who is being barred from the right to opt out of parenting—and thus to opt into infertility. These two infringements are inextricable and together form the bedrock of stratified reproduction and reproductive injustice.

As we wade into a second Trump presidency, and the looming possibility of a national abortion ban, understanding these reproductive politics becomes more dire. 

In the process, a deep dive on hysterectomy sheds light on broader inequalities faced by people with chronic illness, gender-expansive people, and racialized communities. By imagining a world in which hysterectomy is truly choosable, we imagine a world where all people have more freedom to live self-determined lives.

This excerpt, adapted from Get It Out: On the Politics of Hysterectomy by Andréa Becker (NYU Press, 2025), appears by permission of the publisher.

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