The pain was otherworldly. My mouth opened wide in a soundless scream, like I was at the dentist, not the gynecologist. I lay bare-assed on the downward-sloping exam table, fingers clawing at its sides, heels digging against the metal stirrups, tears trickling past my temples. It was a pain distinct from any I’d experienced before: a cold, squeamish penetration that sent spasms down my spine – like getting fucked by an icicle. But then it was over, and I was good to go, liberated for the next five years from worrying over condoms or conception. 

“You might notice a bit of bleeding and cramping for the first few days,” the gynecologist informed me. “It’s totally normal.” 

Biking the mile back to my dorm, I cried as I rode over every bump in the road, hot pain stabbing my insides. I cried as I sat at my desk chair, clutching at my womb, which felt like it was being scraped from within by a demonic claw. When I went to pee, blood swirled in the toilet bowl like Suminagashi, the Japanese ink marbling technique Ms. Lucas had taught us in first grade art class.

I’ve always hated missing school. I hate falling behind, and I hate shirking duty. One day in fifth grade, I tried taking out my piercing studs overnight for the first time, so I could finally sleep without tiny metal needles jabbing at my mastoid bone. I hadn’t dared remove them before, because my ears had been finicky and constantly infected. The piercing lady had said to keep them in for six to eight weeks, so surely they would be healed after eight months. But no: when morning came, I found the holes sealed off and impenetrable. I asked my mom for help, and she crouched down before me in the narrow bathroom and re-punctured my ears. The world spun and then blackened, and I careened backward into the cold tile floor. Despite my passing out and slamming my head on the ground, my mom still made me go to school, where my head pounded and vision blurred as we learned about very important things like isosceles triangles and the Oregon Trail.

My mother had taught me that school takes precedence over physical well-being, a lesson I have struggled to shake off. So despite the knife-like pain in my uterus, I still showed up that afternoon to my three-hour writing class, a freshman requirement universally despised by all freshmen. It was taught by an old white man, who was so old and white that, when discussing a text on critical race theory in pedagogy, he asserted that just because Aja Martínez was talking about white privilege, did not necessarily mean she was talking about racism. 

Halfway through class that day, the pain grew so unbearable that I hobbled over to my old white man professor to beg for clemency. 

“Hi Professor Peterson,” I croaked. “I’m so sorry, um – I had an IUD inserted earlier today, and um – I’m kind of – in a lot of pain –”

His cheeks flushed a bright vermillion, like I had just yelled the word “clitoris” at the top of my lungs. He made a shooing motion with his hands and muttered, “Go take care of that. Go take care of that.”

And so I left. 

 

I hurt and bled the next day too, and the next, and the next, and the next. After a month of non-stop bleeding and cramping, I messaged my gynecologist, asking if I should be concerned. Totally normal, she replied, don’t worry. Just take some ibuprofen for the pain.

After six months, I reached out again. I’m concerned that I’m still bleeding every day, I said. But more importantly, I’m concerned that I’ve been so depressed. The bleeding is a bit unusual, she replied, but not beyond the scope of normality. And mood changes are normal. Just take some ibuprofen for the pain.

It was more than a “mood change.” It was the end of the world. It was a disintegration of my very core. I had always counted on my ability to bounce back to a state of contented okayness. Even on the rainiest of days, where the cold and gray swallowed the sky, I always knew the sun would return. I always knew I would soon dance among the puddles. But now, a crushing misery was the baseline – the tempest raged on and on.

Sometimes the sadness was so acute it was painful, like being forced to stare into the blinding sun. Sometimes it was a despondent numbness – a shocking recognition of my own hollowness, like hearing for the first time what silence truly sounds like. Sometimes it was a paralyzing dread that weighed down my bones and gripped at my lungs. A shivering in my soul that made me retreat from life like a scared animal. 

Depression sapped my creativity. Painting was the last thing on my mind; I was more preoccupied with brainstorming logistically feasible ways to kill myself. The myth of the “tortured artist” is widespread and pernicious – we lionize Van Gogh and Kahlo and Cobain and Plath for their anguished brilliance. Mental illness is romanticized as part of the package deal with artistic genius, as if suffering were a prerequisite for creating great work. No doubt, hardship can give texture and perspective to an artist’s life, which they can then draw upon in their creative practice. But that doesn’t mean it’s necessary, or desirable. As psychologist Kay Redfield Jamison put it, “No one is creative when severely depressed, psychotic or dead.”

Luckily, I did not end up psychotic or dead. Luckily, I reduced my classes and extracurriculars, reached out to loved ones for emotional support, and even signed up for my school’s notoriously unreliable and detested counseling services. After miraculously getting off the waitlist, which was clogged by the glut of students driven to the brink of insanity by the hellish pressure cooker of Stanford University, I was assigned a temporary Zoom shrink. At the end of our first meeting, she said, “I don’t feel the need to hospitalize you yet, but I am concerned.”

I was almost positive that the little fucker in my uterus was to blame. Despite all my adolescent adversity, I had always perceived myself as a generally joyful, optimistic, glass-half-full person. Sometimes bad shit would happen, and I would react with sadness like a normal human being, but then I would get back on my feet. And then the IUD, and then bam. Suicidal. Glass completely empty. So, I was almost positive I had a culprit. But I was also afraid to take it out: what if I did, and I was still depressed? What if it was just me? 

I asked my gynecologist if it was likely that the IUD was responsible for my depression. Numerous health magazine articles and Reddit forums had led me to conclude that yeah, it probably fucking was, but I wanted confirmation from my doctor. “Clinical trials have not demonstrated any causal relationship between hormonal IUDs and depressive symptoms. The effects of the hormones are very localized.” She smiled sweetly, almost cloyingly. “But do whatever makes you feel better,” she chirped. I felt a bit gaslit, a bit hysterical. 

The etymology of the word “hysterical” comes from the Greek hysterikós, which means “suffering in the womb.” The ancient Greeks and Egyptians believed that so-called behavioral disturbances in women, such as infertility or unwillingness to marry, were caused by the uterus literally skedaddling from the abdomen and wandering around the body. Plato called hysteria “female madness.” During the Victorian era, hysteria was an exceedingly common medical diagnosis, one almost exclusively reserved for women. Some of its myriad symptoms included anxiety, depression, emotional outbursts, melodrama, hallucinations, blindness, seizures, fainting, insomnia, chest pain, increased sex drive, decreased sex drive – basically anything deemed unexplainable or unmanageable in women. Crazy, irrational women. I made an appointment to get my IUD removed.

Two months later, at the end of January, the appointment finally arrived. 

“Am I allowed to keep it? As a souvenir?” I asked eagerly.

My gynecologist chuckled and gave a quizzical shrug. “Sure, I guess.”

I wanted the fucker out, but I also still wanted some form of contraception, so she offered to replace my Liletta with a Skyla. This new IUD would last me only three years instead of five, but it had a much lower hormone concentration, which would maybe alleviate the bleeding and the cramping and the wanting to kill myself. Out one came and in the other went, and it hurt just as much as the first time.

My gynecologist placed the tiny plastic devil creature, dripping with congealed blood and uterus juice, into a highlighter-orange biohazard baggie, like a little party favor. When I got home, I washed the IUD thoroughly, glued it to a wood panel, and made it into a painting. Horror rendered aesthetic: Apollo conquers Dionysus. 

With my new IUD, the bleeding persisted, but it was lighter in flow and sometimes gave me a day or two off, if it was feeling generous. But the depression did not abate. I made another appointment. Goodbye Skyla, hello Paragard.

I drew the line: this would be the final IUD attempt. The copper device wouldn’t fuck with my hormones, but it almost surely promised heavy and crampy periods, according to my doctor and the internet. But instead, my body produced no periods at all, for more than half a year. So back to the gynecologist I went. 

We talked about different medication options to induce the shedding of my uterine lining, and ultimately settled on estrogen via patch and progesterone via pill. These hormones would hopefully restore my period; the contraception would still be handled by the copper IUD, which was equipped to fend off sperm for the next decade. At the end of the appointment – since I was already here anyway, stirrups and speculum just an arm’s length away – I asked my gynecologist if she could give the strings of my IUD a little trim. Apparently, the plastic threads had decided to descend from the uterus and turn my vaginal canal into a meat grinder – my boyfriend had recently been yelping in pain when the strings lacerated his defenseless dick.

“Oh!” my gynecologist exclaimed, as she peered deep into me. “Your IUD is actually expelling itself.” Which meant we had to remove it immediately, which meant it hadn’t even been working as contraception, which meant I had to take a pregnancy test, which meant holy shit my uterus really did not fuck with IUDs.

Cumulatively, those three intrauterine devices were supposed to last me eighteen years. I had them all in and out within one and a half. I’m on the pill now. 

 

The doctors suspect the wacky IUD shit may have to do with my abnormally low levels of estrogen, which the doctors suspect may have to do with my history of eating disorders. Since I first lost my period in 2017, I’ve been getting my estradiol levels measured regularly, and I’ve always been in the postmenopausal range. Once, the concentration in my bloodstream was so low that my results reported “undetectable.” This deficiency was a subject of discussion during that fateful IUD-expulsion appointment. 

My gynecologist faced me with a look of intense concern. “If we don’t get those levels up, it might impact your future fertility,” she warned somberly, like she was delivering news that my dog had cancer. 

I brightened. “Oh, that’s it?” 

Her brows furrowed in confusion.

“I don’t want biological children,” I explained, “so I honestly don’t care that much.” I had made up my mind long ago. I'm open to adoption, but I have no desire to bring forth new life into this world on fire. As disasters intensify, oceans acidify, species die out, methane escapes permafrost, bearing children seems almost cruel. And anyway, I don’t think a fetus could even survive in the hostile terrain of my uterus, given its track record.

“You’re young. You might change your mind,” she insisted. 

I pressed my lips into a tight line. “Are there any other health impacts of low estrogen that I should be concerned about?”

Only then did she mention the heightened risk for osteoporosis and heart disease, the predisposition to depression and fatigue, the potential for systemic immune and metabolic dysfunction. I was aghast. All of that was of secondary importance to my hypothetical ability to conceive hypothetical babies?

Fertility had also been a huge concern for my mother when I first lost my period. How could I perform my duty as a woman without my primary asset, my child-rearing capacities? Over the years, my mother was always so diligent about instructing me in proper womanhood. 

“You’re going to get raped in those leggings,” she once called out the car door as I departed from the high school drop-off zone, pointing at the dusty lavender yoga pants that she forgot she had picked out with me just months earlier at the Nordstrom Rack.

“Only Jamie’s allowed to walk home from school because he’s a boy. Bad things happen to girls walking alone. I don’t trust you to protect yourself.”

“You have no breasts. It’s so sad. My one wish in life was for my daughter to have big breasts, which I could never have because I was malnourished as a child. You can’t even give me that.” 

“No man will ever want to marry you if you’re vegan. What if he comes home from a long day of work, and all he wants is a ribeye steak – will you refuse to cook for him?”

“You eat so much – it’s not ladylike.” 

 

Gender is a disciplinary regime. It’s a system of categorizing and classifying ourselves and each other, making us legible and governable, reified through legislation, marketing, consumption, and social interaction. As Judith Butler writes, “those who fail to do their gender right are regularly punished” – whether that be through transphobic bathroom bills or mothers shaming daughters for their flat chests. 

But none of us does gender right. Not if you’re trans, not if you’re cis. The disciplinary force is at work on us all, coercing us toward its rigid prescriptions. Zac Efron, arguably the epitome of white masculinity, fell into a severe depression after preparing for his role as a shredded Olympian swimmer on Baywatch. Overtraining, undereating, undersleeping, and taking diuretics, Efron sacrificed his mind and body in service of the hegemonic masculine ideal. We the people watched the movie, drooled over his abs, ate that shit up. 

Certain kinds of bodies, actions, and presentations are valorized by society as more feminine or masculine, but the ideal of “perfect” femininity or masculinity is forever elusive. The ideal is unattainable by design, a social prescription meant to keep us in line. Meant to keep us transfiguring our appearances and behaviors. Meant to keep us ever-insecure, ever-needing to consume: creatine supplements, anti-aging concealers, gym memberships, weight loss teas, pine tar soaps for men, pink-handled razors for women. It’s a very profitable industry, the things that promise to help us do gender better – but really just serve to reinforce its artificial bounds. 

Gender is now widely accepted as a spectrum and a social construct, but one that nevertheless maps onto a biological “reality” of sex: the cultural and representational is but a garment adorning the underlying material reality. Gender is supposedly changeable and fluid. But sex is supposedly fixed and stable, a male-female binary, determined by tangibles like gonads and genitals and chromosomes – despite the fact that gonads and genitals and chromosomes exist in countless intersexual varieties: ovotestes, XXY, shallow vaginas, XY with no balls. Human biology is irreducibly diverse. It’s almost like sex is a spectrum and a social construct, too.

Another quintessential biological arbiter of sex is hormone levels. Their easy measurement allows for easy regulation, easy construction of the perimeters delimiting sex. Caster Semenya is barred from the Olympics for her “advantageous” naturally high testosterone, while Michael Phelps is glorified for his genetically-endowed height, wingspan, and webbed feet. Testosterone is the essence of masculinity: strength and speed and aggression. Estrogen, on the other hand, is womanhood distilled into a molecule.

The gender-affirming medication regimen used by some trans women is called “feminizing hormone therapy” – to take estrogen, therefore, is to be feminized. No wonder men panic about estrogen-like BPA in plastic water bottles giving them man boobs. They also panic about too much tofu, because soy contains isoflavones, a type of plant estrogen that can mimic the effects of its human counterpart in the body. According to Urban Dictionary, “Soy boy,” a pejorative lobbed largely by the alt-right against progressive (especially feminist) men, is “used to describe males who completely and utterly lack all necessary masculine qualities. This pathetic state is usually achieved by an over-indulgence of emasculating products and/or ideologies.” Estrogen makes men less manly, makes women more womanly. 

So where did that leave me, with my undetectable estrogen, my menstrual dysfunction, my flat chest, my unladylike appetite, my slanted eyes and stubby eyelashes? If I couldn’t do gender right, if I couldn’t even do sex right, how was I supposed to be a real woman?