The decision to undergo tubal ligation
Fontaine, J.G.
L'Union Medicale du Canada 113(7): 604-606
1984
ISSN/ISBN: 0041-6959 PMID: 6485177 Document Number: 225086
Gynecologists frequently seek the opinion of a psychiatrist before performing tubal ligations. The case of a 25-year-old childless divorcee whose gynecologist feared that her request for sterilization was actually a sign of depression is described to illustrate different aspects of psychiatric evaluation of women seeking sterilization. The patient's appearance and comportment during the interview, husband, family, attitude toward children, and dreams appeared normal. A traditional psychiatric evaluation shed little light on her reasons for seeking sterilization. A scale developed in the course of a few years of interviewing sterilization candidates to try to achieve a degree of objectivity was applied to the case. The scale requires assessment of the client's motivation, contraceptive usage, self-image, psychosexual development, the economic value of the ligation, and the consequences for the patient's sexual, social, and professional life. The psychiatrist summarizes his detailed findings and states them in comprehensible and practical terms for the sterilization practitioner. In this case, the client was raised rather coldly in a large family of 13 children where she received little attention from her father or mother. Her family background caused her to enter the work force at a very early age and to seek affection from an older man whom she married at 19 after 2 years of living together. She soon realized that he could not fill her need for affection and decided to leave him as he was demanding a child. Her 2nd partner was an alcoholic whom she left for the same reasons. She could not accept the idea of having a child who would be demanding when her own needs were so pressing. Her position was reinforced by her belief that she could not use oral contraceptives because of recurrent infections and that the IUD is unreliable. Deep psychotherapy could probably lower her resistence to motherhood but the client had no motivation for it. There was little reason not to approve the definitive contraception that her past deprivation caused her to desire, even though it would prevent her in the future from fulfilling herself through motherhood. A review of the literature from the past decade on psychological aspects of sterilization indicates that sterilization has no therapeutic effect in the sense of making psychiatric problems disappear. A psychological evaluation should be sought if the candidate is young, feels ambivalent about the sterilization, or feels obligated to undergo sterilization for some reason.