Endocrine and psychological problems in women subjected to tubal sterilization
Cappa, F.; Mascaretti, G.; Barchiesi, S.; Iagnemma, G.; Barbati, D.; Marinacci, S.; Pozzi, V.
Patologia E Clinica Ostetrica E Ginecologica 12(3): 209-213
1984
ISSN/ISBN: 0304-0313 PMID: 12267497 Document Number: 417652
Italian law permits sterilization only for therapeutic reasons, i.e., in cases where a woman's health would be endangered by continued pregnancies. Recently, however, new legislative debate has opened for consideration provision of sterilization for nontherapeutic reasons. Ethical, social, and religious questions were raised. Additionally, questions regarding sterilization's psychological effect and its effect on ovarian endocrine activity were raised. Consequently, the authors undertook research to study these areas. 25 women who underwent therapeutic sterilization between 1976 and 1982 were examined. Patients ranged in age from 24 to 42 years, with a median age of 32.8 years. 1 patient had 1 child, 11 had 2 children, 11 had 3 children, and 2 had 4 children. 19 had not used any type of contraception, 4 had used oral contraceptives, and 2 had used IUDs. After sterilization, the women were questioned on the psychological repercussions of their surgery. Regarding sexual activity, 40% reported an increase, 4% a decrease, and 56% reported no change. On psychological aspects of intercourse, 88% reported improvement, while 22% a worsening. The psychosexual attitude of the spouse was positively affected in 60%, negatively affected in 8%, and unchanged in 32%. 12% of the women felt regret over no longer being able to bear children, 72% felt no regret, and 16% were indifferent. Overall satisfaction with the surgery was reported by 88%, while 22% were dissatisfied. Regarding the menstrual cycle, 6 patients reported changes in the rhythm of the cycle, 4 being affected by polymenorrhea and 2 affected by oligomenorrhea. 10 patients reported changes in the quantity of menstrual flow, 8 experiencing hypermenorrhea and 2 hypomenorrhea. 2 patients experienced changes in duration of menstruation. FSH, LH, prolactin, E2, and progesterone blood levels are reported both for women who demonstrated a rise in basal body temperature and for those without temperature elevation. Reduced progesterone levels in 48% of the patients was noted. The authors speculate that this may have occurred because of neurovascular lesions caused during ligation. This hypothesis, confirmed by others, might explain not only cycle irregularities in some sterilized women, but also an increased incidence of fibrocystic breast disease. In conclusion, the authors state that because no psychological or organic alterations exist, except for a slight insuffiency during the luteal phase, that legalization of nontherapeutic sterilization should be considered.