Throughout her years of endometriosis pain, Lena Dunham suspected that her uterus was “defective,” despite her doctors’ assurances. And as her pain became “unbearable,” it was the actress who requested the hysterectomy surgery to remove her uterus and cervix, she reveals in a harrowing essay in the March issue of Vogue.

Dunham, 31, had thought in April that she was finally endometriosis-free, but she was hospitalized in May for further complications. She then spent August to November in “delirious” pain that, she said, her doctors couldn’t explain.

“The ultrasound shows no cysts, no free fluid, and certainly no baby,” Dunham said. “But that doesn’t help the fact that it hurts so bad that the human voices around me have become a sort of nonsense Teletubbies singsong.”

Dunham requested a hysterectomy, but doctors suggested she first spend a few days carefully thinking about her choice since it would mean she could not carry a child, which had been a lifelong dream. The Girls writer and star stayed in a hospital for 12 days “on what is essentially medical-grade heroin to handle the pain,” she wrote. In a final attempt to save her uterus, she had one last surgery: a dilation and curettage, in which excess tissue is cut away from the uterus.

“But it doesn’t go as expected,” Dunham wrote, “and I end up in a recovery bay on an IV drip of Pitocin, the drug used to induce labor. They need my uterus to contract — but once again it won’t comply, for complex medical reasons I can’t understand, so right now I am essentially in labor for seven hours, my back seized, grunting like a creepy dude in a tennis match.”

Her doctors finally supported Dunham’s decision to have a total hysterectomy, and she went into surgery six days later.

“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,” she said.

According to Dunham, after the procedure the doctors said her “uterus is worse than anyone could have imagined.”

“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,” Dunham said.

Now about three months later, Dunham said she’s “healing like a champ,” and figuring out her options for motherhood — from surrogacy to adoption — while coming to terms with the fact that she’ll never be able to carry a child.

“I wanted that stomach. I wanted to know what nine months of complete togetherness could feel like,” she said. “I was meant for the job, but I didn’t pass the interview. And that’s OK. It really is. I might not believe it now, but I will soon enough.”