Narrator: For an average of seven years, a person might visit three, four, or even five different doctors, describing debilitating pelvic pain, heavy periods, and crushing fatigue. They are told it's normal, that it's just stress, or that the pain is all in their head. All the while, their ultrasounds and blood work come back clean, leaving them to question their own sanity. This isn't a rare hypothetical; it is the typical diagnostic journey for someone with endometriosis. This frustrating and painful odyssey, where real physical suffering is systematically dismissed, lies at the heart of a deep-seated problem in medicine.

In the book It's Not Hysteria, Dr. Karen Tang dismantles the historical and systemic biases that have allowed gynecologic issues to be misunderstood, underfunded, and undertreated for centuries. She provides a comprehensive guide that not only explains the "what" of these conditions but, more importantly, the "why" behind the widespread suffering and the "how" for patients to finally reclaim their health and well-being.

Narrator: The modern dismissal of gynecologic pain is not a new phenomenon; it is the direct descendant of centuries of medical misogyny, crystallized in the concept of "hysteria." Dr. Tang traces this idea back to ancient Greece, where physicians like Hippocrates proposed the "wandering womb" theory. They believed the uterus was an independent creature that could move around a woman's body, causing a wide range of physical and emotional distress if it wasn't appeased with pregnancy.

This notion that a woman's health issues originate from her reproductive organs, and are often psychological in nature, persisted for centuries. It reached a new peak in the late nineteenth century with treatments like the "rest cure," famously prescribed by Dr. Silas Weir Mitchell. The writer Charlotte Perkins Gilman was one of his patients, subjected to a regimen of social isolation, bed rest, and a ban on all intellectual or creative work to treat her depression. The experience was so maddening that it inspired her seminal short story, "The Yellow Wallpaper," in which the protagonist, confined to a room, descends into psychosis. Gilman’s story was a powerful exposé of how paternalistic medical practices, designed to control rather than heal, could be profoundly harmful. Dr. Tang argues that while the term "hysteria" is no longer a formal diagnosis, its shadow lingers in the way patients' symptoms are minimized and attributed to emotional or psychological causes rather than legitimate physical disease.

Narrator: The historical biases against women's health have created a modern healthcare system that systematically fails patients with gynecologic conditions. This failure manifests in three critical areas: funding, research, and racial bias. Dr. Tang points to the shocking disparities in research funding from institutions like the National Institutes of Health (NIH). In 2022, the NIH allocated more funding to smallpox—a disease eradicated from the US in 1949—than to endometriosis or fibroids, conditions that affect millions. This lack of investment means there is no known cause or preventative treatment for fibroids, a condition that affects up to 80% of Black women.

This neglect is compounded by deep-seated racial biases. The book recounts the horrific story of Dr. J. Marion Sims, hailed as the "father of gynecology," who perfected his surgical techniques by performing experimental operations on enslaved Black women without anesthesia. This foundational exploitation has echoes today in the staggering health disparities faced by Black women, who are three times more likely than white women to die in pregnancy or childbirth. Dr. Tang emphasizes a statement from the American College of Obstetricians and Gynecologists: it is racism, not race, that impacts health outcomes. This systemic neglect ensures that conditions primarily affecting women, especially women of color, remain poorly understood and inadequately treated.

Narrator: Many gynecologic conditions, such as endometriosis, adenomyosis, and pelvic floor dysfunction, are effectively "invisible" to standard medical tests. They don't appear on imaging or lab work, which leads to immense frustration for patients whose severe symptoms are not validated by objective data. Dr. Tang shares the story of a woman who suffered for over two decades with excruciating periods and bowel issues. Because her mother and grandmother had similar experiences, she, and her doctors, dismissed her pain as a normal part of being a woman. It wasn't until she ended up in an emergency room that she was finally diagnosed with both endometriosis and adenomyosis.

Her story is a powerful illustration of a central theme in the book: symptoms may be common, but suffering that affects your quality of life should never be tolerated as "normal." The book provides a framework for self-assessment, encouraging individuals to track their menstrual cycles, pain characteristics, and related symptoms. This detailed log becomes a "road map" for a healthcare provider. Dr. Tang argues that a patient's story is often the most crucial diagnostic tool, guiding doctors toward the right diagnosis when tests alone fall short. Understanding what is truly normal versus what is common but abnormal is the first step toward getting effective treatment.

Narrator: For many gynecologic issues, there is no single "right" treatment. Instead, Dr. Tang presents a landscape of options where the best path forward is a collaborative decision between the patient and their provider. The book details a wide array of treatments, from medications and hormonal birth control to minimally invasive procedures and major surgeries like hysterectomy.

A key point is that these decisions are highly personal and depend on an individual's goals. For example, a patient with uterine fibroids might be presented with two primary options: a hysterectomy, which offers a definitive cure, or a uterus-preserving procedure like a myomectomy. For a patient who is finished having children and wants to eliminate the problem permanently, a hysterectomy might be the best choice. However, for someone who still desires fertility, a myomectomy, despite the risk of fibroid recurrence, would be the more appropriate path. The book stresses that the patient is the ultimate expert on their own quality of life. It empowers them to weigh the risks and benefits of each option—including the choice of no treatment at all—to find the solution that best aligns with their personal health goals.

Narrator: Throughout the book, the ultimate solution presented is a combination of knowledge and self-advocacy. Dr. Tang highlights the shocking lack of basic education around reproductive health, sharing an anecdote about a professor who gave his college students a simple anatomy quiz. The students, despite being sexually active adults, could not correctly identify basic reproductive organs, a failure of both the educational system and societal taboos. Without a fundamental understanding of their own bodies, individuals cannot effectively advocate for their health.

The book serves as a comprehensive resource, covering everything from anatomy to the specifics of conditions like PCOS, ovarian cysts, and pelvic organ prolapse. It also extends this empowerment to be inclusive, with dedicated chapters on gender diversity and intersex conditions, affirming that everyone deserves care that respects their identity. By arming readers with information and encouraging them to seek second opinions, question dismissive attitudes, and demand better care, Dr. Tang reframes the patient's role from a passive recipient of care to an active, informed partner in their own health journey.

Narrator: The single most important takeaway from It's Not Hysteria is that the widespread suffering caused by gynecologic conditions is not an inevitable part of biology, but a direct result of a medical system steeped in historical ignorance and systemic neglect. Women's pain is real, it has a biological basis, and it deserves to be taken seriously. The path forward requires dismantling the cultural and medical biases that have allowed this suffering to continue in the shadows.

Dr. Karen Tang has written more than just a health guide; she has authored a manifesto for a revolution in gynecologic care. The book leaves readers with a powerful challenge: to transform their personal struggle into a collective movement. By sharing their stories, demanding more research, and refusing to accept dismissal, individuals can break the cycle of silence and misinformation, ensuring that future generations will not have to fight so hard just to be heard and healed.