All Tied Up: Selling Sterilization

Here is an article that I wrote for Associated Content.  Thought I would share it with everyone.

Over 43 million women in the U.S. today are using contraception, 27% of those rely on surgical sterilization as a permanent form of birth control. Many women are sold on this procedure by their gynecologists, girlfriends, family or are simply pressured into it by a partner than feels strongly about it.   Statistics show that half of all women ages 40-44 have been sterilized.  Sterilization is pushed primarily toward women who are 35 or older, married, with two or more children, and with incomes that fall below the poverty level.  The biggest issue to face women concerning sterilization is not about choice, but rather one of informed consent, and whether or not women are being given all the information they need to make a truly informed decision.  Unfortunately, doctors often trivialize the possible complications and thereby make the side effects of tubal ligation invisible.

Brochures on sterilization misrepresent tubal ligation with subtle terms that lessen the severity of the procedure.   After all, it’s all about how it is presented. Words can have emotional connotations and the medical community does not want to scare women by using the terminology that might give light to the procedure that is actually occurring. The understatement of bodily information makes tubal ligation seem like a simple contraceptive method. It also makes women believe that it is not as invasive and physically mutilating as the operation actually is. Gynecological texts are not neutral with their language.  They accurately explain that the surgery crushes a portion of the tube and kills the tissue that surrounds it.  Medical texts discussing electro coagulation  describe the fallopian tubes as smoking, swelling, and finally popping when the tube has been damaged enough to tear away a segment. Other texts say that “complete vascular obliteration” must be assured.  In other words, cutting off the blood flow to the tissues and surrounding area.  Would women agree to surgery if the text read “crushing, smoking, swelling, popping and obliteration”?  They might stop to consider the surgery more carefully if they were fully aware that cutting off blood flow to the ovaries is nothing less than female castration. 

Most brochures give a brief explanation of reproduction followed by a very basic description of the surgery. Words such as “closed”, “blocked”, “clamped” or “tied”, make it sound like reversing it would be as easy as “unblocking”, “unclamping” and “untying”.  Some doctors even promote certain types of tubal ligation as more “reversible” than others.  The current worst offender is the Filshie Clip, made by Cooper Surgical, that promotes in their patient literature that, “Reversal of Sterilization is Possible!”  Yet these clips work not only by blocking the tubes, but by causing inflammation and scar tissue that could likely make any hope for reversal impossible.  Just the discussion of reversal by a doctor, or in a pamphlet makes women disregard the permanence of the procedure and sets up the idea that the operation is semi-permanent. 

Sterilization reversal, or tubal reversal, is not a simple procedure, but requires major surgery by someone who is skilled in microsurgical repair of the fallopian tubes.  Studies show that over 25% of women who chose sterilization would like to have a reversal.  The actual numbers of reversal, however, are about ten percent of all tubal ligations.  The lower numbers of tubal reversal reflect both the cost and the difficulty.  Even if the reversal is a success, most women still have to use fertility treatments to become pregnant due to reduced ovarian function.  A study in 1994 (Hakverdi) showed ovarian deficiency after 12 months in 60% of women, and 30% stopped ovulating all together.  So even though tubes can be opened, hormonal deficiencies keep the ovaries from making eggs and generally reduce any possibility of pregnancy. 

The seriousness of tubal ligation is also negated in the literature.  Laparoscopic sterilization is sold as “quick”, “simple” and a “band aid” operation.  After all, if it only requires a band aid on the outside, it must be no big deal right?  Depending on the technique used, between 800 and 2,000 women out of every 100,000 will have a major complication at the time of the operation, according to the Guttmacher Institute. But the safety of sterilization is measured by how many women are subsequently admitted to the hospital for complications after the procedure.  What gets swept under the rug are women who end up at the gynecologist office complaining of pain, discomfort and menstrual problems.  These problems go unrecorded and are often dismissed as minor.  Women are left to deal with the effects of their sterilization on their own.  They are told the side effects are all in their heads, and are offered birth control pills and anti depressants to “deal with” their symptoms.  This silences the collective voices of women’s experiences of pain and discomfort and allows sterilization to be continually seen as a safe and simple procedure.

There are many documented side effects of having a tubal ligation and these have become know collectively as Post Tubal Ligation Syndrome:

1)      40%  more menstrual blood loss (Lawson, Cole, Templeton, 1975)

2)      Pelvic pain, especially with clip and ring methods (Lawson, Cole and Templeton, 1975)

3)      40% increase in irregular menstrual patterns (Tappan, 1973)

4)      Ovarian dysfunction (Alvarez-Sanchez, 1981)

5)      Lower progesterone levels (Sumiala, Tuominen, 1986)

6)      Early onset menopause due to damaged ovarian blood flow (Alvarez-Sanchez, 1981)

7)      3-4 times more likely to need a hysterectomy, and that doubled for women who were under 25 years when sterilized (Shy, 1992)

8)      Mood disorders and depression caused by hormonal imbalance; increase in suicidal thoughts (Wyshake, 2004)

9)      Loss of libido, or sex drive in 44% of women (Philliber, Philliber, 1985)

10)   Increased risk of ectopic pregnancy to 7% or more compared to 1% of the population.

11)   Bladder or bowel puncture, or other tissue damage during procedure. (Harlap and Kost, 1991)

12)   49% suffer heavy periods and 35% suffer more menstrual cramping (Wilcox, 1990)

13)   Risk of cervical cancer at 3.5 times the normal rate (Wilcox, 1990)

14)   Increased risk of spinal fractures and osteoporosis (Wyshak, 2005)

15)   Lowered milk supply if done during the post partum period (Vytiska, 1989)

16)   Hot flashes, Night sweats, and flushing (Wyshak, 2004)

17)   Lower abdominal pain experienced by 35% of women (Smith, Lyons, 2010)

These are just the effects that are currently documented.  Women suffering from PTLS have a much longer list of symptoms than have not been studied in the medical community.  What is concerning is that many of these side effects have been know since 1975, and yet are still discounted by the medical community.

How can women give a truly informed consent when doctors are still perpetuating a mythical account of sterilization as a quick, easy, simple, procedure that enhances sex drive?  The pain and discomfort from this procedure is so downplayed that women are often caught off guard, and are left feeling scared, confused and angry that they were not told how much damage was going to be caused to their health.

Sterilization is sold to women by playing on the fear of pregnancy, and encouraging them to alter their bodies to “protect” themselves.  They are told that by removing the threat of pregnancy that they will enhance their sex lives.  But sterilization does not remove tiny children needing your care, nor does it make up for the exhaustion from working all day, nor will it improve an existing relationship.  Many studies have looked at sexual satisfaction in terms of frequency.  The implication is that more sex means better sex, but from a woman’s point of view this may not be so.  44% of women experience decreased sexual desire after tubal ligation. (Phillber and Philliber, 1985) Since many women experience heavy and prolonged bleeding, and/or abdominal pain, this can put a serious stop to the uninhibited sex that they were promised.  Many women can’t even get help from their doctors until they tell them that the pain and bleeding is ruining their sex life.

If you are considering sterilization for yourself, or discussing it with your partner, please take into consideration the possible ramifications that the surgery will have.  The fallopian tubes are not just “tubes” but a hormonal conduit between the ovaries and the uterus that can greatly alter a woman’s physiology if damaged.  The potential for mental and psychological side effects are much greater than is explained by doctors and literature.  Consider all of your options of reversible contraception before making a body altering decision that could result in irreversible damage.