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bad periods are just part of being a woman opens in a new tab or window as much as we scapegoat the uterus when the organ actually falls ill we do a terrible job of diagnosing and treating it endometriosis affects up to 15 of peopleopens in a new tab or window with a uterus 50 of infertility sufferersopens in a new tab or window and 70 of thoseopens in a new tab or window who have chronic pelvic pain yet with an average diagnosis delay of 6 7 years in patients ages 18 45 it has earned the title of the missed disease opens in a new tab or window its treatment is inconsistent at best if not outright lackingopens in a new tab or window similarly premenstrual dysphoric disorder pmdd affects between 2 to 8 opens in a new tab or window of the 1 8 billion menstruating peopleopens in a new tab or window worldwide its debilitating emotional and physical symptoms are linked to a sevenfold increaseopens in a new tab or window in suicide attempt risk yet thanks to symptom dismissal or misdiagnosisopens in a new tab or window it takes an average pmdd sufferer 12 years and six different healthcare providersopens in a new tab or window to be accurately diagnosed pregnancy potential as an excuse a question i often repeat in my practice is we don t know how safe this medication is for a developing fetus are you planning to become pregnant soon due to historical failuresopens in a new tab or window of inadequate drug studies the fda recommended the exclusion of women of childbearing potential from phase i and ii drug trialsopens in a new tab or window in 1977 even if they were on contraception it wasn t until more than 15 years later that congress mandated womenopens in a new tab or window be included in clinical research today safeguarding a potential fetus is still an excuse for only a scant percentageopens in a new tab or window of medication trials to focus on pregnancy related outcomes making pregnant and lactating people drug orphans opens in a new tab or window this forces clinicians like me to overestimate the harm medications have for anyone who could become pregnant reinforcing the minimizing view of uterus owners as only prenatal pregnant or postnatal in the eyes of medicine uterus owners as baby vessels following this logic the value of a uterus varies according to its candidacy as a baby vessel my patient julie has wanted her uterus taken out due to severe bleeding and pain for over 30 years you are too young your child might need a sibling your husband might want more kids the doctors said when they rejected her request now at age 45 after three kids julie is finally getting a hysterectomy they found some shadows on my ultrasound and thought i might have cancer even though my biopsy was benign the doctor still thinks it would be safer to have my uterus removed she told me while julie was ok with the decision she was unsettled by the lack of diagnostic certainty the prevalence of hysterectomy for women younger than 45 is one in 36opens in a new tab or window 2 8 in america but by age 75 it increases drastically to 42 as the racist history of hysterectomy abuseopens in a new tab or window clings to our time it s no surprise that this number is the highest for black womenopens in a new tab or window at any age and through more invasive meansopens in a new tab or window to be clear as our bodies age our body parts can fail but no other organ is taken out at a steeper rate or more casually than the uterus once it s deemed too old for reproduction performed nearly 500 000 times a year hysterectomy is among the most common surgeriesopens in a new tab or window in the u s not only is it the lone operation on the list of common surgeries where an entire organ is removed but over 99 opens in a new tab or window of the time it s done for benign reasons of course benign doesn t mean unnecessary many suffer from debilitating non cancerous conditions that warrant hysterectomies by today s treatment protocols and these patients have every right to receive a hysterectomy to help with their symptoms but let s imagine if the prostate or the testicles caused dysfunctional symptoms as much as the uterus did and prostatectomy or orchiectomy were said to be the standard of care would one in three menopens in a new tab or window over 50 walk around without a prostate or testicles or would we have cured them with something much less invasive by now such as a pill a uterus owner is more than a person attached to a uterus our pregnancy choices and fertility status shouldn t dictate our healthcare to prioritize the well being of people over their body parts medicine and society as a whole must look beyond uterus owners childbearing potential my womb isn t my legacy i replied to the friend my words are patient s name has been changed for privacy share this share on reddit opens in new window reddit share on x opens in new window x share on tumblr opens in new window tumblr share on linkedin opens in new window linkedin share on pinterest opens in new window pinterest share on whatsapp opens in new window whatsapp share on telegram opens in new window telegram email a link to a friend opens in new window email print opens in new window print like loading posted in medicine obs gyn tagged endometriosis fibroids health hysterectomy womb women s health nov 07 anatomy of a suicide crisis life after abuse love shouldn t hurt posted by zedie 0 lee is a psychiatry resident content warning discussion of suicide domestic violence if you are in crisis text or call 988 do you know what it is that i fear the most when i yearn for something so much in a world so hopeless that it weakens my heart gyeongseong creatureopens in a new tab or window it s a discomfiting idea to confront the idea that psychiatrists may need help we re doctors after all islands of resilience for our patients amidst a sea of chaos while we re wonderful advocates for our patients we hide our most vulnerable moments fearing the ramifications but we re subject to human experiences depression regret shame anxiety as much as anyone else domestic violence and its associated mental health outcomes constitute one such experience from which physicians are not exempt despite a pervasive mythopens in a new tab or window that it should not happen among educated medical professionals leaving abuse is among the hardest things we will ever do some of us will returnopens in a new tab or window some of us will not survive most of us will face humiliation dismissal and re victimization from the individuals and institutions meant to protect usopens in a new tab or window and what of the aftermath of abuse the pain that lingers even years after leaving september and october are challenging months for me an intersection of suicide prevention awareness and domestic violence awareness for weeks now i ve tried to write about the mental health impact of intimate partner violence ipv i could have reviewed papers on its physiological effects or the impact of relational trauma i could have offered dataopens in a new tab or window on risk factors for perpetration and victimization but no statistics will sufficiently convey what is happening inside us in lieu of data i offer narrative one of our most powerful tools for connection and empathy in medicine unless you have lived through domestic violence yourself i cannot make you truly understand the intensity of emotion many of us rage and wonder how is it that those of us who survived continue to endure this pain while our abusers move on but me i withdraw morosely existing on the periphery of other people s lives and wondering just how valuable my life is i ve become a voyeur envying people who return to daily stability and love that i borrow only transiently from my support system because i worry i m a nuisance withdrawal while emotionally safer is deeply lonely my sleep is chronically poor my emotional load at baseline is too heavy and with enough stressors i fall into a deep prolonged guilt ridden depression but it becomes dangerous when my mind races uncontrollably and one insidious thought my life is no longer worthwhile overwhelms all others the first time it happened i was debating stay or leave in an abusive relationship i didn t appreciate the danger at the time i felt worthless in fact he outright told me so a quiet exit from the world felt like my only choice privately i called it my escape plan my little secret the one thing i could control the idea lived in the back of my mind for weeks the thoughts started racing one afternoon i knew unequivocally i was remorselessly unloved in that relationship and i feared inconveniencing others with my problems i collected materials i wrote a note i never completed the act like i was nothing i didn t tell anyone unwittingly inspired by virginia woolf how many times have people used a pen or paintbrush because they couldn t pull the trigger i started writing to cope but many women like me take the route i seriously contemplated on the psychiatry consult service i met that version of myself in the form of a patient who had left a relationship similar to mine and later attempted suicide in a highly lethal way for therapeutic rapport i broke my rule of non disclosure which i break only for ipv victims in special circumstances he looked at me like i was nothing she whispered tears streaming down her face she described the physical acts of violence against her in excruciating detail i froze i could see his face twisting in rage cold slits for eyes i could feel cruel hands on me my body tightened preparing to run you re reliving what he did to you aren t you my patient asked your face right now you rub your hands to self soothe you ve been doing it since you first met me in the icu suddenly exhausted i leaned against the wall and nodded unable to deflect what i didn t say to her i easily could have done what you did i hope you get better she said mournfully almost a question as though she needed to know that the pain would subside with time i wanted to reassure her to tell her with certainty that she would hurt less and be more sure of herself someday but i knew in my heart i d be lying and the words wouldn t come don t worry about me i replied instead it s not your job it s my job to worry about you one day at a time for whatever it s worth i m here for you i remembered something she d sobbed to me that echoed my private thoughts i love so deeply i just want someone to love me the way i m willing to love i hid in a stairwell after that then the tears came fast hot blinding it doesn t end with us i knew what would come next after leaving abuse the reality that i didn t want to tell my patient while she was so vulnerable existing not living overwhelming isolation the desire for intimacy paradoxically coexisting with a terrible fear of intimacy wondering if i will ever feel whole again often i want to reach out to my loved ones and i don t always want to talk i just want them there but the anxious guilt of being a burden stops me and i withdraw instead externally i function well most people do not understand the sheer force of will it took for me to come this far you re the most resilient person i know someone told me i m not i just didn t have a choice i wanted to answer i don t want to be resilient anymore there are some things you don t return from no matter how hard you try the hypervigilance fear and elevated mistrust are deeply isolating seemingly permanent features of my life now it s not a life i d want for anyone my patient had whispered it feels awful i could relate to everything she was saying there are days when i wake up wishing i hadn t the world seems suffused in gray less colorful there are days when i think what is the point of trying anymore i am so tired i don t want to try shortly after i met that patient and inadvertently relived my own past those racing thoughts began again overwhelmed by a terrible sense of guilt and sadness and the thought that my life is pointless feeling the need to apologize to everyone for being so weak unable to stop crying i somehow made my way to my closest safe person my residency program coordinator she sat me down in her office and hugged me wordlessly the act of kindness i didn t know i needed the touch i wanted but didn t know how to request my whole body tense and fearful relaxed in her warm embrace i ll let go in a minute just let me stay here for another minute i want to feel safe only for a few moments maybe just a minute longer and then i ll let go i promise just hold me for one more minute love should not hurt everyone deserves relationships free from abuse the national domestic violence hotline is available 24 7 at 1 800 799 safe 7233 if you or someone you love are in immediate danger please call 911 if you or someone you know may be experiencing a mental health crisis contact the 988 suicide crisis lifelineopens in a new tab or window by dialing or texting 988 share this 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