Lena Dunham & making tough reproductive choices

I should start by saying that, while I know who Lena Dunham is, and that she is a somewhat outspoken & controversial celebrity figure, I have never watched an episode of "Girls" or formed my own opinion about her. I had heard about her struggles with endometriosis, and that she recently had a hysterectomy to try to resolve the problem permanently.

I just read Dunham's essay about her experience from Vogue magazine. I have never had to deal with endometriosis (although I have wondered, sometimes...), but there was much in her article that was familiar -- from the doctors who held out hope even as Dunham herself knew better, to coming to the end of a long-held dream, only because the pain (physical for her, emotional/mental for me) of hanging on got to be too much, to making a "choice" that creates a new kind of pain at the same time that it resolves another kind.

But I know something else, too, and I know it as intensely as I know I want a baby: that something is wrong with my uterus. I can feel it, deeply specific yet unverified, despite so many tests and so much medical dialogue. I just sense that the uterus I have been given is defective. 

And while I’ve been battling endometriosis for a decade and this will be my ninth surgical procedure, no doctor has ever confirmed this for me. They’ve told me I have a slightly higher chance of miscarriage. They’ve told me not to wait forever to “get it going.” But through the 40-plus vaginal ultrasounds where I’m forced to stare at the black emptiness of my uterus, they say things like “Look at those egg follicles! You better be careful or you’ll have a baby next week!” Their goal is to preserve my fertility. That is what they consider to be their job. And I laugh and smile, but I know that the blank space, the black hole that is an empty womb captured on-screen, is all I’ll ever see...

In the operating room the lovely Haitian anesthesiologist, Dr. Lallemand, lets me select a favorite Rihanna song, and I try to absorb the gravity of the moment—at least a dozen people dressed in blue scrubs with face masks, the fact that I could run right now but instead I am choosing to stay, choosing this. I have to admit I am really choosing this—I gave up on more treatment. I gave up on more pain. I gave up on more uncertainty.

Dunham's hunch about her uterus was vindicated by the results of her hysterectomy:

I wake up surrounded by family and doctors eager to tell me I was right. My uterus is worse than anyone could have imagined. It’s the Chinatown Chanel purse of nightmares, full of both subtle and glaring flaws. In addition to endometrial disease, an odd humplike protrusion, and a septum running down the middle, I have had retrograde bleeding, a.k.a. my period running in reverse, so that my stomach is full of blood. My ovary has settled in on the muscles around the sacral nerves in my back that allow us to walk. Let’s please not even talk about my uterine lining. The only beautiful detail is that the organ—which is meant to be shaped like a lightbulb—was shaped like a heart... 

Because I had to work so hard to have my pain acknowledged, there was no time to feel fear or grief. To say goodbye. I made a choice that never was a choice for me, yet mourning feels like a luxury I don’t have. 

She still holds hope of having children, perhaps via egg freezing,  perhaps via adoption. I wish her luck.

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I came to Dunham's essay in a roundabout way, via an article from Slate:  "The Only Certainty in Reproductive Health Is Uncertainty."  "As a gynecologist, I am grateful whenever celebrities publish articles about their reproductive health,"  writes Anna Reinart.

These women, whose lives and bodies are already the focus of incredible public scrutiny, are laying bare one of the most private and vulnerable aspects of their life—all for the sake of raising awareness about a medical condition they share with other women...  

They also tend to receive a hefty amount criticism for doing so. Dunham’s piece certainly did, which is unsurprising, since her story highlights some of the most uncomfortable themes that I’ve encountered as a women’s health care provider—namely, the issues around reproductive self-determination and the capacity for informed consent.

(I am hearing here all the echoes of "Oh, don't give up!!" and "Have you tried/thought of...?")  I had an "ah-ha" moment of recognition/deja vu when I read:

At the core of the impulse to question Dunham’s choice is the myth that if women just try hard enough, they can achieve reproductive self-determination. We all want to believe that Lena Dunham has the ability to conceive and carry the pregnancy that she eloquently describes herself as having always dreamed of. We all want to believe that she has a right to parent the biologic children that she desires. But in the fight for women’s reproductive freedom, in our efforts to remove external constraints on women’s reproductive choices, we have forgotten the one internal constraint over which even medicine is often powerless: biology... I have comforted women suffering through [various fertility-related scenarios], trying to reconcile her long-standing belief that she had control over her reproduction with the reality imposed by her biology.

Reinert concludes:

...many times, there are simply no good answers. So before you judge Lena Dunham, yourself, or anybody else for the decisions they have made about their reproductive health, remember—we have influence, but not control over our biology. We can hope for the best, but we can’t expect it.

I've cherry-picked the passages from both articles that spoke most directly to me, but I encourage you to read them both in their entirety. And let me know what you think.