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Women regretting their sterilization
FERTILITY AND STERILITY Copyright Q 1986 The American Fertility Society
Vol. 46, No.4, October 1986 Printed in U.SA.
Women regretting their sterilization
Hans M. Verner, M.D., Ph.D.*t Pieter Colla, Psych. Drs.:j: Dick C. Schoot, M.D. * Wim N. P. Willemsen, M.D., Ph.D. * Piet B. Bierkens, Ph.D.§ Rune Rolland, M.D., Ph.D.* R~boud
University Hospital, Nijmegen, The Netherlands
Regret after sterilization is common, although usually of fairly short duration, 1 and only a few women ask for a reversal of sterilization. It is worthwhile to try to avoid such an operation as much as possible, because reversal of sterilization ~s a major operative procedure. This is especially Important because the number of women asking for a reversal of their sterilization is probably still increasing. In the literature2 there are profiles on women who have asked for a reversal of sterilization. Only three studies were published containing a comparison between women who regretted their sterilization and women who did not. 3 -5 In our retrospective study, we compared women who asked for a reversal of their sterilization with other sterilized women. The groups were matched with respect to time of sterilization.
Received December 27,1986; revised and accepted June 12 1986. ' *Department of Obstetrics and Gynecology. tReprint requests: Hans M. Vemer, M.D., Ph.D., Department of Obstetrics and Gynecology, Radboud University Hospital, Geert Grooteplein zuid 14, Postbus 9101, 6500 HB Nijmegen, The Netherlands. :j:Department of Psychiatry. §Department of Medical Psychology.
724
Vemer et al. Communications-in-brief
MATERIALS AND METHODS
We compared two groups of women. The first group (patients) consisted of118 sterilized women who came to our institute between 1978 and 1984 for a reversal of their sterilization. Most of these patients were sterilized elsewhere. Sixty of the women had a semistructured interview. Qualitative data obtained through this interview were used to illustrate quantitative facts. The second group (controls) consisted of 116 women. A matched control (i.e., a woman who was sterilized on or near the same date at the Radb.oud Universit~ Hospital) was found for each patIent by consultmg the operation records. The follow~ng data.were collected from both groups: age, ~arlty, marital status and duration of marriage (If any) at the time of sterilization, and combination of sterilization with other gynecologic or obstetric procedures. The following data were collected at the patient's first visit: time lag between sterilization and request for reversal, reason for the request ' and possible changes in marital status. Information about the controls regarding the changes in marital status (if any) and any signs of regret was supplied by the general practitioners. For statistical evaluation, we used the chisquare test. Fertility and Sterility
RESULTS
The time lag between sterilization and request for reversal was between 3 weeks and 11 years (median: 3 years and 5 months; mode: 1 to '2 years). The patients were significantly younger than the control (X 2 = 76.83; P < 0.005). Fourteen patients and 1 control were sterilized when they were < 25 years old, 58 patients and 12 controls were 25 to 29 years old, and 46 patients and 103 controls were> 29 years old at the time of sterilization. There was no significant difference in the number of children or in the incidence of childlessness between the two groups. Sterilization in combination with other gynecologic or obstetric procedures occurred 24 times in the patients and 3 times in the controls. A change of marital status after sterilization was significantly more frequent in the patients than in the controls (X 2 = 89.4; P < 0.005): 5 patients married, 77 divorced, and 1 was widowed, compared with 1, 2, and 0, respectively, in the control group. The duration of marriage at the time of sterilization appeared to be longer in the controls than in the patients. However, the mean age of the controls was high, influencing the duration of marriage. When samples from both groups were matched for age (in 38 cases), the patients had been married longer than the controls. The reason for the request for reversal in 89 cases (75%) was a new partner and in 26 cases (22%) the wish for more children with the same partner. DISCUSSION
Women who regret being sterilized usually do so soon after the procedure. The mean length of time between sterilization and request for reversal was 3.8 years, measured from the date the patient presented for reversal. Actually the patients had regretted their sterilization for a longer period of time. According to the general practitioners, only 1 of the 88 women from the control group regretted her sterilization after the death of one of her children. We confirmed data from the literature3 ,5 concerning the age at the time of sterilization. In 20% of the patients, the sterilization took place in combination with another gynecologic or obstetric procedure: therapeutic abortion (12 times), prolapse operation (6 times), cesarean section (4 Vol. 46, No.4, October 1986
times), and operation for ectopic pregnancy (twice). This combination was the case in only 3 women in the control group. It is clear that the sterilizations combined with other procedures were performed with the objective of saving the patient another anesthesia. But this combination bears a serious risk: the women will be inclined to follow the doctor's advice, and this does not make the sterilization a well-considered and free choice. This must be avoided, especially because tubal 'sterilization can now be performed under local anesthesia, as an outpatient procedure. At the time of the interview about the request for reversal, 27 of the patients reported that their relationship at the time of sterilization was already poor. It was clear that these women did not want any more children with their current husband/partner. Some of the women said they had kept silent about their marital problems fearing that otherwise they would not be sterilized. The remark about poor marriage could be a rationalization after the fact. However, in view of the fact that one-half of the divorces took place within 2 years after sterilization, one must assume that the marital relationship was already poor at that time in , a large number of cases. This manifests itself in the fact that one-third of the patients who were interviewed indicated that their former husband/ partner was an alcoholic and/or batterer. Three of the women were left by their husbands within 10 days after sterilization. Another alarming discovery was that 12 of the patients were sterilized after their divorce under the age of 30 years. In this case, a request for sterilization may be considered a reaction to their bad marital experience. The reason for requesting a reversal of sterilization was a divorce and a new partner in threefourths of the cases. In view of the short time lag between sterilization and divorce, we advise that the physician tries to check the stability of the relationship before performing the sterilization. If there is any doubt, it would be wise to refer the patient to a psychiatrist or a psychologist to clarifY the real reason for the request. We determined three risk factors based on the differences between the patients and the controls (Table 1). In individual cases, the risk factors cannot form an absolute indication against sterilization; one cannot exclude the fact that the majority of women are satisfied with the sterilization despite these risk factors. 5 Therefore, in these cases Verner et al. Communications-in-brief
725
Table 1. Risk Factors at the Time of Sterilization
Sterilization at young age < 30 years < 26 years Marital problems (divorced < 2 years after sterilization) Sterilization in combination with other gynecologic or obstetric procedure
Patients No. %
Controls No. %
72 28 56
61 15 48
13 1 0
11
24
20
3
2
1
one must carefully weigh the desirability of sterilization to decrease the risk of a request for reversal. One hundred eighteen women who requested reversal of sterilization (patients) were compared with 116 controls. The groups were matched for date of sterilization. The patients were sterilized in combination with other gynecologic or obstetric procedures more frequently than the controls.
726
Vemer et al. Communications-in-brief
The patients changed their marital status after sterilization more often than controls. The number of children at the time of sterilization was the same. Acknowledgments. We thank Rolinka Feijten-Buitelaar for her secretarial assistance and Judith Abma-Hill for the English editing of the manuscript. REFERENCES 1. Wright AF: How women felt about their sterilization: a
2. 3.
4. 5.
follow-up of 368 patients in a general practice. J Roy ColI Gen Pract 31:598, 1981 Winston RML: Why 103 women asked for reversal of sterilization. Br Med J 2:305, 1977 Leader A, Galan N, George R, Taylor PJ: A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization. Am J Obstet GynecoI145:198, 1983 Divers WA Jr: Characteristics of women requesting reversal of sterilization. Fertil Steril 41:233, 1984 Grubb GS, Peterson HB, Layde PM, Rubin GL: Regret after decision to have a tubal sterilization. Fertil Steril 44:248, 1985
Fertility and Sterility
Vol. 46, No.4, October 1986 Printed in U.SA.
Women regretting their sterilization
Hans M. Verner, M.D., Ph.D.*t Pieter Colla, Psych. Drs.:j: Dick C. Schoot, M.D. * Wim N. P. Willemsen, M.D., Ph.D. * Piet B. Bierkens, Ph.D.§ Rune Rolland, M.D., Ph.D.* R~boud
University Hospital, Nijmegen, The Netherlands
Regret after sterilization is common, although usually of fairly short duration, 1 and only a few women ask for a reversal of sterilization. It is worthwhile to try to avoid such an operation as much as possible, because reversal of sterilization ~s a major operative procedure. This is especially Important because the number of women asking for a reversal of their sterilization is probably still increasing. In the literature2 there are profiles on women who have asked for a reversal of sterilization. Only three studies were published containing a comparison between women who regretted their sterilization and women who did not. 3 -5 In our retrospective study, we compared women who asked for a reversal of their sterilization with other sterilized women. The groups were matched with respect to time of sterilization.
Received December 27,1986; revised and accepted June 12 1986. ' *Department of Obstetrics and Gynecology. tReprint requests: Hans M. Vemer, M.D., Ph.D., Department of Obstetrics and Gynecology, Radboud University Hospital, Geert Grooteplein zuid 14, Postbus 9101, 6500 HB Nijmegen, The Netherlands. :j:Department of Psychiatry. §Department of Medical Psychology.
724
Vemer et al. Communications-in-brief
MATERIALS AND METHODS
We compared two groups of women. The first group (patients) consisted of118 sterilized women who came to our institute between 1978 and 1984 for a reversal of their sterilization. Most of these patients were sterilized elsewhere. Sixty of the women had a semistructured interview. Qualitative data obtained through this interview were used to illustrate quantitative facts. The second group (controls) consisted of 116 women. A matched control (i.e., a woman who was sterilized on or near the same date at the Radb.oud Universit~ Hospital) was found for each patIent by consultmg the operation records. The follow~ng data.were collected from both groups: age, ~arlty, marital status and duration of marriage (If any) at the time of sterilization, and combination of sterilization with other gynecologic or obstetric procedures. The following data were collected at the patient's first visit: time lag between sterilization and request for reversal, reason for the request ' and possible changes in marital status. Information about the controls regarding the changes in marital status (if any) and any signs of regret was supplied by the general practitioners. For statistical evaluation, we used the chisquare test. Fertility and Sterility
RESULTS
The time lag between sterilization and request for reversal was between 3 weeks and 11 years (median: 3 years and 5 months; mode: 1 to '2 years). The patients were significantly younger than the control (X 2 = 76.83; P < 0.005). Fourteen patients and 1 control were sterilized when they were < 25 years old, 58 patients and 12 controls were 25 to 29 years old, and 46 patients and 103 controls were> 29 years old at the time of sterilization. There was no significant difference in the number of children or in the incidence of childlessness between the two groups. Sterilization in combination with other gynecologic or obstetric procedures occurred 24 times in the patients and 3 times in the controls. A change of marital status after sterilization was significantly more frequent in the patients than in the controls (X 2 = 89.4; P < 0.005): 5 patients married, 77 divorced, and 1 was widowed, compared with 1, 2, and 0, respectively, in the control group. The duration of marriage at the time of sterilization appeared to be longer in the controls than in the patients. However, the mean age of the controls was high, influencing the duration of marriage. When samples from both groups were matched for age (in 38 cases), the patients had been married longer than the controls. The reason for the request for reversal in 89 cases (75%) was a new partner and in 26 cases (22%) the wish for more children with the same partner. DISCUSSION
Women who regret being sterilized usually do so soon after the procedure. The mean length of time between sterilization and request for reversal was 3.8 years, measured from the date the patient presented for reversal. Actually the patients had regretted their sterilization for a longer period of time. According to the general practitioners, only 1 of the 88 women from the control group regretted her sterilization after the death of one of her children. We confirmed data from the literature3 ,5 concerning the age at the time of sterilization. In 20% of the patients, the sterilization took place in combination with another gynecologic or obstetric procedure: therapeutic abortion (12 times), prolapse operation (6 times), cesarean section (4 Vol. 46, No.4, October 1986
times), and operation for ectopic pregnancy (twice). This combination was the case in only 3 women in the control group. It is clear that the sterilizations combined with other procedures were performed with the objective of saving the patient another anesthesia. But this combination bears a serious risk: the women will be inclined to follow the doctor's advice, and this does not make the sterilization a well-considered and free choice. This must be avoided, especially because tubal 'sterilization can now be performed under local anesthesia, as an outpatient procedure. At the time of the interview about the request for reversal, 27 of the patients reported that their relationship at the time of sterilization was already poor. It was clear that these women did not want any more children with their current husband/partner. Some of the women said they had kept silent about their marital problems fearing that otherwise they would not be sterilized. The remark about poor marriage could be a rationalization after the fact. However, in view of the fact that one-half of the divorces took place within 2 years after sterilization, one must assume that the marital relationship was already poor at that time in , a large number of cases. This manifests itself in the fact that one-third of the patients who were interviewed indicated that their former husband/ partner was an alcoholic and/or batterer. Three of the women were left by their husbands within 10 days after sterilization. Another alarming discovery was that 12 of the patients were sterilized after their divorce under the age of 30 years. In this case, a request for sterilization may be considered a reaction to their bad marital experience. The reason for requesting a reversal of sterilization was a divorce and a new partner in threefourths of the cases. In view of the short time lag between sterilization and divorce, we advise that the physician tries to check the stability of the relationship before performing the sterilization. If there is any doubt, it would be wise to refer the patient to a psychiatrist or a psychologist to clarifY the real reason for the request. We determined three risk factors based on the differences between the patients and the controls (Table 1). In individual cases, the risk factors cannot form an absolute indication against sterilization; one cannot exclude the fact that the majority of women are satisfied with the sterilization despite these risk factors. 5 Therefore, in these cases Verner et al. Communications-in-brief
725
Table 1. Risk Factors at the Time of Sterilization
Sterilization at young age < 30 years < 26 years Marital problems (divorced < 2 years after sterilization) Sterilization in combination with other gynecologic or obstetric procedure
Patients No. %
Controls No. %
72 28 56
61 15 48
13 1 0
11
24
20
3
2
1
one must carefully weigh the desirability of sterilization to decrease the risk of a request for reversal. One hundred eighteen women who requested reversal of sterilization (patients) were compared with 116 controls. The groups were matched for date of sterilization. The patients were sterilized in combination with other gynecologic or obstetric procedures more frequently than the controls.
726
Vemer et al. Communications-in-brief
The patients changed their marital status after sterilization more often than controls. The number of children at the time of sterilization was the same. Acknowledgments. We thank Rolinka Feijten-Buitelaar for her secretarial assistance and Judith Abma-Hill for the English editing of the manuscript. REFERENCES 1. Wright AF: How women felt about their sterilization: a
2. 3.
4. 5.
follow-up of 368 patients in a general practice. J Roy ColI Gen Pract 31:598, 1981 Winston RML: Why 103 women asked for reversal of sterilization. Br Med J 2:305, 1977 Leader A, Galan N, George R, Taylor PJ: A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization. Am J Obstet GynecoI145:198, 1983 Divers WA Jr: Characteristics of women requesting reversal of sterilization. Fertil Steril 41:233, 1984 Grubb GS, Peterson HB, Layde PM, Rubin GL: Regret after decision to have a tubal sterilization. Fertil Steril 44:248, 1985
Fertility and Sterility