what women are not told about tubal ligation

TITLE: Risk and contraception: what women are not told about tubal ligation.

AUTHORS: Turney L

SOURCE: WOMEN'S STUDIES INTERNATIONAL FORUM. 1993 Sep-Oct;16(5):471-86.

SECONDARY SOURCE ID: PIP/091715

ABSTRACT: The most common method of fertility control is tubal ligation. Physicians and some women promote tubal sterilization as an extremely safe and very effective method of permanent fertility control. Yet the medical profession has known since 1930 that significant numbers of women suffer serious and irreversible complications from tubal ligations; women have died from tubal ligation. Its mortality rates in Bangladesh, the UK, and US, are 1/5000, 1/10,000, and 1/25,000, respectively. Women experience complications both during and after surgery (e.g., twisting of the tube, sometimes accompanied by gangrene, and accumulation of fluid in a tube). After tubal ligation, many women develop endometriosis.

Torsion, hydrosalpinx, and/or endometriosis contribute to increased menstrual pain. Disturbance of the local flora can cause sepsis (e.g., toxic shock syndrome). Some women have a severe inflammatory reaction to the silicone in clips and rings. Tubal ligation may be linked to an increased risk of cervical cancer. Many sterilized women eventually undergo hysterectomy. Many women experience excessive bleeding during menstruation, but many physicians discount this as women not knowing their own bodies and subjective estimates of blood loss. Impaired ovarian blood supply and altered nerve supply to the tube and/or ovary are possible causes for post-tubal ligation menstruation problems. Many women experience memory loss, general decline in feeling of well-being, lethargy, and loss of libido after tubal ligation, indicating a spontaneous iatrogenic menopause. Yet physicians often attribute these symptoms to psychological problems, thereby denying women knowledge of their own bodies. Tubal ligation-induced problems should not be limited to the medical profession. We need to seriously examine the processes that keep this information from women.

TITLE: Sterilisation of women [letter]

AUTHORS: Dickon S

SOURCE: NEW ZEALAND MEDICAL JOURNAL. 1987 Dec 9;100(837):755.

SECONDARY SOURCE ID: PIP/057531

ABSTRACT: There is some evidence that women who undergo tubal sterilization, especially with cautery techniques, are at greater risk of subsequent hysterectomy. The tubal surgery apparently interferes with the ovary's blood supply, leading to decreased hormonal output, irregular ovulation, and an abnormal pattern of uterine bleeding that becomes the basis for the need for hysterectomy. Given this evidence, it is appalling to find that New Zealand women are being encouraged to undergo tubal ligation without any counseling regarding the chance of heavy bleeding problems within 5-10 years. Moreover, the alternative of having the male partner seek vasectomy is rarely presented. It is the duty of gynecologists to give this problem more attention in pre-sterilization counseling sessions. Useful toward this end would be a leaflet that could be given to patients at the time of their 1st consultation outlining the risks and benefits of tubal ligation.