Regarding Your Ugly Uterus

The uterus is a muscular organ that sits in the female pelvis. And if you have one, it’s probably ugly.

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I talk to a lot of women about their uteri. In doing so, I’ve discovered a colossal gap between women’s expectation of their reproductive organs and the biological truth. Many of my patients feel alone, unlike themselves, and less like women because they think there is something “wrong” with their uterus. As someone who somewhat regularly looks inside other people’s bodies, I can tell you that most small bowel looks prettier (and is certainly less complicated) than the average uterus.

In defense of any woman who has ever felt guilty, shamed, or alone because her reproductive organs are not perfect, let’s have this very candid discussion about the realities of the uterus.

Let’s first agree that your uterus is not a ball of pink cotton candy. It is not shaped like the pink pears from your high school biology/sex-education illustrations. It is more likely shaped like a fist, a thick capsule of tissue encasing a tight muscle that you feel contracting deep in your pelvis every month.

It is understood that 1 in 200, to as high as 1 in 10 women have a uterine anomaly. That is, your uterus might actually be two uteri; it might be shaped like heart with two horns; there might be a wall separating the uterine cavity into two; and your uterus may fall somewhere on the whole spectrum in between. You wouldn’t necessarily know your uterus is so special. I will support you in assuming it is.

Your uterus might have fibroids. As many as 7 in 10 women have fibroids. ‘Fibroids’ sound like alien creatures, but really they’re just bundles of tissue that can grow erratically and cause intractable bleeding and pain. Nothing too far departed from your normal bleeding and pain. Similarly, you may also have polyps or thickened glands. You might not know you have them, or they might cause your periods to be so heavy you bleed like an open vessel and have a heart attack at age 22.

Your uterus is capable of world domination. You spent the better part of your adolescence navigating the isles of tampons and maxi-pads, scented or non-scented, with or without wings, sharing embarrassing stories with your girlfriends or sisters or mom about when your period caught you off-guard. Meanwhile, your uterus is drinking a cocktail of hormones and building itself into a fort. It regenerates itself cyclically to stay in shape. It evolves to support a human life growing inside of you. It evolves to support a human life growing inside of you.

Your uterus may hemorrhage. No exaggeration — your uterus may actually kill you. During pregnancy, the heart pumps 30–40% more blood through your body every minute than it does in the non-pregnant state. Near term, 10–20% of your body’s blood is shunted to the uterus and the placenta. Labor and childbirth, like your uterus, are not perfect. To say that the maternal-uterine-placental-fetal axis is precarious would be an understatement. Your blood vessels might spasm. The placenta might detach too early. The umbilical cord might be fragile. At the end of it, your uterus might be functionally exhausted and not contract after childbirth, statistically adding you to the number one cause of maternal hemorrhage.

Your uterus might even tear, and, by the grace of modern medicine, it may be removed to save your life. For the women who had hysterectomies because of massive hemorrhage, let us all come together and say, “good riddance.” They are better off alive.

All this to say: I think the concept of the uterus as a perfect, naturally child-nourishing organ is inaccurate, misogynistic, and even dangerous.

We must take responsibility over what is perceived as reproductive normalcy.

It is easy to criminalize the men in power, the anti-choice organizations and the insurance companies for attempting to control our bodies. However, it is more difficult to admit that we as women are sometimes our worst oppressors: the midwives telling stories of perfect deliveries; the so-called friends bragging about their perfect pregnancies at a baby shower; the judgmental mother who had you without an epidural; the Beyonce’s of the world telling you your body should snap back, that pregnancy is divine and you are a goddess, that if you did everything right, nothing should go wrong; the bloggers with their pages and pages of opinions about what to do and what not to do, as if everything is a choice, as if you from the onset of your fertility have had any control over how the uterus and the placenta — those labile organs ready to bleed — miraculously quiesce to what your friends will consider a normal pregnancy.

I invite women to entertain the concept of the uterus as an imperfect organ. Your uterus is a misshapen muscle that bleeds, transforms, is capable of building a microclimate for new human life, and might kill you in the process. In one word, it is powerful, and not to be trifled with. Because it is your little monster, no one can make decisions about it except you.

Don’t even get me started about your vagina.