Sterilization: Questions and Answers
SEXUAL STERILIZATION: SOME QUESTIONS AND ANSWERS
The relative permanence of sexual sterilization causes people to pause before taking such a serious step. Yet, driven by fear--fear of sickness or death from the Pill and/or the IUD, fear of the abortion causing effects of the IUD and the Pill, fear of unplanned pregnancies resulting from the less effective barrier methods, and sometimes fear of exercising sexual self-control--many couples have turned to surgical sterilization out of desperation. Many later regard this step as drastic and unwise especially after they have become informed about the highly effective modern method of natural family planning known as the Sympto-Thermal Method.
The following information is provided so that interested couples may be more adequately informed before taking such a serious step with such long-range and serious effects.
WHAT IS VASECTOMY?
A vasectomy is a surgical operation performed to make a man sexually sterile. In a vasectomy the two vas deferens, ducts through which sperm pass from the testes, are located after a small incision in the scrotum. The urologist cuts out a portion of each, ties or coagulates the ends, and sutures the cut. Usually done under local anesthesia, the operation is relatively painless, although some swelling and tenderness are common afterward, and the recovery period is brief.
WHAT IS TUBAL LIGATION?
A tubal ligation is a surgical operation done to make a woman sexually sterile. There are two common forms of tubal ligation: the mini-laparotomy and laparoscopy. A mini-laparotomy involves making a small incision in the abdomen and exploring for the Fallopian tubes which conduct the eggs from the ovaries to the uterus. After the tubes are found, a portion of each is
removed, and the ends are tied.
In laparoscopy the woman's abdomen is first inflated with gas creating a gap between the bowel and the abdomen. A fiberoptic light is inserted by puncturing the abdominal wall, and an instrument either cuts or coagulates the tubes with an electric current.
ARE THESE SURGERIES 100% EFFECTIVE?
No. The only 100% effective sterilization surgeries are male castration (removal of the testicles) and female castration (removal of the ovaries), and these surgeries are simply not performed for birth control purposes.
Vasectomy has a failure rate of .15, or 15 pregnancies per 10,000 woman-years of exposure.[1] Recannulation, the reestablishment of a vas deferens by internal healing processes, occurs in one instance per thousand, and sometimes the urologist will not catch the rare presence of a third vas deferens. Both of these incidences can result in a surprise pregnancy. More often pregnancies result from the failure to wait until two negative sperm counts are obtained before considering oneself sterile.
Tubal ligation has an overall failure rate of .04, or four pregnancies per 10,000 woman-years.[2]
WHAT ARE THE HEALTH RISKS OF VASECTOMY?
Although the final verdict of the medical safety of vasectomy is not in yet, suspicions are rising that the long term effects on the immunological system will reveal that a vasectomy can cause serious health problems. Criticism is rising within the medical community about the highly uncritical way in which vasectomy has been assumed to be medically safe. According to Dr. Harold Lear, "You just don't operate on a million men a year without looking for effects. You don't just rely on impressions."[3] The director of a research laboratory has noted that "the medical community has made virtually no serious objection to mass vasectomy. Since information already exists suggesting possible adverse delayed sequelae, this acceptance poses cause for concern."[4]
WHAT HAPPENS TO THE SPERM?
After a vasectomy the sperm production is the same as before, around 50,000 spermatozoa every minute.[5] Lacking a normal anatomical passage, these cells are either consumed by destroyer cells (macrophages) or degenerate and produce antigens which cause antibodies to be produced that will remove the sperm from the system.[6] These antigens frequently will infiltrate into the bloodstream and other cells throughout the body begin to manufacture antibodies against the sperm. These are "anti-sperm autoantibodies."[7]
WHAT IS INVOLVED IN AUTOIMMUNITY?
Antibodies are the way we immunize ourselves to specific diseases from the outside environment. Antigens are merely the triggering mechanism the body needs in order to produce the right antibodies for its defense. An allergic reaction in which the body becomes highly sensitive to a particular kind of food cell is an example of this mechanism's effect. When the body generates its defenses to ward off cells of its own making, as after a vasectomy, the body becomes "auto-immune,"--allergic to itself.
HAS THIS BEEN LINKED WITH VASECTOMY?
Several studies have found such antibodies generated in response to sperm antigens in 55% to 75% of patients within two years after vasectomies.[8]
ARE SOME MEN MORE DISPOSED THAN OTHERS TO AUTOIMMUNE DISEASES?
Dr. H. J. Roberts has said, "A number of medical, nutritional, and immunologic factors may predispose a vasectomized individual to autoimmune responses or may enhance those responses. Such forces include important ecological influences that have become increasingly pervasive in our society.
They also encompass individual characteristics such as multiple immunizations, an allergic diathesis, poor nutrition, smoking, infection, and the hyperinsulinized-diabetic state."[9]
WHAT ARE SOME AUTO-IMMUNE DISEASES?
Auto-immunity has been implicated in multiple sclerosis, diabetes mellitus, rheumatoid arthritis some types of hepatitis, Addison's disease (malfunctioning adrenal glands) and lupus erythematosis.[10]
A study by Thomas B. Clarkson and Nancy J. Alexander concluded that "the immunologic response to sperm antigen that often accompanies vasectomy can exacerbate atheroclerosis.[11] Atherosclerotic diseases, such as coronary thrombosis, pulmonary embolism, thrombophlebitis, arteritis, and angina pectoris, are aggravated by high cholesterol intake. It is well established that the diet of American males tends to be high in cholesterol.[12]
Dr. Roberts' analysis of his own patients found a high correlation between systemic diseases and men with fairly recent vasectomies. He noted sudden occurrences of thrombophlebitis, pulmonary embolism, lymph node enlargements, joint inflammation, severe narcolepsy (uncontrollable sleeping), hypoglycemia, diabetes mellitus, hormonal imbalances, liver dysfunctions, skin eruptions, inflammation of the heart lining, inflamed prostate glands, pulmonary fibrosis, allergic disorders, acute multiple sclerosis, and altered blood coagulation.[13] According to Roberts, "Their patterns of response suggest a cause-and-effect relation between vasectomy and various disorders, especially in light of the fact that the majority had enjoyed good health before surgery "[14]
WHAT ARE THE HEALTH RISKS OF TUBAL LIGATION?
Laparoscopy has complications such as perforation of the bowel leading to massive infection of the abdominal cavity, injuries from poorly administered anesthesia and improper clearance of the windpipe during the operation, pulmonary embolism, and cardiac deviations due to the gas used to inflate the abdomen for the procedure.[15]
Apart from these immediate complications of surgery there appear to be significant increases in gynecological problems experienced by women who have tubal ligations. A follow up study of 374 patients with tubal ligations revealed that 43% had subsequent gynecological treatment for such conditions as menorrhagia (heavy menstrual bleeding), menstrual disturbances requiring hormonal treatments, cervical erosion, ovarian tumors, and recanalization of the Fallopian tubes requiring a second operation.[16]
A 1979 British study found a 40% increase in menstrual blood loss, and 26% of the women with tubal ligations reported increased menstrual pain. It was also discovered that women who had been using the birth control pill before their tubal ligation reported a higher incidence of these complaints than did other patients.[17]
There is an increased incidence of women with tubal ligations undergoing subsequent hysterectomy because of severe menstrual problems. Of the 374 patients followed in the study cited above, 70--or 18.7%--returned for a hysterectomy.[18] A study by James G. Tappan found a 40.7% incidence of menorrhagia and suggested that cystic degeneration of the ovary as a result of an interruption of the uterine artery might account for this.[19] In any case, the figure of a 40% increase in menstrual problems as the result of tubal ligation seems standard. In addition, the rate of cervical cancer experienced by one group of 489 women three and a half years after tubal ligation was three and a half times the normal rate.[20]
WHAT ARE THE PSYCHOLOGICAL SIDE EFFECTS OF STERILIZATION?
A 1966 study of vasectomy patients and their wives by Dr. Frederick Ziegler found "striking adverse changes and reduced marital satisfaction in husband and wife notwithstanding general satisfaction with the procedure itself."[21] A standard personality disorder test found that over 40% of a vasectomy study group experienced personality disturbances between their first testing and that of a year later, after the operation.[22]
Since it takes longer than the time frames of most follow-up studies to encounter the full effects of a sterilization operation, it is difficult to gauge the true psychological stress involved. Complicating the findings of those attempts[23] that have been made to understand the real effect of sterilization on mental health is what Dr. Helen Wolfers calls "the need to proselytize" for these surgeries.[24].
Any person contemplating sterilization is, or should be, told that the operation is relatively irreversible. Only about 33% of vasectomy and tubal reversals are functionally successful.[25] When a person takes such an irrevocable course of action, it is psychologically difficult for him or her to admit that a mistake has been made. This explains why the number of those willing to recommend or express satisfaction with sterilization is always higher than the number of patients who have no complaints about the actual results of their own operation. As Dr. Wolfers explains this discrepancy in the questionnaires received from patients, "The need to convince ourselves is served by convincing others."[26]
Thus, a study of 1,191 vasectomized participants in a sterilization campaign in India revealed decreased sexual desire appearing in 53% of those surveyed. However. 92% Of that same group expressed satisfaction with the operation.[27]
WHAT ARE THE SOCIAL CONSEQUENCES OF STERILIZATION?
There is a crying need for research on the social consequences of sterilization. It has been suggested that men who believe themselves to be truly sterilized may feel more inclined toward marital infidelity Vasectomy may also play an important part in aggravating the tendency of some middle-aged men to discard their middle aged wives in favor of younger women.[28]
Another concern is the implication of viewing one-s body as a machine that can be disconnected if one of its functions is no longer necessary. This has grave consequences. Cats and dogs are spayed in order to suit the convenience of their masters. but who are the masters in the human social order?
CAN "VOLUNTARY" STERILIZATION LEAD TO FORCED STERILIZATION?
Yes. Perhaps the greatest social danger from 'voluntary sterilization is that it is only a half step away from forced sterilization. If people are led to ignore the reality that deliberate sterilization is a serious evil and are instead led to think it is a morally neutral action. the way is paved for forced sterilization. In any decent social order. citizens may be morally forced to do certain things. but they may not morally be forced to perform evil actions or be forced to consent to them For example traffic laws force us not to exceed certain speed limits. but there is nothing inherently evil in driving slower. Thus legitimate traffic laws are a morally justified form of coercion.
However. sterilization attacks the integrity of the human person. While this may sometimes be justified as a punishment for crime. the evil of sterilization may not be forced upon anyone as a matter of social policy. However. the Nazis sterilized those considered unfit by Nazi standards. and Indira Gandhi launched a massive coerced sterilization drive that finally brought about a revolt of the masses and led to her electoral defeat. In the United States. Margaret Sanger. the foundress of Planned Parenthood. advocated sterilization of the poor[29] and there have been other attempts to use sterilization for forced population control.[30]
HOW DOES RELIGION VIEW STERILIZATION?
Before 1930, no Christian Church accepted sterilization or any form of contraception as morally acceptable. The Catholic Church and some Protestant Churches still teach that deliberate sterilization is an immoral form of birth control. "Equally to be excluded (as morally permissible), as the teaching authority of the Church has frequently declared, is direct sterilization, whether perpetual or temporary, whether of the man or of the woman" (Humanae Vitae. 14).[31]
DO COUPLES REGRET BEING STERILIZED?
Yes. Some of the most heartbreaking letters received by the Couple to Couple League come from couples who have the deepest sorrow and bitter regrets about a sterilization operation.
IS THERE A SAFE AND HEALTHY ALTERNATIVE?
Yes. Even for the couple who have a most serious reason to avoid pregnancy, the Sympto-Thermal Method of Natural Family Planning (NFP) offers a realistic and moral alternative. Such a couple will undoubtedly use the rules more conservatively than some other couples, and they will realize that no methods are 100% effective except total abstinence or castration. However, one study showed that a temperature-only form of NFP had an unplanned pregnancy rate even less than that for vasectomy and tubal ligation sterilization.[32]
HOW DOES A COUPLE FIND OUT ABOUT NATURAL FAMILY PLANNING?
Contact The Couple to Couple League either in your own area or at its national office in Cincinnati.
ENDNOTES
1. Robert A. Hatcher, et. al., "Contraceptive Technology 1978- 79 (New York, Irvington, 1978) 20
2. Ibid.
3. Harold Lear quoted in "Vasectomies Beget Baby Doubts," "National Observer" January 20, 1973. 15
4. H. J. Roberts, "Is Vasectomy Safe? (West Palm Beach, Florida, Sunshine Academic Press, 1979). 18
5. Ibid.
6. Nancy J. Alexander and Thomas B. Clarkson, "Effect of vasectomy on diet-induced atherosclerois," "Vasectomy Immunologic and Pathophysiologic Effects in Animals and Man" Irwin H. Lepow and Ruth Crozier, eds (New York
Academic Press, 1979.) 122
7. Nancy J. Alexander quoted in "Vasectomy" John Fried (New York, "Saturday Review" 1972) 52-53
8. K S K Tung, "Human sperm antigens and antisperm antibodies" "Clinical Experiences in Immunology" (1975); 20, 93-104. R. Ansbacher et al "Sperm antibodies in vasectomized men," "Fertility and Sterility 22 629. Rudi Ansbacher "Vasectomy, sperm antibodes," "Fertility and Sterility, 24 788- 792. Nancy J. Alexander, B. J. Wilson and G. D. Patterson, "Vasectomy Imnmunologic effects in rhesus monkeys and men." "Fertility and Sterility" 25 149. S. Shulman, E. Zappi, U Ahmed and J. E. Davis, "Immunologic consequences of vasectomy," "Contraception" 5(4) 269-278 (April 1972)
9. Roberts. 131
10. Fried. 46
11. Nancy J. Alexander and Thomas B. Clarkson, "Effect of vasectomy on diet-induced atherosclerosis. 154
12. Enos. Holmes and Beyer (1953) reported some degree of coronary atherosclerosis in 77.3% of United States combat casualties In Korea. . . McNamara and associates (1971) found comparable evidence of atherosclerosis in 45% of 105 American soldiers killed In Vietnam The mean age was 22.1 years in both studies Roberts. 35
13. Ibid. 37-86
14. Ibid. 39
15. D. B. Scott andD. G Julian. "Observations on cardiac arrhythmias during laparoscopy" "British Medical Journal" 1:411 (1972)
16. M. J. Muldoon, "Gynaecological Illness after sterilization" "British Medical Journal" (January 8, 1972). 84-85. Table III.
17. S. Lawson, R. A. Cole and A. A. Templeton. "The effect of laparoscopy sterilization by diathermy or silastic bands on post post-operative pain, menstrual symptoms and sexuality." "British Journal of Obstetrics and Gynecology" 66: 659 663 (August. 1979). This updates J. R. Neil's follow up of 454 women in 1975. which found an incidence of between 22% to 39% of the study experiencing menstrual problems after their tubals. J. R. Neil. et al . "Late complications of sterilization by laparoscopy and tubal ligation, a controlled study" "The Lancet" (October 11. 1975) 699- 700
18. Muldoon Table II.
19. James G. Tappan, "American Journal of Obstetrics and Gynecology," 115:8. 1056
20. Ibid.
21. F. J. Ziegler, D. A. Rodgers, S. A. Kriegsman. "Effect of vasectomy on psychological functioning" "Psychosomatic Medicine" 28:50. (1966)
22. H. Edey "Psychological aspects of vasectomy," "Medical Counterpoint" (January, 1972). 19
23. Ziegler. op cit Helen Wollers. "Psychological aspects of vasectomy," "British Medical Journal" 4:297.(1970). For an excellent review of this topic see John Fried's "Vasectomy" (New York. "Saturday Review Press" 1972).
24. Wollers quoted in Fried. 97
25. H. Y. Lee. "Clinical experience of vasovasostomies," "Korean Journal of Fertility and Sterility" 2(1):2-20 (December. 1975)
26. Fried loc cit.
27. K. Dandekar. "Alter-effects of vasectomy," Artha Vijnana" (Gokhale Institute of Politics and Economics. Poona. India) 5:212. (1963).
28. The psychological forces which might be responsible for this distressing phenomenon are described superbly in George Gilder's "Sexual Suicide" (New York Quadrangle. 1973)
29. Margaret Sanger "Pivot of Civilization (New York Brentano's. 1922) 124-145 Sanger expresses an especially strong paranoia that "subhumans irresponsibly copulating will overpopulate the earth and contaminate the gene-pool.
30. Sterilization as a tool of the state has a long history in America. In the mid-1890's castration was used on the feeble- minded. In Kansas in 1899 a 19-year-old boy was castrated at the Indiana Reformatory because of his addiction to masturbation. 1907 marked Indiana's sterilization of the criminal and unfit elements in the state. Fifteen states enacted similar sterilization laws between 1907 and World War I. The eugenics movement touted the social benefits of involuntary sterilization into the 1930's. In 1974 two Alabama sisters age 12 and 14 were sterilized without their consent at a Montgomery birth control clinic.
31. Pope Paul VI. Encyclical letter "Humanae Vitae" dated July 28, 1968.14
32. B. Vincent et al "Methode Thermique a et Contraception," "Approches medicale et psychologique" (Paris Masson, 1967) 52- 73 ------------------------------------------------------------------------------------------------- c 1981 The Couple to Couple League International, Inc.
Further Information
For further information about Natural Family Planning (NFP), for referral to Couple to Couple's NFP instruction in your vicinity, or for information on self-instruction contact:
The Couple to Couple League P.O. Box 111184 Cincinnati, OH 45211 (513) 661-7612
This information is from a brochure titled "Sexual Sterilization Some Questions and Answers". The brochure and related material may be ordered from Couple to Couple League direct or through CRNET's Catholic MarketPlace.
