On Choosing a Hysterectomy

As I sipped my coffee and surfed the news this morning, I saw that Angelina Jolie has written an Op-Ed for the NYT, explaining her choice to have elective, preventative surgery to remove her ovaries and fallopian tubes. This follows her piece two years ago discussing her choice to get a double mastectomy.

Social media has erupted, as it did two years ago, with messages of support, and calls for more women to open up about their own experiences with these surgeries.  I never expected to write about my surgery, but I found myself putting down my coffee, opening up Word, and almost being late for class as I sifted through my own memories.

Nine years ago, I was treated for fast-growing tumors on my uterus. They came with a long, Latinate name I no longer recall, as another term loomed over the diagnosis: cancer. After a week of hand-wringing, a biopsy revealed that the tumors were not malignant after all.

I vividly remember how hot my face felt the nurse called to explain that no, I did not have cancer. I immediately called my husband with the good news and, wondering over his silence, realized he was quietly crying with relief. 

But I still had those fast-growing tumors. My gynecologist reviewed the options. I could have the tumors removed, a fairly routine surgery. They were likely to grow back, however, and repeatedly, after each removal. They would, if left unchecked, interfere with my health, and could return in cancerous form. 

The second option was a hysterectomy. I was thirty-five and did not have any children.

I knew immediately that this was the option I wanted.

Matthew and I had discussed children. While we both like kids, neither of us felt especially desirous of having them. I used to joke that my biological clock was broken, as I never felt the urge to reproduce like some of my friends, both male and female, did. When I got my monthly period, Matt and I would high five and cheer, “No babies!” To make sure we were on the same page in our marriage, we’d revisit the conversation about having children regularly, always boiling down to, “Feel any urge to have kids yet?” followed by “Nope.”

Given that history, one might think that the decision to remove my uterus, and thus my ability to have biological children, was without tension. It was not. Yes, I knew immediately that the hysterectomy was the best decision for me. We didn’t plan to have any children. We didn’t want even the slightest risk that the tumors would return malignant. This was the logical choice.

We live in a world, though, that complicates such decisions, connecting reproduction as it does to identity, to self-worth. I felt this long before the surgery.  I noted how many conversations with new female acquaintances in their twenties and thirties began with “do you have children?” I realized that when a healthy, married, economically stable woman chooses not to have children, many people are astonished. Complete strangers would ask me, “Why don’t you have kids?” as though the answer would be their business, as if my childless self were an anomaly in need of explanation.  Some good friends would argue with us, claiming Matthew and I were, somehow, the sort who “should have kids.”  Putting aside the implied belief that reproduction is deserved by some and not others, I was always struck by the suggestion that I was under some social obligation to replicate. Despite my instincts otherwise, I occasionally wondered if something were indeed wrong with me for not wanting what so many people believed I should want.  Maybe I was low on some hormone, or wired incorrectly. I’m sad now that I ever had those moments.

I give our parents credit. My parents never pressured us, never once made me feel uncomfortable for my choice to be childless. My husband’s parents were clearly disappointed, but didn’t try to make us feel guilty for depriving them of grandchildren.

In the months after the surgery, I was surprised to find myself feeling fraught. I’m a feminist, a critical thinker, and a teacher. Why did I find myself wondering if I were somehow less of a woman now that my uterus, an organ I’d never planned to use anyway, was removed? I was frustrated by my irrational response, and it took me a good year to work through it.

With the wisdom of retrospect, I know my feelings grew out of the long history of my reproductive decisions being treated as something to be publicly discussed and judged. This hit home when one family member asked me, post-surgery, if the tumors had been caused by my use of birth control—as if I had caused my illness by taking measures to remain childless.  This implication was rare, thankfully, but the pained apology in people’s eyes when I told them about my surgery was not.  The most common response to hearing of my hysterectomy was “I’m so sorry,” something no one said to my husband when he had is appendix removed. This response came from a well-meaning place, I know. I’m not angry with the kind people who assumed that this childless thirty-five year old without the ability to have biological children must be heartbroken. I am angry, however, that we live in a culture that trains people to assume, immediately, that heartbreak must have been my response.

I am now almost forty-three years old, and new acquaintances no longer ask me, first thing, whether or not I am a mother. It comes up, to be sure, but further into the conversation, and usually in context. This may be indicative of social progress. No one pries when I say that no, I don’t have kids, perhaps this time indicative of my age. Or perhaps it is because the women I’m meeting are often well into their forties as well, and they know better, from experience, that we don’t all want the same things.

What do I want out of sharing my story? I’m not sure, but the reactions to Jolie’s public accounts of her surgeries do suggest to me that more of us need to share our experiences.

I want it to be ok that I chose, before tumors chose for me, not to have kids.

I want people to be more thoughtful about when, why, and how they ask women and men about their reproductive choices.

I want people to be more thoughtful about how they react to mastectomies and hysterectomies. Joy and congratulations that cancer or other complications have been avoided might sometimes be a better response than sorrow. 

Mostly, I hope that someday a woman recovering from a gender-specific surgery will not have to wonder what this means, who she is.

My body matters; it is a significant part of my identity. But it is not all of who I am.