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.
