Hysterectomy

Hysterectomy is one of the most common surgeries of any kind and is the most frequently performed gynecological surgery, and yet it has been minimally studied by historians of medicine. Like other medical treatments, hysterectomy was theorized by physicians many centuries before it became a viable, survivable surgery, sometimes causing writers to situate its origins as far older than is appropriate. There is a paucity of historical research on hysterectomy, which may reflect the contested nature of the surgery in intersecting biopolitics over its history in a variety of forms: as an elective surgery primarily targeting benign uterine growths that can be treated more minimally; as a method of covert sterilization or contraception, not always conducted consensually; as a form of hormone manipulation and masculinization for gender transition, not always available for those who seek it; as a central therapy in cancer treatment, not always with high standards of care; as a form of cancer prophylaxis, not always considered relative to risk; and, most recently, as a therapy in the treatment of endometriosis and other chronic pain conditions of the female reproductive organs, albeit often denied to those of childbearing age—especially those who are racially privileged. Some scholars writing about hysterectomy’s dangerous past have assumed it must have been developed principally to treat cancer, but early surgical case-notes indicate it was always primarily targeted at nonlethal uterine growths, especially fibroid leiomyomas, despite the high risk of death it entailed for these otherwise healthy patients in the early years of its experimental use. As hysterectomy became safer due to aseptic surgical technique, antiseptics, antibiotics, improved surgical technique and anesthesia, its standard use for the treatment of benign fibroid tumors proliferated, despite alternative surgeries for such tumors being frequently possible. By the 1970s, more than 30 percent of women in North America received hysterectomy by the age of sixty, rising to 40 percent by the age of seventy-five, with slightly lower rates in the United Kingdom, Europe and Australasia, and lower but rising rates throughout the Global South since the 1990s. It became a central treatment for women’s reproductive cancers after the 1930s, and from the 1950s to 1970s, gynecologists often recommended elective hysterectomy to healthy patients as a form of cancer prophylaxis. It first became available for gender transition in 1912, becoming a common surgery for around half of transmen by the late twentieth century. Its use for treating endometriosis and other chronic gynecological pain conditions has grown since the 1990s.