Get it out: On the Politics of Hysterectomy by Andréa Becker (New York University Press: 2025)
Hysterectomy is the most common gynecological procedure worldwide, yet until recently only one book, written by Jean Elson in 2003, has previously taken it as its central focus, reflecting a dominant narrative that obscures the diversity of its interpretations. Often viewed through the lens of grief or loss, hysterectomy had not yet been addressed as a theme through the other meanings it may signify: autonomy, for example, or empowerment. In her book, medical sociologist Andréa Becker addresses this gap. Challenging the binary opposition between elective and necessary surgery, she reframes the procedure through the lens of choice, demonstrating how it reveals the gendered and racialized dynamics shaping the experience of an otherwise technically standardized intervention. Drawing on 100 narratives from participants of diverse ages, ethnic groups, sexual orientations, and gender identities, Becker traces the trajectories associated with this procedure to uncover its meanings, motivations, and consequences within the social contexts in which it is embedded. Whether in cases of endometriosis, fibroids, or adenomyosis, or within the context of trans health, both the reasons for undergoing hysterectomy and individuals’ access to it highlight how biological and structural forces intersect with culture and policy to shape experiences of care and embodiment.
Structured into five chapters, Becker’s book opens with a historical overview that uses hysterectomy to reinterpret the histories of gynecology and trans health. Tracing “women’s disorders,” medical abuses targeting racialized women, and the emergence of trans care, she highlights how sexism, eugenics, and colonialism have shaped both the procedure and its contemporary meanings. Revisiting hysteria, she further reveals the gendered ambivalence of pain, oscillating between naturalization and minimization. This historical lens underscores the persistence of medical imaginaries that represent the intervention as dangerous and continue to shape access to hysterectomy despite technical advances.
The following chapters draw on collected narratives and explore three central themes, enabling the author to develop her core argument: access to hysterectomy, and the meanings it carries, are socially, historically, and normatively situated.
Hysterectomy as a technofix
The first line of analysis developed by Becker draws on an STS perspective to conceptualize hysterectomy as a “technofix”: a biomedical technology used to repair or optimize bodies. The procedure can be understood as a solution mobilized by individuals in response to a range of situations, whether chronic pain, gynecological conditions, or gender‑affirming care. Embedded within a broader process of biomedicalization, hysterectomy is not limited to healing; it also contributes to transforming and “customizing” bodies so that they align with social and cultural expectations, such as having an able body to engage in social roles. At the same time, hysterectomy enables the acquisition or redefinition of sociocultural identities. By stopping menstruation and inducing sterility, it becomes a “tool in the toolbox” (p. 54) that some patients appropriate to make their bodies more livable and to achieve specific goals. In this sense, it can constitute a form of (self) care – preventive, therapeutic, and affirming – while simultaneously reshaping the very concept of health.
This conceptualization, developed in the second chapter, allows Becker to highlight the shift – both material and symbolic – of hysterectomy from a procedure historically instrumentalized by oppressive systems to a tool appropriated by individuals seeking to care for a “broken or erroneous body” (p. 20). However, she emphasizes that access to this « fix » is unevenly distributed and conditioned by norms of gender, race, and medical legitimacy, which illuminate the narratives and stereotypes surrounding bodies and identities.
Stratified pathway to hysterectomy
The author then turns, in chapter three, to the notion of choice to examine the differentiated nature of access to hysterectomy. By framing the procedure as an example of reproductive stratification – an unequal valuing and distribution of reproductive capacities and rights – she shows how the ability to obtain it is socially situated, shaped by gendered and racialized identities and by their proximity to “white motherhood” (p. 98). Between pressures directed at certain racialized and trans individuals and the barriers imposed on white women or non‑binary people, differentiated medical rationales operate within a broader “set of reproductive politics” (p. 75) that values certain forms of fertility. These rationales also condition access to the procedure according to identity and resources. Becker thus brings to light a continuum of inequalities in which the possibility of choosing to have – or not have – a uterus depends on how bodies are perceived and evaluated by medical institutions, revealing a reproductive autonomy that is unevenly distributed.
This reading through the lens of reproductive injustice allows the author, in chapter 4, to problematize reactions to hysterectomy, challenging the dominant framing which is usually the presumption of regret. By highlighting the variability of “post‑hysterectomy” (p. 108) feelings and drawing on Lock and Kaufert’s concept of “local biologies” (2001), Becker shows that emotional experiences are diverse – and not only regretful. They are shaped by the conditions under which the procedure takes place, the degree of perceived autonomy in the decision, and internalized expectations surrounding reproduction. Because agency is stratified along lines of gender and race, emotional responses to the operation are therefore socially situated.
Challenging the medical system from within
If access to hysterectomy is shaped by systemic norms and logics, Becker devotes her fifth chapter to examining the strategies individuals deploy to obtain it. She analyzes the work required to legitimize such a request within the medical system, as well as the ways patients adjust their narratives to align with the expectations of healthcare professionals and with normative frameworks. Combining biomedical with embodied knowledge, securing the procedure requires specific forms of learning and resources, such as cultural health capital (Shim 2010), in order to overcome gendered and racialized biases. Access to hysterectomy thus appears as the outcome of a strategic appropriation of the medical system, mobilized as a resource to achieve both bodily and identity‑related goals.
Not your mother’s (view on) hysterectomy
Andréa Becker’s book takes up a common medico-technical object to reveal its social, political, and symbolic complexity. It offers a way to think about a routine yet largely unspoken procedure by uncovering the logics that sustain the silence surrounding it. But it also sheds light on the social dynamics shaping its accessibility, lived experience, and effects. Through an analysis of determinants such as gender and race, Becker shows how this biomedical procedure is both shaped by social structures and mobilized by individuals as a tool to pursue their own goals. The book thus invites readers to rethink the multiple meanings of hysterectomy, emphasizing its fundamental ambivalence as both a potential instrument of oppression and a lever for empowerment.
The work is particularly compelling in its ability to move beyond the binary opposition between agency and structure, notably through a subtle treatment of choice and through its rich empirical material drawn from numerous testimonies. It sheds light on the ways in which the notion of choice cannot be understood independently from the socio-historical context that shapes the expectations, desires, and meanings attached to a medical procedure such as hysterectomy. In doing so, Becker’s work nuances a reading that is often polarized between complete self- and social determinism.
While one might occasionally regret a somewhat rigid distinction between hysterectomies linked to chronic illness and those situated within trans health – as the underlying issues they engage with may overlap more often than their theorization at times suggests – the book nonetheless stands as an important and innovative contribution to critical gynecology studies. It situates itself within a broader field of scholarship that interrogates the social, systemic, and cultural dimensions of medical practices and technologies. Its account of stratified reproduction first draws on key work on reproductive rights, including for example Ginsburg and Rapp’s (1995) edited volume on power, resistance, and reproductive practices in cultural contexts. Becker’s book also echoes work of authors such as Wendy Kline (2024) and Terri Kapsalis (1997), on the pelvic exam and the representations and performative dimensions of gynecology. Both examine gynecology and its objects or procedures as a site where medical knowledge, power relations, and the politics of the reproductive body intersect. These works show that gynecological practices are never neutral: they produce and regulate meanings attached to gender and reproduction, while also being shaped by social and historical inequalities, revealing tensions between autonomy and control. In this sense, Becker’s book opens promising avenues for rethinking the optimization of the self, the body, and health.
References
Ginsburg, Faye D., and Rayna Rapp (eds). 1995. Conceiving the New World Order. The Global Politics of Reproduction. University of California Press.
Kapsalis, Terri. 1997. Public Privates. Performing Gynecology from Both Ends of the Speculum. Duke University Press.
Kline, Wendy. 2024. Exposed: The Hidden History of the Pelvic Exam. History of Health and Illness. Polity Press.
Lock, Margaret, and Patricia Kaufert. 2001. “Menopause, Local Biologies, and Cultures of Aging.” American Journal of Human Biology 13 (4): 494–504. https://doi.org/10.1002/ajhb.1081.
Shim, Janet K. 2010. “Cultural Health Capital: A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment.” Journal of Health and Social Behavior 51 (1): 1–15. https://doi.org/10.1177/0022146509361185.
