Consented, p.11
Consented, page 11
But today is a clinical day for you: Prenatal visits in the morning, elective abortions in the afternoon. Thanks to the #FairAndJust movement, abortion access is free, equitable, and judgment-free, alongside comprehensive sex education and improved birth control. Abortion rates and maternal mortality have plummeted as a result.
You review your first patient’s digital shared-decision (DSD) system: Delia, pregnant with her second child, here for her thirty-nine-week checkup. You supported her through her first pregnancy, during which she used the revolutionary “walking pain pad” for pain control. It allowed her to walk freely during labor. With a sticky pad attached to her lower back to modulate the sensitivity of pain receptors in the pelvis, Delia could control how much pain she experienced.
“Hi, Melissa!” Delia beams as you walk in. “Look how big I am now!”
“Any time nowwwww!” you sing-song, making you both laugh.
She fondly recalls her last birth, when she squatted on a birthing stool while her mother marveled at the pain pad. “Too bad my amniotic fluid went all over your midwifery student’s arms!”
You both laugh again.
“Delia, it says here you want to see how ready your cervix is for birth. Are you having contractions?” you ask.
“Yes, I’ve been having contractions here and there for a few days. I suspect I’m in very early labor.”
You nod. Reviewing her chart, you notice she’s also due for cervical cancer screening. Thanks to advancements in vaccines and diagnostics, cervical cancer is now rare.
“Okay. It looks like you’ll also need to be screened for cervical cancer soon. Do you want to do both today?” you suggest.
“Sure! Might as well,” Delia says cheerfully.
“Self-insert or I insert?”
“Self-insert!”
“Want me in the room?”
“Yes, in case I need help.” Delia says, pointing to her very pregnant belly to indicate that it’s been hard for her to be agile lately.
“No problem. Do you want a chaperone in the room with me?” you ask the routine question.
“Meh, you and I go way back!”
That, we do.
You retrieve the softscope—a speculum-free, next-gen diagnostic tool—from the warmer beneath the exam table. As the name implies, though the softscope has some internal stiffness to facilitate insertion, it’s outer surface is soft and conforms to the vaginal canal without causing significant discomfort. As Delia inserts it, you both watch the screen.
“Looks good!” You click the Collect button. The softscope utilizes micro-sampling technology to collect some cells from the cervix. No pinch. No cramping. No bleeding.
“And your cervix is about one to two centimeters open,” you inform Delia, who looks a little disappointed. “Want to check stretchiness?” you offer. “It’ll hurt.” You don’t sugarcoat it, which Delia appreciates.
She shakes her head. “No, let’s wait.”
You nod. Birth, like progress, moves at its own pace.
Later, Dr. Tran, a family physician, stops you as he sees you walk by. “Melissa! Can I get your advice on something?” Though he’s not under PRIM, you’ve been mentoring him since he was hired. Even though you don’t mentor for money, your role as a mentor comes with extra pay automatically.
“Sure! What’s up?” you switch from clinician to administrator mode.
“I think one of my patients experienced medical misogyny in the ER,” he says.
You invite Dr. Tran to your office to gather more details. His elderly patient had a minor heart attack and was briefly hospitalized. She is now recovering well. But something in the ER report caught Dr. Tran’s attention.
“Our hospital usually scores well in equity metrics, but her EKG was delayed by twenty-three minutes compared to men that same day.”
Your eyes widen. “That’s two standard deviations off! Why?”
Dr. Tran pulls up DSD, where details of every patient’s care are recorded and visible to the patient. “They had her fill out an anxiety questionnaire during that time, even though her GSHD risk was high enough to trigger an immediate EKG.”
GSHD stands for Gender-Specific Heart Disease, one of many conditions now understood to have gender-specific biological variance across a spectrum. And it goes beyond the gender binary. Vast datasets have identified risk factors and symptom variations among transgender patients on hormone therapy, intersex individuals, and others whose medical profiles don’t fit outdated models. Other GS metrics include GSO (Gender-Specific Osteoporosis), GSPD (Gender-Specific Pain Disorders), and GSAD (Gender-Specific Autoimmune Diseases). Since the GS system was implemented, gender disparities in treatment outcomes and mortality have shrunk, despite conservative politicians’ speculation to the contrary.
As always, science moves forward, regardless of ideology.
“This looks like medical misogyny,” you conclude. “Can we check the ER doctor’s equity ratings?”
Since #FairAndJust, all clinicians’ cultural competency and equity scores are public on DSD. Dr. Tran taps the ER doctor’s profile.
“Well, his gender equity score is well below our organizational average.”
“Let me talk to him.”
You schedule a peer feedback session, a routine part of the hospital’s culture of accountability. When you show the ER doctor the data, he looks surprised but not defensive.
“Wow. I basically told her it was ‘all in her head.’ Who says that anymore?” He shakes his head. “Oh. Me, apparently.”
You chuckle. “The good news? Now you know. We all have biases to work on.”
“When’s the next gender equity training? I need to sign up.” He pulls out his phone.
Then, as you stand to leave, he asks, “Melissa, are you taking new mentees?”
“I sure aaaaaaaam!” you sing.
5
Objectifying the Body
“I’m finally getting a hysterectomy,” Julie said. Her voice was steady but worn.
Last time I heard someone speak with so many mixed feelings, it was my friend announcing that she was “finally getting a divorce.” You know the story: years of struggle, of loving and resenting in equal measure. Some days, they hold on. Other days, they unravel. After countless sleepless nights and too many second chances, they finally make the decision. And when she tells you, as a friend, you don’t know whether to pop champagne or bring out a box of tissues.
“Can I ask why you are getting a hysterectomy?” I cautiously proceeded, eyeing the empty box of tissues on the table. I discreetly messaged my medical assistant for a new box, just in case.
Julie, a new patient of mine, had suffered heavy bleeding and searing pain for over thirty years. She had wanted her uterus removed since she was a teenager. “You may want to have a baby later,” the doctors told her and prescribed birth control pills when she was fifteen. Then at twenty, already a mother of one, they said, “Your child might want a sibling.” At twenty-five, with two kids: “You’re too young. What if your husband wants more?” Now, at forty-five and a mother of three, the system had finally deemed her worthy of the surgery—but only because they found some “shadows” on her ultrasound.
“My surgeon thought he’d better take my uterus out because I might have cancer,” Julie said. I reached for the fresh box of tissues.
She was a tall Latina woman with a no-nonsense way of talking. As she spoke, she kept brushing stray hairs away from her forehead, as if even a single strand in her way was unacceptable.
“But guess what?” Julie slammed her palms against her thighs. “My biopsy was benign.” Champagne, then? Or did that mean she was about to be denied the surgery she had begged for? Julie kept going: “The surgeon said it could still be cancer because of the ‘shadows.’ So, he’s still taking it out just to be sure.” She swept her hair back again. “I told him I didn’t care. I just wanted it gone.” The resigned way Julie said that last line made me think this wasn’t the first time she had uttered those words.
And then her voice cracked. “It just sucks that I had to wait this long,” she whispered. “If I have cancer, then why the hell did they wait until it was too late to listen to me? And if I don’t have cancer”—she exhaled sharply—“then I’m even more pissed, because that means a few shadows on an ultrasound mattered more than my pain. More than me!” Julie pressed a palm against her forehead, as if checking for a fever, but I knew it was to hold herself together. Tears slipped down her cheeks.
For thirty years, Julie’s life revolved around her uterus. She was either in pain, anemic, pregnant, or all three. When she went to doctors, pleading for the removal of the organ that had caused her nothing but suffering, she was met with rejection after rejection because her uterus had more value than her autonomy. It was as if her uterus wasn’t part of her body; instead, she was a person attached to a uterus. In the fight of Uterus Havers vs. Medicine, it was never about what she wanted.
I handed her a tissue, but it felt like a pitiful offering. Even in this hard-won, bittersweet moment, we were still a long way from celebrating.
Cashing In on the Uterus
In societal rape culture, sexual objectification refers to the reduction of individuals, particularly women, to mere objects for sexual use. By regarding victims not as humans with autonomy but as things to be dominated, sexual objectification normalizes sexual violence. In parallel, within medical rape culture, to objectify the body is to reduce patients from individuals with bodily autonomy to a summation of organs that need fixing. Often, the “fixing” and the “fixers” dictate the patient’s health and dignity.
Uterus-having bodies have been objectified for as long as medicine has been authored by men. To keep or to lose the uterus was and still is a fate determined entirely by those holding the literal and metaphorical scalpels.
By 1976, over 794,000 women were projected to undergo hysterectomy, making the uterus the second most commonly removed organ. The first? Tonsils—the pea-sized, sore-throat-causing lymphoid tissues, just one of many in the human body.1 By 1986, according to the educational pamphlet “Most Little Girls Grow Up to Be Hysterectomized,” published by the Hysterectomy Educational Resources and Services Foundation, more than half of all women in the United States would eventually have their uteri removed. Performed nearly one million times a year, hysterectomy had become the most common major surgery in the United States.2 The trend only began to slow in the 1990s, when it was finally surpassed by C-sections—yet another surgery performed exclusively on uterus havers. Still, the numbers remained staggering: By age sixty, over one in three American women and two in five Australian women would have lost their uteri.3
Surely, like Julie, they all desperately needed hysterectomies for valid medical reasons, right? They all fought for years to be heard, to finally have their pain taken seriously? Not quite.
The 1975 New York Times article by Joann Rodgers exposed a hidden motive behind the hysterectomy frenzy: Surgeons weren’t rushing women into hysterectomies to save lives; they were doing it to make money.4 Hysterectomy was, and still is, lucrative. Today, it costs anywhere between $5,000 and $12,000.5 Even back in 1975, a single hysterectomy could pay a surgeon up to $800, with Medicare and Medicaid covering up to 90%. By contrast, a tubal ligation, a far less invasive sterilization procedure that involves blocking the fallopian tubes, paid only $250.6 The financial incentive was clear.
By 1989, American gynecologists were raking in over $2 billion annually from hysterectomies alone.7 And they often targeted the most vulnerable: poor Black women, Puerto Rican women, and other racialized groups, performing elective hysterectomies under the guise of “charity.”8 “Mississippi appendectomies” were, as it turned out, acts of ethnic cleansing and financial exploitation. To make matters worse, Black women were more likely to undergo hysterectomies via more invasive means, were 40% more likely to experience surgical or medical complications, three times more likely to have prolonged hospital stays, and three times more likely to die from the surgery.9
To further maximize profit, excuses for hysterectomies extended far beyond birth control. Internal reproductive organs were removed for almost any reason. Some surgeons justified it by claiming patients were too “obese” to have their ovaries examined through vaginal exams, so they removed the entire uterus instead.10 Some doctors even referred patients to themselves for surgery. Remember the joke among surgeons: “Out comes a uterus or two each month to pay the rent”? Here is another one: “Every person has at least three surgical diseases—all you have to do is find them.”11
With doctors who saw their patients as walking, talking cash cows, who needed medical justification to be butchered?
If uterus havers didn’t need to become ex-havers, what made them sign up for hysterectomies? Time to phone an old friend from Chapter 3: medical gaslighting. During the hysterectomy frenzy of the 1970s, gynecologists claimed the uterus (and the ovaries) was useless except for childbearing. Worse, they warned it could stir up all sorts of trouble after its reproductive purpose was fulfilled: migraine headaches, cancer, “emotional problems of middle age,” menopause, even the empty-nest syndrome. You name it, hysterectomy could cure it. At the same time, they downplayed the risks of this major abdominal surgery, omitting the fact that up to 50% of women sustained one or more complications, including infection, hemorrhage, and injury to the urinary tract,12 and that hysterectomy was twenty times more fatal as a method of sterilization than tubal ligation.13
What about the psychological trauma of losing one’s reproductive capacity? Or the negative sexual consequences of having internal sex organs removed? Not a problem, said the gynecologists. After all, women didn’t “mourn the loss of their reproductive organs . . . the way a man might.”14 That couldn’t be further from the truth. Post-operative depression rates were so high that some doctors recommended psychiatric consultation prior to surgery. And yet, one male surgeon declared: “I have never in [thirty] years had a woman tell me she’s sorry she had a hysterectomy done.”15 Never in thirty years had anyone voiced concern? Or, more likely, were they simply ignored for financial self-interest? Medical ethics be damned.
Fast-forward to 2025. Hysterectomy is still one of the most common inpatient surgeries in the US, performed 498,000 times a year.16 It remains the only surgery on the list in which an entire organ is removed. And over 99% of the time, it is performed for benign conditions.17 To be clear: Benign doesn’t mean unnecessary. Many people suffer from excruciating, life-altering conditions that warrant hysterectomy under modern treatment guidelines. But that doesn’t change the fact that no other organ is removed at this rate. Imagine, just for a moment, if the troubled organ were a prostate or a pair of testicles. Would we be so quick to cut? Would one in three18 men over fifty be content to live without a prostate or testicles? Or would we have cured whatever the problem was with a pill by now?
Perhaps nothing answers those questions more clearly than a statement made at a 1983 conference sponsored by the American Cancer Society: “No ovary is good enough to save, and no testicle too bad to remove.”19
Wombs Before Women
Julie wasn’t the only woman who cried in my exam room that day.
“Clearly, my pain or bleeding wasn’t ‘bad enough’ for them to give me a hysterectomy!” Julie exclaimed.
“Of course not!” Sydney, my medical assistant, shot back, placing a fresh box of tissues on the table. Normally, Sydney wouldn’t stick around or chime in on my conversations with patients, but today, she couldn’t stay silent.
A few years ago, Sydney woke up in a pool of blood. She was found to have a rare form of ectopic pregnancy where a fertilized egg implanted in her previous C-section scar. These pregnancies often lead to catastrophic bleeding, requiring emergency surgery, transfusions, and sometimes a hysterectomy.20 And Sydney was no exception.
“I lost so much blood that, even after multiple blood transfusions, I couldn’t sit up without passing out,” she said. Julie and I watched her with wide eyes as she continued. “My husband later told me the doctors ran around trying everything they could to stop the bleeding. But all I remember was going in and out of consciousness, thinking: I’m going to die.”
Sydney was a petite, soft-spoken Latina woman. I had worked with her for almost a year, but I never knew this part of her life. I had always marveled at how she handled every stressful situation with such grace and lightheartedness. She laughed at every joke, even the bad ones. Now, it all made sense. Perhaps coming so close to death gave her a renewed outlook on life.
“The doctors told my husband that a hysterectomy would solve the problem, but it had to be a last resort because we might want to have more kids,” Sydney’s voice softened. “I remember hearing my husband yell, ‘Is it better for us to never have more children or for our only child to have a dead mother?’”
Eventually, between preserving Sydney’s reproductive potential and saving her life, the doctors reluctantly chose the latter, forgetting that the decision wasn’t theirs to begin with. But for many women like Sydney and Julie, the real choice is between being a person with autonomy or a vessel whose worth is dictated by its ability to produce children.
I was the third woman who cried in the exam room that day. I’ve never been pregnant. I had no life-or-death story to share. But in the shadow of uterine determinism, no one escapes objectification. A recent text from a distant friend said as much: “Been thinking about you. When are you going to start a family?”
The message came out of nowhere. No Hi, how are you? Or How is your family? Only, Are you pregnant yet? I told her, as I had before, that I had no intention of becoming anyone’s mother.
“Without children, what kind of legacy do you plan to leave?”
A dozen responses ran through my mind: I help people heal. I help women through childbirth. I train the next generation of doctors. I write. I create. I exist. Isn’t that enough? But really, when someone casually tells you that you’re failing at the one thing you were biologically built to do, what do you say? My abrasive friend wasn’t the first to question the worth of childless women. She was just echoing the nation’s leaders, who have long defined women’s value by their fertility.21 Little did they know that their misogynistic games were old tricks to medicine, who had been playing it for millennia.
