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Young women seeking hysterectomies often run into roadblocks: their doctors.

A hysterectomy is the second most common surgical procedure for women of reproductive age, following Cesarean sections (C-sections). Despite their popularity, many people remain ignorant of the purposes, procedures and possible side effects of hysterectomies. It is past time to fill in the gaps; the general public should be more aware of what hysterectomies are and why women of all ages might seek them out. It is only from the accumulation of public knowledge of hysterectomies that the stigmas surrounding them can be erased, hopefully making the procedure more accessible for women and other people with uteruses who want them. A more acute understanding of why women might want or need hysterectomies is also imperative if we hope to improve women’s healthcare in the United States, especially after the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization. 

A hysterectomy is a surgical procedure intended to remove or partially remove the female reproductive organs. Typically, hysterectomies entail the removal of the uterus, but they might also include the removal of the ovaries, cervix or fallopian tubes. Of the nearly 600,000 American women who get hysterectomies each year, each person has a unique set of circumstances that has led them to that decision. That said, the most common reasons a person might seek out a hysterectomy include cancer in the reproductive organs, gender-affirming care, unmanageable pain or bleeding, often from other medical conditions such as endometriosis or desire for permanent sterilization. However, many doctors hesitate to perform hysterectomies and only do so as a last resort. Some alternatives to hysterectomies include intense hormone treatments, tubal ligation (cauterization of the fallopian tubes) and endometrial ablation (removal of tissue lining the uterus). These alternatives are incredibly case-specific. For example, tubal ligation is most often done as a form of permanent sterilization and will not effectively prevent the spread of uterine cancer. Because of the case-specific nature of these operations, women, trans men and non-binary people are often left to the mercy of their doctors and their own, probably limited, knowledge of female reproductive health procedures.

In addition to the general public’s lack of knowledge about women’s health, not all doctors are equipped with the expertise and understanding that one might expect. In fact, 45% of women in the United States aged 20-34 say that their medical concerns were not taken seriously by their doctors, and 35% of women from this age group say they have had a condition that was misdiagnosed, undiagnosed or inadequately treated. In contrast, men experience better medical treatment across the board, especially pertaining to reproductive health. Experts have cited the exclusion of women, especially pregnant women, from medical studies as a key factor in medical inequality. Others say it is because researchers cannot “adequately control for women’s variable hormone status.” In the 21st century, these arguments fall flat. 

Aside from any unconscious biases or lack of knowledge about women’s health, many doctors are blatantly hesitant to adhere to women’s requests based on the assumption that all women want to have biological children. Indeed, it is nearly impossible to find a doctor to perform a hysterectomy or similar procedure on a woman between the ages of 18-35, unless they are deemed “medically necessary.” A procedure is deemed medically necessary when the alternative to having the procedure is the death of the patient. Unless a condition is life-threatening, most physicians will explore all other routes of treatment, “even if those options include dealing with unbearable pain.” 

It is no secret that hysterectomies and other similar procedures come with a slew of unfortunate side effects, including early-onset menopause, but the real source of physicians’ hesitancy is often a concern about young women’s reproductive abilities. By irreversibly removing the uterus, a hysterectomy ensures that pregnancy is no longer possible, thereby sterilizing the women who receive the procedure. However, not every woman wants to get pregnant. While some women may see sterilization as a significant deterrent to getting a hysterectomy, others do not, and that decision should have nothing to do with their doctor’s personal beliefs about sex, reproduction or motherhood. 

All medical decisions should be made in consultation with that individual’s doctor; however, medical professionals should not allow their own beliefs to influence the decisions they make in the office. I’m not saying that doctors should be performing hysterectomies and tubal ligations willy-nilly, but I do think that the idea that all women should reproduce or that all women want to reproduce is both antiquated and out-of-place in a doctor’s office. Women looking for permanent birth control options or pain alleviation may find themselves face-to-face with the possibility of a hysterectomy. They may decide that they’ve had enough of the pain or fear of pregnancy in a post-Dobbs society and that a hysterectomy or similar procedure is worth the risks. These women have likely endured years of pain and anxiety. They didn’t come to this decision easily. The last thing they need is a doctor telling them they refuse to perform the procedure because their intensely real pain is “worth it” for the chance at biological reproduction.