Impact of tubal sterilization and vasectomy on female marital sexuality: results of a controlled longitudinal study

Knowledge, attitudes, and perceptions of antenatal women to postpartum bilateral tubal ligation at Greys Hospital, KwaZulu-Natal, South Africa

OBJECTIVES

To evaluate the associations between socio-demographic factors and the general knowledge, the attitudes and perceptions of women attending antenatal clinic at Greys Hospital regarding postpartum tubal ligation (BTL).

METHODS

A prospective cross-sectional study describing the perceptions about BTL in 241 pregnant women was conducted.

RESULTS

One hundred and sixty six (68.9%) participants needed to involve their partners before tubal ligation. Thirty five percent of 102 participants who would not have BTL against partner's wish were unemployed. Eighty three (34.4%) participants, mostly with secondary and tertiary education believed that successful reversal of BTL is guaranteed. Fifty two percent of participants, predominantly with no formal schooling and primary education levels were unaware of the risk of falling pregnant after BTL. Sixty seven (27.8%) participants, predominantly with primary education or no formal schooling believed that BTL protects against STIs and HIV. Seventy eight (32.4%) of participants would not have BTL due to religious beliefs, however, participants from the same religion gave different answers to the question.

CONCLUSION

The study showed a significant lack of knowledge on key points of BTL. Socio-demographic factors still influence this subject and should not be underestimated during counselling of the patients to reduce potential morbidity and litigation.

Evaluation of sexual function and quality of life in Iranian women with tubal ligation: a historical cohort study

Tubal ligation (TL) is an option for contraception for women who have completed their family. The existence of sexual dysfunction and impaired quality of life (QOL) following this procedure has been the subject of debate for decades. The aim of this study was to evaluate the sexual function, QOL and other factors affecting Iranian women who underwent TL. A historical cohort study was carried out on 150 women who had undergone TL and on 150 women who had used a condom (as the control group). The sexual function of participants was evaluated and compared using Female Sexual Function Index (FSFI) questionnaire. They were also asked to fill out the Short Form Health Survey (SF-12) for evaluating their QOL. Furthermore, the effects of educational level and poststerilization regret in the women of TL group were evaluated. With regard to FSFI, all mean values were found to be lower in the TL women and the differences between the two groups were statistically significant in all domains. A significant difference was found in sexual dysfunction in orgasm (P = 0.02), satisfaction (P = 0.01), pain (P = 0.006) and total FSFI scores (P = 0.006) between the women regretting vs those not regretting their sterilization. In evaluating the relationship between FSFI and educational level, with the increase of educational level all domain scores increased significantly only in the TL group. There was a significant difference between the two groups in SF-12 scores (69.18 ± 14.05 vs 78.41 ± 12.50; P < 0.0001). Our findings reveal the adverse effects of TL on the sexual life and QOL of women. It is recommended that the awareness and knowledge of health-care professionals regarding the sexual function and QOL in women undergoing TL should be increased.

Post-vasectomy depression: a case report and literature review

Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient’s current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined.

Sexual function in Iranian women using different methods of contraception

AIMS AND OBJECTIVES

To determine the sexual function in Iranian women using different methods of contraception.

BACKGROUND

Failure in family planning programmes can lead to reduced quality of life and threaten the health of the families in developing countries. One of the major causes of failure in family planning methods could be due to complications of them. One of the major unpleasant side effects of these methods, as an important cause of the rejection, is sexual dysfunction.

DESIGN

A case-control study.

METHODS

In this study, samples included 608 married women aged 15-49 years from Shahin Shahr health centres in Isfahan. Stratified sampling method was used to determine entitlement to select health centres, and convenience sampling method was used for women selection. The selected samples, based on using contraceptive methods, were divided into case group (n = 306) and control group (n = 302). Data were collected using sexual function questionnaire in women using different methods of contraception. Data were analysed by descriptive statistic and anova.

RESULTS

Results of independent t-test showed significant difference in all domains of sexual function in two groups (p < 0·05). Most contraceptive methods in control group were natural methods (28·4%), and the least used was vasectomy (1·8%). Findings showed that the least sexual dysfunction in Iranian women was in condom use method, and the most was in vasectomy method. There was asignificant difference between all domains of sexual function (except pain) in types of contraceptive methods (p < 0·05).

CONCLUSIONS

This study revealed that in family planning programmes, contraceptive methods in women that are more effective and have less sexual function impairments should be recommended.

RELEVANCE TO CLINICAL PRACTICE

Knowledge and awareness of the healthcare professionals regarding the sexual problems should be increased. Management of sexual dysfunction in a holistic approach in the primary care services might improve the wellness and quality of life of the women.

Menstrual, psychosexual, psychological and somatic sequelae following postpartum sterilisation

This study was designed to investigate the menstrual, psychosexual, psychological and somatic sequelae in a group of women who may be more prone to express regret following sterilisation. They were at a younger age, and all underwent postpartum sterilisation. The follow-up was conducted by a questionnaire between 6 months and 5 years following the procedure. Data were available from 242 patients with 76.8% before age 30, and 23.2% age 30 or older. Of all the patients, 21.9% regretted their choice of sterilisation. About one-third had various menstrual cycle disturbances. In general, patients rated their sex life more enjoyable in many aspects. The two most common psychological symptoms were irritability, nervousness and depression. The common somatic symptoms were pelvic/ abdominal pain, backache and tiredness. A complete assessment of the patient's postoperative condition, including menstrual cycle history, sexual history, psychological and somatic complaints if any, is warranted during presterilisation counselling in addition to a routine informed consent. This is especially important for those patients who are known to be more prone to express regret following the procedure.

The influence of a vasectomy on the marital relationship and sexual satisfaction of the married man

The purpose of this study was to determine whether a vasectomy had any effect on important aspects of a marriage, such as sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse. An experimental research design was used. We collected data by means of a biographical questionnaire, the Enriching & Nurturing Relationship Issues, Communications & Happiness questionnaire (Olson et al., 1985), and the Index of Sexual Satisfaction (Fischer & Corcoran, 1990), which were applied prior to and 5 months after the vasectomy. Results indicated no significant difference between the before and after measurements regarding sexual satisfaction, marital satisfaction, communication, and frequency of sexual intercourse.

Female sterilization. Evidence

The literature review herein reveals substantial information regarding the safety, efficacy, short-term complications, long-term complications, and noncontraceptive benefits of sterilization. This information should be helpful for providers and potential sterilization candidates. The review also reveals areas where the data are unclear. Points to keep in mind during counseling include the following: The vast majority of women are satisfied with the decision to undergo sterilization. The fact that regret occurs underscores the importance of counseling and adequate individual deliberation before the procedure. In addition to the difficulty and expense associated with sterilization reversal, the woman should thoroughly understand the permanence of the procedure. Although failure is a rare event, it can occur many years after the procedure. Although evidence suggests that hysterectomy rates are higher in sterilized women aged less than 30 to 35 years, it is unlikely that there is a plausible biologic effect of sterilization on hysterectomy risk. An association between tubal sterilization and menstrual cycle changes does not seem valid for changes noted up to 2 years after the procedure. Data are unclear and inconsistent among studies observing women more than 2 years after the procedure. Evidence consistently shows that sterilization is associated with a reduced incidence of ovarian cancer and pelvic inflammatory diseases. Most studies show no effect or improvement of sexual satisfaction after sterilization. Complications during and postprocedure are rare. Sterilization provides no protection against the acquisition of sexually transmitted disease. Patients and their physicians should recognize that sterilized women may need more targeted preventive efforts for health screening and to reduce high-risk behavior than women who use other contraceptive methods. The surgeon's experience and the woman's preferences should govern the ultimate decision regarding the approach and occlusion method. Level II-2 evidence indicates comparable safety between interval laparoscopy and minilaparotomy. Data consistently show that in experienced trained hands, tubal sterilization is safe and highly effective regardless of the approach or occlusive method. Attention to the subtleties of technique seems to be most important in ensuring procedure safety and efficacy. Reanalysis of the CREST data shows that the cumulative failure rate of bipolar coagulation is comparable with the failure rate of unipolar coagulation if a substantial length of tube is adequately coagulated. The data discussed herein can be used to guide management decisions that may increase accessibility and reduce cost of the procedure. Low-resource settings and office settings have maintained an excellent safety record for this procedure through performance of sterilization under local anesthesia. The use of local anesthesia enables a change in procedure location from an inpatient operating room to a free-standing surgical clinic or adequately equipped office. Local anesthesia, with or without preoperative medication, is an excellent option associated with a lower complication risk, reduced cost, and shorter, easier recovery. The surgeon should have specific training in the effective use of local anesthetics, preoperative medications, and management of rare complications in low-resource settings. Little additional research is needed regarding the safety and efficacy of standard sterilization approaches and occlusion methods. There is a need for continued development of nonsurgical methods of sterilization, microlaparoscopic approaches performed in the office setting, and the feasibility and acceptance of service provision by nonspecialist health care providers. The evidence indicates that female sterilization can be performed safely in a variety of resource settings ranging from rural sterilization camps in developing countries to high-tech, resource-rich operating rooms in developed c

Sterilization and its consequences

The purpose of this review is to analyze critically the two techniques of sterilization (bilateral tubal ligation [BTL] and vasectomy) so that a physician may provide informed consent about methods of sterilization. A MEDLINE search and extensive review of published literature dating back to 1966 was undertaken to compare preoperative counseling, operative procedures, postoperative complications, procedure-related costs, psychosocial consequences, and feasibility of reversal between BTL and a vasectomy. Compared with a vasectomy, BTL is 20 times more likely to have major complications, 10 to 37 times more likely to fail, and cost three times as much. Moreover, the procedure-related mortality, although rare, is 12 times higher with sterilization of the woman than of the man. Despite these advantages, 300,000 more BTLs were done in 1987 than vasectomies. In 1987, there were 976,000 sterilizations (65 percent BTLs and 35 percent vasectomies) with an overall cost of $1.8 billion. Over $260 million could have been saved if equal numbers of vasectomies and BTLs had been performed, or more than $800 million if 80 percent had been vasectomies, as was the case in 1971. The safest, most efficacious, and least expensive method of sterilization is vasectomy. For these reasons, physicians should recommend vasectomy when providing counseling on sterilization, despite the popularity of BTL.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians

LEARNING OBJECTIVES

After completion of this article, the reader will be able to predict the failure rates and likelihood of successful reversal of tubal ligation and vasectomy; to recall the difference in cost between the two sterilization procedures, and to describe the short-term and long-term complications associated with each of the two methods of sterilization.

Is tubal sterilization associated with an increased risk of subsequent hysterectomy but a decreased risk of ovarian cancer? A review of recent literature

Recent epidemiologic studies have suggested that tubal sterilization (TS) may lead to an increased incidence of subsequent hysterectomy but a decreased risk of ovarian cancer. This review evaluates the nature and magnitude of these two relationships, which should be of great concern and interest to women, clinicians and the administrators of family planning programs. The positive relationship between TS and subsequent hysterectomy is more likely to be of a motivational rather than biological nature, and a considerable number of unnecessary hysterectomies after TS could be avoided by changing the attitudes of physicians and women. The inverse relationship between TS and ovarian cancer appears causal, although the exact biological mechanisms remain to be clarified. Theoretically, this non-contraceptive beneficial effect of TS could be used as a primary preventive measure to curb the incidence of the highly fatal ovarian cancer. However, a number of medical, ethical, and economic questions attending use of a generally irreversible contraceptive procedure as a preventive measure must first be answered. The issue of whether TS is associated with any long-term sequelae, and, if so, whether the association is of a cause-and-effect nature or a by-product of time passage and aging of the woman, should be addressed by well-designed studies.

Psychosocial consequences of sterilization: a review of the literature and preliminary findings

Tubal ligation continues as a frequently used method of birth control. Nonetheless, psychosocial consequences, sexual satisfaction, and later regret regarding the procedure and the loss of childbearing potential remain as concerns. This is particularly true for the population of childless women requesting the procedure. The authors review all available recent literature on regret, psychosocial correlates, and sexual satisfaction related to tubal sterilization, with particular attention to the literature on childless women. They also present preliminary findings from a prospective controlled 5-year follow-up study of sterilization in childless women.