Sterilization and Sexism

[Blalron]

I've heard it's virtually impossible for a woman who hasn't had any kids to get her tubes tied, whereas it's relatively easy for a man in a similar situation to get a vasectomy.

If this is indeed the case, shouldn't the law step in to address this inequality?

It always seemed like a bullshit argument to deny the procedure because later the person may regret it. It may very well be a permanent decision, but so is having a child. It is vastly better, in my not so humble opinion, to regret never having a child than to have a child whose existence you'll (secretly, because admitting it out loud would never be socially acceptable) regret.

[Jillyvn]

I have addressed this issue with my doctors and can speak to it from a personal standpoint.

I have wanted to be sterilized since I was about 19. At that age, I knew it was impractical, and I held off doing anything about it since I knew I would be laughed out of the office. My reasons, however, may somewhat complicate the debate since they are medical in nature - I would like to have a hysterectomy to help deal with my endometriosis.

When I was 22, and the pain was so intense I could barely function, I asked about a hysterectomy. I was told that I would need to have a child before they would consider it. I explained that I do not ever intend to have child, which was greeted with much scepticism. I was repeadetly told that I would change my mind when I "settled down". When I was 24, I asked again, and was given the same reason. At 27, I was told they would consider it if I was firmly committed to being childless after 30. All this when I had a sound medical reason for wanting the hysterectomy. I can't imagine what women go through trying to get their tubes tied at a younger age without children.

I wonder if the doctors refuse to do this is based on the numbers of women who later "regret" their decision. I'm not sure of the stats on this. I would be curious to know if a woman can sue a doctor for malpractice for performing a sterilzation at a young age and if this is a factor in the doctor's decision making process?

I fully agree with the OP, and I think this is firmly a women's rights issues. No one but me should be entitled to decide if I have children, and if I make the choice to deal with it permanently before becoming pregnant so much the better. Complications may arise if there are mental health issues, or rash decisions due to sudden life changing events... but on the whole, this one is clear cut for me.

[Blalron]

When I was 24, I asked again, and was given the same reason. At 27, I was told they would consider it if I was firmly committed to being childless after 30. All this when I had a sound medical reason for wanting the hysterectomy. I can't imagine what women go through trying to get their tubes tied at a younger age without children.
.

So apparently it takes 12 years or so of consistantly wanting to be childless for that decision to be "valid", but the decision to have a child can be had in a single night over a few glasses of wine.

[Der Trihs]

So apparently it takes 12 years or so of consistantly wanting to be childless for that decision to be "valid", but the decision to have a child can be had in a single night over a few glasses of wine.Rather like the abortion debate, where an underage girl isn't "responsible enough" to choose abortion, but somehow IS responsible enough for pregnancy, childbirth and parenthood.

[Justin_Bailey]

Doesn't this really just come down to the fact that a vasectomy can be reserved and a tubal ligation or hysterectomy can't?

[WhyNot]

Doesn't this really just come down to the fact that a vasectomy can be reserved and a tubal ligation or hysterectomy can't?

Vasectomies can not be reliably reversed. If you're considering a vasectomy, consider it permanent. While a reversal can sometimes be done, you won't know before hand if your scar tissue will allow it.

As for the matter at hand, I think it's ridiculous, but I'm not sure legislation is the way to go here. Seems like what it would take is a change in standards of practice - probably by the The American Board of Obstetrics and Gynecology and/or the AMA.

And I do think it's a misogynistic holdover - from the idea that all women must want children from their own wombs and the fragile creatures will be devastated someday if they can't. And, of course, Doctor Knows Best. Otherwise, they'd suggest egg harvest and surrogacy or adoption as alternate ways to become a mother.

[Drain Bead]

I've also heard about successful tubal reversals--I've seen a few women get pregnant after a tubal reversal on a pregnancy message board I frequent.

[Kobal2]

Vasectomies can not be reliably reversed. If you're considering a vasectomy, consider it permanent. While a reversal can sometimes be done, you won't know before hand if your scar tissue will allow it.

As for the matter at hand, I think it's ridiculous, but I'm not sure legislation is the way to go here. Seems like what it would take is a change in standards of practice - probably by the The American Board of Obstetrics and Gynecology and/or the AMA.

And I do think it's a misogynistic holdover - from the idea that all women must want children from their own wombs and the fragile creatures will be devastated someday if they can't. And, of course, Doctor Knows Best. Otherwise, they'd suggest egg harvest and surrogacy or adoption as alternate ways to become a mother.

Not sure it's misogynistic per se. I too don't ever want to have children, yet every time I mentionned the fact to siblings or doctors, I got the "you don't know yet, you'll change your mind, trust us, you'll settle down, you're young, blah blah blah" speech. Yet I'm a big (er...) strong (ERRRR...) man.

So either it's merely an age thing ("you're a dumb 18...22...30 year old kid, Father Knows Best") or it's a societal thing ("If you don't want kids, you're a freak, buddy.")

[Justin_Bailey]

So either it's merely an age thing ("you're a dumb 18...22...30 year old kid, Father Knows Best") or it's a societal thing ("If you don't want kids, you're a freak, buddy.")

Couldn't it be super secret choice C: This is a fairly permanent operation (that can only be reversed with luck) and it it not medically beneficial to 99.9% of the world. Therefore, it would be irresponsible to do it to someone under X number of years old.

[catsix]

Justin_Bailey said:
Couldn't it be super secret choice C: This is a fairly permanent operation (that can only be reversed with luck) and it it not medically beneficial to 99.9% of the world. Therefore, it would be irresponsible to do it to someone under X number of years old.

The age at which I can have elective surgery under general anesthetic by providing informed consent is 18. I could go into an operating room for a tummy tuck, a breast augmentation, breast reduction, ACL repair, or any other procedure without anyone ever saying 'You are too young to make this decision.'

I've been trying to get sterilized for 12 years, since I was 18. Although most such procedures require going under general anesthesia, there is at least one that does not. Essure (http://www.essure.com/) is permanent, non-hormonal birth control which can be put in place as an outpatient procedure with minimal risk and recovery time.

The fact of the matter is that I could decide, as has been mentioned, after a couple or ten drinks that I need to have a kid, right now, and nobody would dare ever question whether I am old enough (I'm 30) to make such a permanent decision. I have had doctors tell me that I'm not old enough, that I don't understand what it's like, that I will feel differently about my own kids, that I'm in denial, that I will later regret it, that my biological clock will start ticking when I'm 25 (28, 30, 35.. the age keeps changing) and that I should see a psychiatrist to learn to accept my natural role as a woman.

This has nothing whatsoever to do with any risk about it being an elective, unnecessary surgery and everything to do with the fact that doctors don't want to be sued later by women who regret their decision. They think a jury would hammer them for not protecting us poor, incapable women from making decisions we might regret.

Every time, I ask them, which is worse? If I never have kids and one day regret that, or if I do have a kid and one day regret that? They don't seem to understand, or care, about the consequences of that question. In my personal experience, women doctors have been the most hostile.

[WhyNot]

Couldn't it be super secret choice C: This is a fairly permanent operation (that can only be reversed with luck) and it it not medically beneficial to 99.9% of the world. Therefore, it would be irresponsible to do it to someone under X number of years old.
No, not when the procedure is being sought by someone with a medical problem that could be solved by it.

[Justin_Bailey]

No, not when the procedure is being sought by someone with a medical problem that could be solved by it.

Thus, the 0.1% of people that are not covered by Super Secret Choice C

[jsgoddess]

No, not when the procedure is being sought by someone with a medical problem that could be solved by it.

Everyone who seeks sterilization has a medical problem that could be solved by it: fertility

[catsix]

jsgoddess said:
Everyone who seeks sterilization has a medical problem that could be solved by it: fertility

And when you don't want kids, ever, fertility is a HUGE problem.

[Vox Imperatoris]

As far as I can tell, you're saying it's not illegal, but that the doctors refuse to do it. I think they're wrong, but it is their choice.

Valete,
Vox Imperatoris

[Blalron]

As far as I can tell, you're saying it's not illegal, but that the doctors refuse to do it. I think they're wrong, but it is their choice.

So if there's a trend where most doctors decide that black folks aren't competent enough for surgery X, but white folks are, is that ok because it's "their choice"?

"We have the right to refuse service to anyone" isn't an absolute principle, especially if discimination is rampant.

[Jillyvn]

As far as I can tell, you're saying it's not illegal, but that the doctors refuse to do it. I think they're wrong, but it is their choice.

Valete,
Vox Imperatoris

I don't think a doctor can refuse to provide a valid surgical option to a patient solely on the basis of their belief that a woman will be naturally inclined to pregnancy at some point in her future. Unless the surgeon is also a trained psychologist with insight into the mental well-being of this patient, this is a leap of logic they are not qualified to make. Furthermore, this is not a procedure that is dangerous or out of the norm. I can understand a doctor refusing to perform a breast augmentation surgery on a 16 year old with body issues. I cannot abide a doctor refusing to sterilize a woman on the patriarchic notion that she must be delusional or mistaken in her commitment to remain childless.

To Catsix - I, too, was denied the Essure, which indicates to me that the refusal to provide service is not at all linked to the invasive nature of the surgery.

[Jillyvn]

I missed my edit window, but wanted to add...

I have tried several approaches to convince the doctors I have seen that my desire to be sterilized is a well thought out decision. A hysterectomy seems the best approach because it solves a dual problem: my endometriosis and my desire to not have children. When that was taken off the table, I appealed for the essure. I told them that I didn't want children, but, in the highly unlikely event that I do decide to have a child, I would not, under any circumstances, bear my own child. I have serious medical history in my family that I've no wish to pass on to a child. The fact that I had medical justifications that were entirely rational for my decision and yet was still refused by three separate doctors is further justification for the argument that this decision is being passed on archaic notions of womanhood.

[even sven]

One factor is surely that there are a half-dozen very effective and fully reversible means of birth control.

[aruvqan]

Doesn't this really just come down to the fact that a vasectomy can be reserved and a tubal ligation or hysterectomy can't?

i had a tubal ligation that reversed itself ... the old style where they just sort of made a loop and tied it off.

When they fixed *that* little issue, they actually cut and removed tube.

And I had a seriously great obgyn, i got my tubal at 22 ... but i had almost died 2 times from pregnancies first.

[Lamia]

I know a woman who had her tubes tied at 30, AFTER having three kids, and even then she said she had a hard time convincing a doctor that she was really really sure she didn't want to have any more children and really really wanted to have the procedure.

This attitude is pretty obnoxious, but I don't know that this is a problem that can be legally addressed without interfering with the rights of doctors. I don't think a doctor can be required by law to perform an elective procedure. The patient is, in theory, free to find another doctor who is willing to perform the requested procedure.

The problem comes when the patient can't find another doctor who is willing to perform the procedure. In some areas this is also an issue when it comes to abortion. It may be perfectly legal for the woman to seek an abortion, but there might not be any local doctors who perform them. This is a bad situation to be sure, but I don't see an easy solution to it.

A simply discrimination lawsuit is unlikely to work, as a vasectomy is not actually the same procedure as a tubal ligation. The latter is more expensive, more invasive, and more dangerous. I doubt that the same doctor would normally be qualified to perform both procedures, so it would be unusual for a woman to be able to say "This doctor could sterilize me but won't, but is perfectly happy to sterilize a man."

[mswas]

Endometriosis is a strange condition and I feel sorry for any woman who has it. My sister wanted to get one when her endometriosis got really bad. She has since had a child and her endometriosis symptoms have gone away. I have heard a similar story from someone I went to school with when I did a paper on endometriosis. If you don't want kids then you should be allowed to get the procedure.

[QuercusMax]

One thing I would add is that it's a lot easier and more reliable for a man to freeze some sperm and use it later if he changes his mind.

Additionally, there is no permanent-ish male birth control system, unlike the Pill, IUDs, NuvaRing, Depo-Provera, etc. Basically, the only types of birth control that a man has any say in are the barrier methods (condoms, etc).

I wonder if there are any statistics related to how many men/women get vasectomies/tubal ligations regret their decision and try to have it reversed? If there is a large difference between these numbers, that might explain some of the reticence to perform these procedures.

Now, the issue that Jillvyn refers to is very different. Sounds like her doctors have been a bunch of jerks.

[mswas]

And when you don't want kids, ever, fertility is a HUGE problem.

The menopause at a young age side-effect doesn't bother you?

[Der Trihs]

The menopause at a young age side-effect doesn't bother you?Not that I'm an expert, but having her tubes tied shouldn't do that to a woman since her ovaries are still there. It's the difference between a vasectomy and castration.

[mswas]

Not that I'm an expert, but having her tubes tied shouldn't do that to a woman since her ovaries are still there. It's the difference between a vasectomy and castration.

She talked about the possibility of the biological clock ticking early. I thought that meant early menopause.

[Der Trihs]

She talked about the possibility of the biological clock ticking early. I thought that meant early menopause.
She was talking about what excuses the doctors were using to refuse her; "biological clock" clearly meaning that they think she'll suddenly want a baby.

[torie]

I don't know how reliable this number is, but the website for the IUD Mirena states that 25% of women who have tubal ligation later regret it.

[alphaboi867]

...Additionally, there is no permanent-ish male birth control system, unlike the Pill, IUDs, NuvaRing, Depo-Provera, etc. Basically, the only types of birth control that a man has any say in are the barrier methods (condoms, etc)...

Good point. The only male contraceptive is a condom and if it fails he has no control over results. Women have several methods of contraception and the option of terminating the pregnancy if they fail..

[Guinastasia]

I probably won't ever have kids biologically, because of medical issues-all the meds I'm on, the seizures, etc. Would that make a difference? (Apparently, lamictal can cause birth defects, and the recently when the doctor tried a new type of drug, I ended up having grand mals every other week). So if I ever want to have kids, I'll have to adopt.

[Chief Pedant]

I've heard it's virtually impossible for a woman who hasn't had any kids to get her tubes tied, whereas it's relatively easy for a man in a similar situation to get a vasectomy.

If this is indeed the case, shouldn't the law step in to address this inequality?

It always seemed like a bullshit argument to deny the procedure because later the person may regret it. It may very well be a permanent decision, but so is having a child. It is vastly better, in my not so humble opinion, to regret never having a child than to have a child whose existence you'll (secretly, because admitting it out loud would never be socially acceptable) regret.


I'd be curious to see a study reflecting how often such a request is refused. It would not surprise me (a physician) to find out that it is, in fact, commonly refused, particularly to nulliparous women.

Why?

Tradition is probably the simplest answer, annoying as it might be, especially if the woman is young. With respect to this reason, I suspect younger and (possibly) female Ob-Gyn surgeons might be better prospects to ask.

Other reasons that I suspect are advanced:

1. It is a more complicated to reverse if the woman does change her mind. Most Ob-Gyn surgeons are going to have at least some anecdotal experience with patients who decide to have a baby late in life.

2. It involves more risk than a vasectomy. It is not risky in absolute terms, although of course for a given individual factors such as obesity would come into play for increasing risk.

Having suggested those two weak reasons I wonder if there is third one: it's just not worth the bother of figuring out if it's really the right decision for a young and childless woman to undertake. I mean, to do it right you would have to make sure she's not a nut; that her psychologic state is good; that she's not gonna come back and haunt you...etc etc. Fair or not, I'd venture a guess that physicians don't think the chance a male patient would blame them for a too-hasty vasectomy is as high as the chance a female patient would. While it may be the political position du jour that modern women are as capable of standing behind their decisions as modern men, I don't think that's the perception. So it's easier to just not risk being the doctor who did it.

Here's a study for a little ammo. It's very small, and it's very old. But it's the sort of thing I might take into a physician's office if I were trying to persuade her.

http://www.ncbi.nlm.nih.gov/pubmed/7409229

There may be newer ones. And as always, there is usually a niche market for some guy willing to do what others pass up. So the trick is to ask "Who will?" if your doc happens to think procreation is some sort of sacrosant opportunity that no woman in her right mind would pass up.

Let me be the first to encourage all you women to remain childless. Despite my criticism of Anti-Natalists in another thread, I am closet member. Life would be so convenient without any children in the world. Until I need them to pay off our national debt, anyway.

One last thing: you can't really make a law ordering doctors to do a particular surgery. Damn prima donnas (Prime donne? Primi uomini?).

[SenorBeef]

Have we become such a ridiculous and litigous society that the idea that someone fully conseting to a certain procedure will have a doctor perform it without error and still get sued by malpractice because the victim changed their minds about it?

If so, nuke us from orbit, it's the only way to be sure.

[Chief Pedant]

At the bottom of this article are a number of additional studies looking at post-sterilization regret (First nineteen cites, I believe). I did not look through the cites themselves.

http://www.who.int/reproductive-health/publications/mec/13_ster.pdf

There is this comment on Page 2 of the article:


Clarification: Young women, like all women, should
be counselled about the permanency of sterilization
and the availability of alternative, long-term, highly
effective methods.
Evidence: Studies show that up to 20% of women
sterilized at a young age later regret this decision, and
that young age is one of the strongest predictors of
regret (including request for reversal information and
obtaining reversal) that can be identified before
sterilization. Cites 1-19

You might look through the articles cited to see if nulliparous women were parsed out from those who had children.

[Manda JO]

Additionally, there is no permanent-ish male birth control system, unlike the Pill, IUDs, NuvaRing, Depo-Provera, etc. Basically, the only types of birth control that a man has any say in are the barrier methods (condoms, etc).


Except that hormonal birth control has significant side effects for many women--and yes, you can always try a wide variety of types and find an option that works better for you, but that can literally take years -- that's years of significant weight gain and a cratered libido, and there's no promise that you will actually find anything that works in the end. If a woman is positive she won't ever want to have kids, why should she have to go through all that?

[Zoe]

I would contact Planned Parenthood for a referral to a doctor who treats women as if they are adults and does not believe in prolonged suffering until she's a big girl in her thirties or forties. Yes, she may regret it. She may regret cosmetic surgery too, but that doesn't slow surgeons down much in that field.

Women who choose hysterectomies should talk to other women who have had the work done to see how it has affected their sex lives. Doctors aren't as informative as they should be. Maybe it's because male surgeons don't realize what a change it can make.

[Green Cymbeline]

I came across this tidbit today in [url=http://www.time.com/time/magazine/article/0,9171,1865975,00.html]Time Magazine, which is about Essure: "a newer, cheaper, faster, scalpel-free alternative to tubal ligation"[url]One general concern among doctors is that women who choose to get sterilized might later change their minds. In a study in Obstetrics & Gynecology of 11,232 women who had been voluntarily sterilized, 20% of those who were younger than 30 at the time of the operation felt regret later, compared with 6% of those who were older than 30.
But you know what? Who cares? The medical establishment should not discriminate against women based on the fact that some women regret it later on. How easy is it to just have the patient sign a form stating that they are aware of what they are doing and agree not to sue later on?? I think it's shameful that women have to go through this...

[Green Cymbeline]

Sorry, that should be:
I came across this tidbit today in Time Magazine, which is about Essure: "a newer, cheaper, faster, scalpel-free alternative to tubal ligation" (http://www.time.com/time/magazine/article/0,9171,1865975,00.html)...

[Markxxx]

I don't know how reliable this number is, but the website for the IUD Mirena states that 25% of women who have tubal ligation later regret it.

I don't doubt the figure, but how does one qualify this? Everyone has regrets. But since there is no real way to see if they really regret it enough to fix it, the question is not valid.

What I mean is, suppose I wanted to visit the World Trade Center. Well I can't it's gone. So I say "I regret not having visited it while I have the chance." Since there is no way in reality I can reverse this, the choice is meaningless.

If by magic I could make the Twin Towers reappear, does this mean I would immediately go into hock or whatever to get money to visit NYC and see them?

Would a woman who KNOWS she can't get pregnant and says she regrets it, still feel that way if she COULD get pregnant? It's easy to say something when you know it can't happen.

Did these women who say they regret it, try to adopt? Did they think of artifical means like surrogacy or whatever?

As Archie Bunker said "It's easy to be generous when it ain't costing you nothing."

To parapharase that, "It's easy to say something when you know you'll never be called on to prove your point."

[Kobal2]

I would contact Planned Parenthood for a referral to a doctor who treats women as if they are adults and does not believe in prolonged suffering until she's a big girl in her thirties or forties. Yes, she may regret it. She may regret cosmetic surgery too, but that doesn't slow surgeons down much in that field.

Damn you Zoe, elective plastic surgery that was the zinger I wanted to throw Justin_Bailey's way :).

Plus, what kind of half-assed reason is "you may regret it" in the first place ? Would a sports medicine practician refuse me a certificate of good health on the grounds that Scuba diving is dangerous and trust me, you may regret that bill of clean health later when you get decompression sickness ?

Or, to put it in another context, would it be OK if your voting rights were suspended because you might regret voting for that guy later ? For that matter, think about all the decisions you've made that you later came to regret, would it have been OK at the time for a third party to deny you the option ? Of course not.

Bottomline is : it's her damn decision, good or bad. If she comes to regret it later, there's lots of kids need adoption.

[Grumman]

How easy is it to just have the patient sign a form stating that they are aware of what they are doing and agree not to sue later on??
Has there been a precedent in the U.S. courts that would confirm that such an agreement would be binding?

[Jillyvn]

Living in Canada throws another wrench into the issue for women here. I'm given to understand that, in the US, patients have choice of doctor. Here, once you get referred to a specialist, and wait the requisite period of time to get in, the chances of changing to another specialist are very slim. For reasons that are TMI, I wanted to change gynes once. I was basically told by my family doctor to be very subtle about it because I did not want to get a repuatation as a "high maintenance" patient, but that he would help me out b/c the particular gyne I wanted to switch from had a bad rep.

So, unless things are radically different in other parts of Canada, women here don't have the option of asking "well, who will?"

Side tracking somewhat, I did contact planned parenthood in Calgary about this issue, before I ever got a reference to a gyne in that city. This was after three cities, three doctors, three different "no's" and I was at the point where I was ready to cut myself open. They gave me the name of a female doctor who had, in the past, consented to procedures that would sterilize young women. This doctor was wonderful. We agreed to try one last option before the big H, the Mirena. Luckily for me, this was a magic bullet that got rid of my pain, so I've been able to delay the surgery for five years. Unluckily for me, I've since moved, so I'll need to start this dance all over again if the Mirena stops working.

I would just say - all of this is unnecessary. There seems to be some sort of sanctity attributed to the ability to bear a child. I second the adoption comment - really, if you have the procedure and deeply regret it, it's not as though you have no other options. Everything comes with risks.

[jsgoddess]

But you know what? Who cares? The medical establishment should not discriminate against women based on the fact that some women regret it later on.

And 80% don't regret it.

How many women regret having to wait so long?

[Vox Imperatoris]

But saying the medical establishment shouldn't discriminate against young women because they may regret their decisions later is like saying a car insurance company shouldn't be allowed to discriminate against 16-year-old boys because they are more likely to have a wreck. Most women may be perfectly committed in their decisions, but it only takes one crazy woman and a good lawyer to ruin a doctor's day. Again, I'm not saying that this is the correct decision (I don't pretend to be an expert on this issue), but that seems to be the situation from the doctor's point of view.

Valete,
Vox Imperatoris

[Der Trihs]

But saying the medical establishment shouldn't discriminate against young women because they may regret their decisions later is like saying a car insurance company shouldn't be allowed to discriminate against 16-year-old boys because they are more likely to have a wreck. Most women may be perfectly committed in their decisions, but it only takes one crazy woman and a good lawyer to ruin a doctor's day. Again, I'm not saying that this is the correct decision (I don't pretend to be an expert on this issue), but that seems to be the situation from the doctor's point of view.And do you have any evidence this has a thing to do with fear of lawsuits ?

And the other problem with your argument is that amounts to a claim that doctors shouldn't practice any kind of medicine at all, since anyone can sue. If lawsuits were the problem, such a massive problem that denying women their choice and condemning at least some to major suffering ( like Jillyvn ), they'd be a problem for all medical procedures. "Fear of lawsuits" sure doesn't seem to keep them from cosmetic surgery.

No. This is about sexism, not lawsuits.

[maggenpye]

Not that I'm an expert, but having her tubes tied shouldn't do that to a woman since her ovaries are still there. It's the difference between a vasectomy and castration.

Sorry to take so long to get to this point - hysterectomy may also leave the ovaries. My mother had hers during the 70's and menopause three years ago. A pedant could argue (and probably will, given our location) that menopause literally means the end of menstruation and that would have happened with the hysterectomy. The periods did stop then, but there were none of the other biological alterations associated with 'the change' until she had a normal hormonal shift as her ovaries finally ran out of eggs.

She'd asked for a hysterectomy after my birth (mid 60's) having completed the parental plan of 'one of each', but was told she should wait, in case she needed to 'replace' either myself or my sibling. Her personal doctor hit the roof, saying that a tubal ligation would only lead to a collapsed uterus later, given the medical history.

But, the GYN knew better.

So she had 10 years of birth control (which, back then, had to be changed every year or so - pills, cap, iud, lather rinse repeat), until her uterus collapsed.

She was married, had completed her family, had her husband's full support and a doctor on her side - but at 21 she couldn't get a medically indicated hysterectomy.

[Grumman]

"Fear of lawsuits" sure doesn't seem to keep them from cosmetic surgery.
Why do you trust plastic surgeons' judgement over that of other doctors? Couldn't you just as easily argue that cosmetic surgery should not be offered as readily, given that 20% of patients are not satisfied with the results of their surgery?

No. This is about sexism, not lawsuits.
You throw that accusation around too freely.

[Manda JO]

But saying the medical establishment shouldn't discriminate against young women because they may regret their decisions later is like saying a car insurance company shouldn't be allowed to discriminate against 16-year-old boys because they are more likely to have a wreck. Most women may be perfectly committed in their decisions, but it only takes one crazy woman and a good lawyer to ruin a doctor's day. Again, I'm not saying that this is the correct decision (I don't pretend to be an expert on this issue), but that seems to be the situation from the doctor's point of view.

Valete,
Vox Imperatoris

But, by definition, an insurance company is liable for the accidents a teenager causes. This is not the case with elective surgery.

[Malacandra]

I could be wrong, but couldn't the difference between the sexes be explained by the fact that it is really easy for a man to take steps to ensure his future fertility despite vasectomy, and it's a darned sight harder (and seldom done) for a woman?

[Broomstick]

No, because I remember hearing about the same bias before saving sperm was as easy and as inexpensive as today.

I really think it's explainable as a cultural bias that the "proper role" or "natural role" of woman as childbearer. It not that different from when I go to a new doctor and say I have no children - I am immediately bombarded with questions about whether my fertility problems have been looked into (actually, it's my husband who sterile, not me) and bombarded with information on assisted fertility and/or psychological counseling and support groups - all before I have a chance to say I'm totally OK with not having kids, it was never a priority for me, and that's not what I came here to talk about.

I look forward to menopause when I am no longer fertile and don't have to listen to all that anymore. I can just say "I never had kids" and be done with it, although I suspect there will still be cultural baggage to contend with,

[catsix]

mswas said:
The menopause at a young age side-effect doesn't bother you?

Tubal ligation does not cause menopause. Removal of the ovaries would, but that's not what I asked for. With tubal ligation (or Essure), your ovaries are still there, cranking out the hormones and popping the follicles. They just can't get the eggs to the uterus. I would also be OK with a hysterectomy in which the ovaries were left in place because although periods would stop (who needs 'em if you never intend to get pregnant?) the ovaries would still be there regulating the hormones.

Der Trihs said:
She was talking about what excuses the doctors were using to refuse her; "biological clock" clearly meaning that they think she'll suddenly want a baby.

Yes, that's what it means. Doctors seem to think that there is some magical age at which I will suddenly hear that clock and think that I just have to have a baby, right now.

torie said:
I don't know how reliable this number is, but the website for the IUD Mirena states that 25% of women who have tubal ligation later regret it.

Part of being an adult means that you can make choices you one day might regret. From tattoos to breast implants, adults can alter their bodies in many permanent ways that they could later regret.

No one would dare say to a 30 year-old woman who is about to enter into the equally permanent scenario of getting pregnant and having a baby 'What if you later regret this?'

However, I am of the mind that it is far worse to reget having a kid than it is to regret not having one.

Kobal2 said:
Damn you Zoe, elective plastic surgery that was the zinger I wanted to throw Justin_Bailey's way

I already mentioned it way back up there in post #10

Vox Imperatoris said:
But saying the medical establishment shouldn't discriminate against young women because they may regret their decisions later is like saying a car insurance company shouldn't be allowed to discriminate against 16-year-old boys because they are more likely to have a wreck.

The standard for elective surgery is whether or not the patient is over the age of majority (which is 18 years where I live) and whether or not they can provide informed consent. We don't judge any other surgery based on whether the doctor thinks the patient will later regret it. That insulting and paternalistic bullshit is reserved solely for women who want control over their reproductive future.

Broomstick said:
'I really think it's explainable as a cultural bias that the "proper role" or "natural role" of woman as childbearer.

It's even more apparent when those actual words come out of a doctor's mouth. As one told me that I should 'see a psychiatrist to learn to accept my natural role as a woman'.

[WhyNot]

It should also be mentioned that in a case like catsix's, where she's not requesting hysterectomy but fallopian tube blockage, that she'd be perfectly capable of carrying an in vitro fertilized embryo to term should she get hit by a brick, wake up with amnesia, undergo a complete personality rewrite and suddenly start craving sprog.

[Jillyvn]

I could be wrong, but couldn't the difference between the sexes be explained by the fact that it is really easy for a man to take steps to ensure his future fertility despite vasectomy, and it's a darned sight harder (and seldom done) for a woman?

in some cases, maybe. However, with newer methods of non-invasive sterilization for women, such as Essure, this excuse is losing weight.

MY experiences parallel those just related by Catsix. I have had doctors encourage me to visit a psychiatrist to discuss my resistance to child bearing. I even had one lovely doctor ask me to consider what this will do when I "settle down" with a nice man and he decides he wants to have kids.

I think there is a larger issue in place here - one that I'm only just now starting to see the other side of. From 19 -29, being childless by choice was something I only had to justify to a doctor when asking for a sterilization. Now, this weird thing has started happening... When I meet new people, they ask if I have children. When I say no, I frequently get this strange, sometimes fleeting, pitying or confused look. On more than one occasion, I've had people I've just met say "well, that's not too far down the road, so don't worry" or, "bet you can't wait!" I never take it personally, it doesn't offend me, and I usually laugh it off. But, it is the first time I've come smack up against the societal expectation that I ought to reproduce. If the attitudes are this prevalent in well-meaning, intelligent and otherwise sensitive people in general society, it is little wonder they have a strong hold in our medical community, reflecting as it does societal norms.

[Der Trihs]

Why do you trust plastic surgeons' judgement over that of other doctors?It has nothing to do with trust. It has to do with the fact that if fear of lawsuits was the problem, then that fear would logically apply to ALL of medicine; I just picked cosmetic surgery at random. Why aren't other specialities so "afraid of lawsuits" that they refuse to treat their patients ?

No. This is about sexism, not lawsuits. You throw that accusation around too freely.Have you been reading the same thread I have ? There's no reason to consider it anything else. "Sexism" is being polite; a less polite way of saying it is that this is about treating women as subhumans and brood mares, as creatures who have no right to make their own decisions and whose overriding function is to breed. Regardless of their health or desires.

[Speaker for the Dead]

Have you been reading the same thread I have ? There's no reason to consider it anything else. "Sexism" is being polite; a less polite way of saying it is that this is about treating women as subhumans and brood mares, as creatures who have no right to make their own decisions and whose overriding function is to breed. Regardless of their health or desires.Or, doctors who have seen upset and lawsuit-happy patients come down on other physicians after they (the patients) did something they regretted want to cover their asses. Or, they've had many women come to them after requesting and being refused a sterlisation and thank them, since they did change their minds. Or, as you say, some hold sexist ideas about women's fertility. I doubt that we can generalise any single reason to a given doctor, let alone the whole profession.

[Manda JO]

Or, doctors who have seen upset and lawsuit-happy patients come down on other physicians after they (the patients) did something they regretted want to cover their asses. Or, they've had many women come to them after requesting and being refused a sterlisation and thank them, since they did change their minds. Or, as you say, some hold sexist ideas about women's fertility. I doubt that we can generalise any single reason to a given doctor, let alone the whole profession.

Except this isn't a matter a sizable portion of doctors won't perform sterilization procedures on women but will on men--this is a virtually uniform practice across the profession. And no one has presented any evidence whatsoever that patients are more likely to sue over this issue than they are to sue over any other elective procedure.

Hell, there is a protocol for a person in their early twenties to get a sex change--you have to jump through hoops, but at least the hoops are defined. Women who want to be sterilized--even when they have legitimate medical reasons--aren't told to go off and think about it for a year or three and then come back. They aren't even asked to consult with an expert to discuss the issue with a professional to make sure they are really sure. They are simply told "no".

[Der Trihs]

Or, doctors who have seen upset and lawsuit-happy patients come down on other physicians after they (the patients) did something they regretted want to cover their asses.AGAIN, if that's the problem, then why does it to apply to sterilization of women and that alone ?

[WhyNot]

Hell, there is a protocol for a person in their early twenties to get a sex change--you have to jump through hoops, but at least the hoops are defined.
Now that's a really good effin' point. See, catsix, you can get sterilized, you just have to accept a penis first. :rolleyes:

[Jillyvn]

Der Trihs is right. This is very much an issue of sexism. If this wasn't an issue of blatant and unchecked sexism, then doctors would have set up a formal and accepted medical route to the procedure, as Manda JO suggested.

For example, the doctor I saw who did agree that the hysterectomy would be an option for me was entirely rational. She advised me that she would not consent to perform any seriously life-changing procedure on any client, male or female, without being able to assure herself that the procedure was a) well-considered and consented to in the face of full evidence of consequences and risks and b) all other non-invasive options had been considered, and, if agreed to by the patient, tried. Her practice is to counsel a woman to see her for six months. By then, she will know the patient well enough, and have had time to ensure she has related all the necessary medical knowledge the patient needs to consent to the procedure. Is she determines that there is no deficit motivating the patient to make a decision (personal pressures, mental illness etc), she would happily move foward. In fact, it was her that told me about the Essure, just before I left town. My Mirena was working well, and I joked that this had derailed my option to kill two birds with one stone, since the hysterectomy was no longer "necessary". She told me that she would consider the Essure if I wanted to do that instead.

Here's my proposal. Doctors should be educated in med school that part of our societies protection of the right to chose includes the right of a woman to of sound mind and free will to decide not to get pregnant at all, not just to terminate a foetus should they become pregnant. Doctors should be advised that choosing sterilization instead of permanently medicating oneself with hormones is a valid medical choice. They should be taught how to assess for informed consent. With a little education, this could all switch. It's an archaic holdover from the patriarchy, and one one we have long since outgrown.

[KarlGrenze]

I know a woman who had her tubes tied at 30, AFTER having three kids, and even then she said she had a hard time convincing a doctor that she was really really sure she didn't want to have any more children and really really wanted to have the procedure.


Not to get into the rest of the thread, but wouldn't that be something that changes by geography? I seem to remember reading than in some countries/areas (Puerto Rico, Mexico), female sterilization is one of the main forms of birth control. Now, by the time it is performed the woman already has one (or more) kids, but there is no question nor is it denied...

My cousin's wife had her tubes tied immediately after having her second child (she was in the late 20's-early 30's, in Puerto Rico), and had no problem finding who would do the procedure, which is why I find it weird what happened to your friend.

Not only that, but I've known of friends' and relatives' mom who've had histerectomies performed (for medical reasons) before turning 30. Again, they already had a couple of kids, but unlike someone else's relative experienced earlier in this thread, there was no question about doing the surgery.

[Blalron]

I'm very curious about the whole "lawsuit" angle.

Can anyone cite even one case of a successful lawsuit from a woman who agreed to be sterilized, but later regreted it? Or a man, for that matter?

[Speaker for the Dead]

I'm very curious about the whole "lawsuit" angle.

Can anyone cite even one case of a successful lawsuit from a woman who agreed to be sterilized, but later regreted it? Or a man, for that matter?
Here's opposite, from 35 years ago: women suing to be sterilised (http://www.popline.org/docs/0150/732930.html).

[Speaker for the Dead]

Another related area is the "Wrongful Pregnancy Action," (http://www.fightingforyou.com/SiteMap/ShowTopic,3,105.html) in which women sue doctors if they conceive after a sterilisation procedure.

And as an anecdote, the OP here (http://www.atheistnexus.org/group/thechildlessandgodless/forum/topics/2182797:Topic:65445) is having the same problems as women seeking sterlisation.

[kanicbird]

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

[doreen]

Except this isn't a matter a sizable portion of doctors won't perform sterilization procedures on women but will on men--this is a virtually uniform practice across the profession. And no one has presented any evidence whatsoever that patients are more likely to sue over this issue than they are to sue over any other elective procedure.

But it also isn't a matter of the same doctors performing sterilization procedures on men and refusing to perform them on women. It's generally going to be an OB/GYN treating women and a urologist treating men. I don't know of any evidence that women are more likely to sue over this issue, but I'd be willing to bet that OB/GYNs are more likely to be sued than urologists are. And a lawsuit doesn't need to be successful to change someone's behavior.

[Manda JO]

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

So? Even if what you say is true, why should the freedom to make this bad choice, of all the bad choices in all the world, be denied to women?

And in any case, many women may want children but feel like they ought not have them--due to their own personality issues or the genetic legacy they carry. There are lots of reasons not to have children beyond the simplistic "not wanting them"

[Manda JO]

But it also isn't a matter of the same doctors performing sterilization procedures on men and refusing to perform them on women. It's generally going to be an OB/GYN treating women and a urologist treating men. I don't know of any evidence that women are more likely to sue over this issue, but I'd be willing to bet that OB/GYNs are more likely to be sued than urologists are. And a lawsuit doesn't need to be successful to change someone's behavior.

That may be a reason, but is it a justification? Do you really feel it's right that the standards for getting the two procedures done are so different?

[Lamia]

Not to get into the rest of the thread, but wouldn't that be something that changes by geography? I seem to remember reading than in some countries/areas (Puerto Rico, Mexico), female sterilization is one of the main forms of birth control. Now, by the time it is performed the woman already has one (or more) kids, but there is no question nor is it denied...

My cousin's wife had her tubes tied immediately after having her second child (she was in the late 20's-early 30's, in Puerto Rico), and had no problem finding who would do the procedure, which is why I find it weird what happened to your friend.AFAIK this woman didn't have to change doctors or anything, my impression was more that she had to go through a lot of "You're sure? You're sure you're sure? You're really, really, REALLY sure?" before her doctor would agree to tie her tubes. I know she had the procedure performed locally.

[Rune]

Why are some people getting so upset when being told by others that they think they at some point later on might still want to have children, even though they don’t want any just now? Many people have experienced not wanting to have children, and at a later time changed their mind. I didn’t want children when I was 22. Now I want more. Sure some people never want children. Not when they are 22, 32 or 42. Many other people on the other hand do change their mind.

And is it really a good idea to force doctors to perform operations they find ill advised? If a guy come in and insists on a trepanning, few people would think the doctor should be forced to perform such an operation against his own best judgement.

[doreen]

That may be a reason, but is it a justification? Do you really feel it's right that the standards for getting the two procedures done are so different?
If there were one organization setting different standards for the two procedures , it would be wrong and sexist. But in my view, it's impossible to call it sexism when each individual doctor is making his or her own decision based on their own experiences. Individual doctors might actually be sexist, but there's just no evidence to say that as a group, doctors are doing this because of sexism and the situation would be no different if urologists had the highest malpractice premiums and any behavioral differences between the patient groups were reversed. And there may be behavioral differences- men may be less likely to request sterilization at a young age or when they are childless, or less likely to change their mind or even just less likely to let the doctor know they changed their mind.

[coffeecat]

I knew a woman who got her tubes tied in her 20s. The operation gave her Guillain-Barre syndrome, which took forever to get diagnosed. One of the hoops she had to jump through on the way to the right diagnosis was a stay at a psych unit, with a psychiatrist who thought it was all in her head: Since she was going against her Womanly Reason For Existence, she had to have a lot of repressed feelings about the surgery, which were causing her symptoms.
I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.
You're not a doctor, are you?

[Jillyvn]

Why are some people getting so upset when being told by others that they think they at some point later on might still want to have children, even though they don’t want any just now? Many people have experienced not wanting to have children, and at a later time changed their mind. I didn’t want children when I was 22. Now I want more. Sure some people never want children. Not when they are 22, 32 or 42. Many other people on the other hand do change their mind.

And is it really a good idea to force doctors to perform operations they find ill advised? If a guy come in and insists on a trepanning, few people would think the doctor should be forced to perform such an operation against his own best judgement.

With all due respect, I am not upset when other people tell me at some point I might want children. 99 percent of the time, I smile it off, after all - anyone who knows me knows just how seriously I am committed to not having a child, so people who say this likely are strangers or new to my life. I am "upset" when I am told by a doctor, regarding what I view as an entirely rational, well thought out and valid medical decision, that my whimsical decision will change once I get the baby bug. This is not a valid reason to deny a medical procedure. Would you have elected to be sterilized at 22? I would have, and eight years later, I can tell you my decision remains the same.

I am very open about my decision, and I know from personal experience that it can be very difficult for the average person to understand why I don't want to have a child at first, but once I explain my decision (if I choose to elaborate), everyone comes around. I'm not sure why I should even have to, but I am fine with it. I am less ok with the doctor's responding like a "friend" than a medical professional.

[jsgoddess]

I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

So, if I say I'm quite happy, your reply is what?

[Broomstick]

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.
I'm in my 40's and I'm quite happy. I knew when I married my husband he was sterile. No children, but happy. Are you saying I'm mis-wired, or saying I'm not a woman....?

I mean, really, if it had been that important to me to have children I would have, but it's not. I just couldn't be bothered to buy a turkey baster. If I can't expend that little effort and money I guess I just don't want children.

[catsareawesome]

I had my tubes tied when I was 25. I wasn't married and I hadn't had children. The doctor asked what if I meet someone who wants children and my reply was that he wouldn't be the man for me. I wasn't about to have a child just to make some man happy. I also told him I would never be able to afford a child and that I dislike anyone who has a child and has to have help. I also explained that I like to be able to go where I want and when I want without having to worry about finding a babysitter. Last but not least I told him that since baby selling was illegal I told him I wasn't about to have a child unless I could benefit from it. After that he agreed and said that he hopes I don't regret it. It's been 22 years now and I haven't regretted it for a second. So you just have to be persistent.

[Rune]

So, if I say I'm quite happy, your reply is what?Well, "lies of this world" obviously. Personally I think it’s great some people, many people, and especially people whom don’t want children, aren’t having them. It’s merely Darwinism in action. Their genes have shown themselves to be evolutionary defective and they are voluntarily removing themselves from the common future genepool. I expect, it will in some small way result in people in the future will love their children more. Besides it leaves more space for my brood.

[treis]

So? Even if what you say is true, why should the freedom to make this bad choice, of all the bad choices in all the world, be denied to women?


Having M.D. at the end of your name doesn't turn you into your patient's slave. If someone is uncomfortable with performing a procedure, I don't see why they should.

[catsix]

Manda JO said:
They are simply told "no".

That is actually the most polite of the responses that I have gotten. Most are far more insulting and unprofessional.

KarlGrenze said:
My cousin's wife had her tubes tied immediately after having her second child (she was in the late 20's-early 30's, in Puerto Rico), and had no problem finding who would do the procedure, which is why I find it weird what happened to your friend.


The key factor there is that she had children.

Again, they already had a couple of kids, but unlike someone else's relative experienced earlier in this thread, there was no question about doing the surgery.

Entirely because they had already fulfilled their womanly duty -- they already had kids.

kanicbird said:
I think women who have this done early in life have a very good chance to greatly regret it.

And there are women who have a kid and regret that they did. Which is worse?

I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

I have never wanted children. I've known this in the same way that I know I am straight for as long as I can remember. The idea of having a kid is so foreign and alien to me that I have a hard time even imagining it. Thanks to attitudes like yours, I have been faced with medical professionals who have been so cruel as to suggest that there is something fundamentally wrong with my brain, that I have a mental disease, or that I am a failure of a woman because I lack all desire to ever have a kid. Complete strangers feel free to comment on my lack of children as if my childlessness is some sort of tragedy, or to remind me that I better get cracking on popping out some sprog because I'll run out of time.

While you may not be able to imagine what it is like to be a woman who doesn't want kids, you should also recognize that those who are like me are unable to imagine what it is like to be a woman who does want them. I can no more picture myself as a mother than I can picture myself as a lesbian, or a black person, or a religious believer. It is not who I am.

Rune said:
Why are some people getting so upset when being told by others that they think they at some point later on might still want to have children, even though they don’t want any just now?

Ever ask a gay person if they might be straight later on in life? Ever ask a straight person if they might be gay later on in life? Ever ask someone who's 25 and having a kid 'What if you decide when you're 35 that you never really wanted kids?'

If you wouldn't comment to them, you shouldn't comment to me.

The short answer to this is that it's really fucking rude to say something like that.

catsareawesome said:
So you just have to be persistent.

I guess trying to get fixed for twelve years isn't persistent enough.

[Algher]

A couple of additional thoughts / comments:

1) When I had my vasectomy, I was counseled by the Doctor. He spoke to me, he spoke to my wife, and he told me that if I was even slightly wondering about the reversal possibilities he did not want to do the surgery for me. I had kids already, and we were fine - but I did go through counseling.

2) Vasectomies are done by Urologists. Penis specialists. That is a different doc than an OB/GYN. I would hypothesize that OB/GYNs have a different mindset than Urologists, helping drive more of the "are you sure" types of comments.

3) When my wife was pregnant with our second child, we asked our OB/GYN if he would perform an abortion if the child was Down's syndrome, etc. He said no, but that he would give us the name of a doctor that would.

I would make some calls to find a doctor who will perform the surgery, perhaps even calling the insurance company for a name of someone who will do the work and go in with the authorization. If they still say no, ask who will. After that, contact the medical director at the local hospital for the name of the doctor who will do the procedure. Having the "referral" come in from the top might help.

[Eliahna]

It seems accepted here that young childless men have no trouble getting a doctor to agree to sterilize them, but is that always the case? Usual disclaimer about being outside the US and things maybe being different here, but I ask because I've known several men who were denied vasectomies because of their age, one of whom was a 24 year old father of four. He was absolutely rock-solid in his conviction that he didn't want more children, and his wife had vowed after the last time that she would never endure pregnancy and childbirth again so she was completely on board with the decision. The doctor asked him "What if you split up with your wife and meet another woman who does want children?" and he said "I'll still have the four I already have to support.". The doctor still wouldn't agree to the operation at that point but said if he went through counseling to make sure it was the right choice, and still wanted it done after 12 months, he'd see about giving him a referral for it.* They were furious that they had to wait and quite vocal about how absurd it was to treat adults as though they couldn't make decisions about their own bodies or fertility.

I've also heard about successful tubal reversals--I've seen a few women get pregnant after a tubal reversal on a pregnancy message board I frequent.
I think these are the people the OP needs to slap. I've met many people who've had reversals or who were adamant in their youth that they never wanted children, and changed their minds later. I know comparatively fewer people who have remained happily childless by choice for all their lives. I guess that doctors have trouble believing you because of the other umpteen patients they've had in who swore, vowed, declared and insisted that they never ever ever wanted any [more] children, no way, not in a million years... and then changed their minds. How's a doctor supposed to tell the difference?

* Several months later, he and his wife changed their minds and started trying for number 5 :rolleyes:

[WhyNot]

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.
I'm sorry, but I think you meant to post this in the Things you believe in but cannot prove (http://boards.straightdope.com/sdmb/showthread.php?t=497022) thread.

I had my tubes tied when I was 25. I wasn't married and I hadn't had children.
Are you willing to share where you live?

A couple of additional thoughts / comments:
2) Vasectomies are done by Urologists. Penis specialists. That is a different doc than an OB/GYN. I would hypothesize that OB/GYNs have a different mindset than Urologists, helping drive more of the "are you sure" types of comments.
Now that's an interesting thought. Perhaps it's the fact that OBs are so constantly trying to bring babies into this world that makes them project* that desire onto their patients. Maybe women would do better talking to a GP instead of an OB.

*"project" in the layperson sense, not the Freudian, of course.

[maggenpye]

Well, "lies of this world" obviously. Personally I think it’s great some people, many people, and especially people whom don’t want children, aren’t having them. It’s merely Darwinism in action. Their genes have shown themselves to be evolutionary defective and they are voluntarily removing themselves from the common future genepool. I expect, it will in some small way result in people in the future will love their children more. Besides it leaves more space for my brood.
Isn't there another thread round here about welfare moms neglecting their kids, just dropping multitudes of little money magnets so mommy can afford to get trashed again? That's also Darwinism at work, multiple births canceling poor survival rates, it's kept poverty stricken societies fully stocked for centuries.

The willingness to have children (or lack of willingness to prevent pregnancy) has absolutely no connection fitness of the parent - to suggest otherwise is ridiculous in the face of current child abuse statistics. Fertility in no way guarantees love or the ability to care for a child.

[Chief Pedant]

AGAIN, if that's the problem, then why does it to apply to sterilization of women and that alone ?
Your determination to see the issue in such stark terms takes a minor aspect of it (there is an element of clinical judgment that treats men and women differently) and over-simplifies it.

I am uninterested in talking you out of such a simplistic approach, but it's mostly wrong.

First of all, in the US physicians are compensated for doing procedures. If they are turning down procedures, it merits pointing out that they are costing themselves income by doing so. While that may not justify it, it should weigh into the equation of their motivation.

Second, I have seen no data suggestig that male physicians approach the decision differently from female ones. Until such data are presented, your assumption that the problem is "sexism"--whatever that means, seems a bit premature. I've been a physician for 25 years and human for a lot longer than that. Men and women are different. It's easy to holler sexism, but unless you can pull up a study showing post-vasectomy regret is also at least 20%, guess what?--the distinctive approach between men and women would appear justified. Just for grins, here's a nice post-vasectomy regret story for you: http://www.svmoms.com/2008/03/vasectomy-regre.html I might add that the mechanism of expressing regret--suck it up and move on; get weepy and let it turn into a Life Event--varies between sexes as well. The physician is the one left hold the bag, and Ob-Gyns take it on the chin more than Urologists, I suspect.

I confess some irritation at your oversimplification, but here's the main point: it just may be that physicians refusing to sterilize young nulliparous women are trying to make the best judgment they can, in the patient's interest. They may be wrong, and it may be frustrating to the patient, but to be so dismissive about their motivation and/or thought process reflects a shallow perspective devoid of any understanding of what it feels like to be on the physician's side of the equation.

Medical practice and judgment changes slowly. That doesn't mean there is some superficial reason for current practice.

[catsix]

Chief Pedant said:
I confess some irritation at your oversimplification, but here's the main point: it just may be that physicians refusing to sterilize young nulliparous women are trying to make the best judgment they can, in the patient's interest.

And that's the problem. It's not a doctor's place to make decisions about my future because they think they know better than me what is in my best interest.

It's their job to make sure that I understand the medical implications of what I have asked for, and that I've given consent for the procedure.

I used to have people who made decisions for me based on what they thought was in my best interest. Those people were called parents, and their job ended when I was 18.

They may be wrong, and it may be frustrating to the patient, but to be so dismissive about their motivation and/or thought process reflects a shallow perspective devoid of any understanding of what it feels like to be on the physician's side of the equation.

I'm pretty clear on their motiviation. That's what makes it all the more disgusting. If their motivation was actually based on some sort of medical fact, I'd be a lot more willing to accept it. The only thing worse than the fact that these doctors (and the female ones have been worse for me) think they have some parental right to decide what's best for me is that anyone thinks I should sympathize with them.

Where does anyone, doctor or not, get off telling me that I do not have the absolute right to self-determination when it comes to my reproductive system?

[Guinastasia]

It's even more apparent when those actual words come out of a doctor's mouth. As one told me that I should 'see a psychiatrist to learn to accept my natural role as a woman'.

Holy shit, I would have read that doctor the riot act.


And Kanicbird, Rune, what about people like me, who have medical reaons, perhaps, for wanting to be sterilized?* It might not be safe for them to bear children. In that case, what's wrong with having a tubal and then adopting? If I ever decide to have children, that would most likely be my option.





*BTW, this is totally hypothetical. I'm not currently seeking to be sterilized, I'm just saying if I ever get married and/or decide to have kids, this would be my only option. My only options would be to stop taking my meds and/or pass along birth defects to my child. Neither of which is an option I'm willing to take.

[ParentalAdvisory]

Where does anyone, doctor or not, get off telling me that I do not have the absolute right to self-determination when it comes to my reproductive system?

I call it The Bible.

[Der Trihs]

Second, I have seen no data suggestig that male physicians approach the decision differently from female ones. Until such data are presented, your assumption that the problem is "sexism"--whatever that means, seems a bit premature. What does that to do with anything ? Both genders have a long history of engaging in sexism against their own gender. That's one of the factors that makes it so persistent.

And have you actually been reading this thread ? Some of the women here have been insulted and patronized to their face on this.

I've been a physician for 25 years and human for a lot longer than that. Men and women are different. It's easy to holler sexism, but unless you can pull up a study showing post-vasectomy regret is also at least 20%, guess what?--the distinctive approach between men and women would appear justified. Oh, garbage. People regret things all the time. BOTH genders do. And that doesn't explain why they drag their feet even in cases of medical need.

I confess some irritation at your oversimplification, but here's the main point: it just may be that physicians refusing to sterilize young nulliparous women are trying to make the best judgment they can, in the patient's interest. They may be wrong, and it may be frustrating to the patient, but to be so dismissive about their motivation and/or thought process reflects a shallow perspective devoid of any understanding of what it feels like to be on the physician's side of the equation.No, it's that I simply don't care. And I don't sympathize with people who behave in such a manner. Nor do I see any reason to give them the benefit of the doubt, any more than I would people who, say, refused black people a medical procedure because "they might regret it later".

[Der Trihs]

Well, "lies of this world" obviously. Personally I think it’s great some people, many people, and especially people whom don’t want children, aren’t having them. It’s merely Darwinism in action. Their genes have shown themselves to be evolutionary defective and they are voluntarily removing themselves from the common future genepool. I expect, it will in some small way result in people in the future will love their children more. Or it means that humanity will continue to breed and breed and breed itself into overpopulation and collapse. And since when has a desire for children had anything to do with loving them, or even treating them well ?

[faithfool]

I call it The Bible.

Are you a doctor? If so, and that's what you are basing your decisions for women on regarding their reproductive health, than I suppose that's you're right. But if you're not, so? What's that got to do with it? Not everyone veiws the bible as their authority.

And I am beyond happy that I didn't have to go through this to have my hysterectomy at 40 and childless. I can't imagine what you all go through. I do believe I'd have gone ballistic. I'm also grateful for the men in this thread who support women who wish to remain childless. Thank you.

[even sven]

I agree there should be clear and reasonable criteria, just like there are for trans-gender surgeries.

But I'm not buying all of these arguments.

The first reason is that, as mentioned before, there many birth control options. It would be a rare woman who could not tolerate hormonal birth control AND all of the variety of barrier methods available. Any doctor is always going to push non-invasive and reversible options over major surgery no matter what the problem is. Only when it becomes clear that nothing else is going to work will they look towards such major procedures.

It's worth noting that for men there is only one birth control option, and it comes with some major drawbacks. A man who does not wish to have a child does not have the plethora of options that we have. I imagine if a woman's only other option had such problems we would see a lot more acceptance of surgical sterilization. And imagine if men had more options we wouldn't be as quick to cut.

Another is indeed social. I'm 27 years old and old enough to know myself pretty well. And if I want to go to a plastic surgeon and get a nose job there would be no problem. But if I wanted to get, say, an un-removable second nose installed on my face, the surgeon would probably not want to do it. That would have major repercussions in my life. Even if I had some really good reasons for wanting that. The fact remains that it would run a very good chance of keeping me from living "a normal life" and I would run a good chance of regretting it. The surgeon would no doubt want to steer me towards a removable prosthetic nose or something, even if that was less convenient for me. Nobody wants to do an unnecessary, irreversible life-altering procedure.

One reason why women who already have children have an easier time is that they are more likely to have made a decision with an established partner and will be less likely to face the changes of circumstances and heart that might lead to regret.

By no means do I believe "a woman's natural place is childbirth" and I'm not sure that I want to have children myself. But I think there are some very reasonable reasons to look at surgical sterilization as a last resort.

[Jillyvn]

Second, I have seen no data suggesting that male physicians approach the decision differently from female ones. Until such data are presented, your assumption that the problem is "sexism"--whatever that means, seems a bit premature.
In my opinion, you have grossly misunderstood the nature of sexism. Women, as much as men, are culpable of adhering to sexist attitudes, both being influenced by the society in which they are raised. Indeed, women physicians can be worse. Similar to what Catsix mentioned, the women in a support group I used to attend for endometriosis who were childless had the hardest time getting a hysterectomy from a female doctor. The consensus among them seemed to be that a woman with children has a harder time believing that another woman might not really want children. Anecdotally, one of these women told me that the female doctor tsk tsk'd her, and said “When I was your age, I didn't want children either, but trust me, you'll change your mind”. This woman was 30, so it's not as though she was some spring chicken.

Medical practice and judgment changes slowly. That doesn't mean there is some superficial reason for current practice.

I think the problem is that the reasoning is very much not superficial. It would be foolish to suggest that long held and deeply embedded societal norms are superficial. My argument is that they are wrong, and that we have progressed to the point where medical practice needs to change.

I have never wanted children. I've known this in the same way that I know I am straight for as long as I can remember. The idea of having a kid is so foreign and alien to me that I have a hard time even imagining it. Thanks to attitudes like yours, I have been faced with medical professionals who have been so cruel as to suggest that there is something fundamentally wrong with my brain, that I have a mental disease, or that I am a failure of a woman because I lack all desire to ever have a kid. Complete strangers feel free to comment on my lack of children as if my childlessness is some sort of tragedy, or to remind me that I better get cracking on popping out some sprog because I'll run out of time.

While you may not be able to imagine what it is like to be a woman who doesn't want kids, you should also recognize that those who are like me are unable to imagine what it is like to be a woman who does want them. I can no more picture myself as a mother than I can picture myself as a lesbian, or a black person, or a religious believer. It is not who I am.

I would like to second Catsix in her statement here. I turn 30 in June, and I have never desired a child. My mother remembers me, at age six, being incredibly disinterested in babies – something she thought odd at the time, since most girls she knew loved babies. She loves to tell this story about a friend bringing over their new bouncing baby boy, and me, at the ripe old age of six, walking into the room, wrinkling up my nose, saying “gross” and marching out. I did not babysit as a child. I started telling people I'd never have a baby when I was 12, and I haven't let up since. I have never changed a diaper. I have held a newborn/baby once, and did not get all weepy, emotional or suddenly decide that I wanted one. My friends, who do want children or have children, do this frequently. We'll be walking down the street and I'll hear a chorus of “awwwws” because some chubby cutie has done something particularly adorable that I've been utterly oblivious to. My SIL is pregnant right now, and I'm excited to have a nephew, but the entire pregnancy thing squicks me out.

Now, I don't hate kids. I don't particularly covet spending time with them, but I don't dislike them either. I quite like children old enough to read to, or read with, and at around age 12, they start to seem a little more interesting to me. I would not necessarily turn away from a prospective partner who had children. But, I emphatically do not want one of my own, and I know this in the same ways Catsix mentioned.

Another point I'd like to raise that is tangential to the above. Earlier, someone in the thread (and on preview, below) mentioned that the fact that there are other viable and non-invasive methods of birth control might be a reason for not allowing elective sterilization without considerable hurdle jumping. This, I think, is terribly short-sighted and does not at all consider the well-being of the patient long term. First, what are the long-term consequences of using hormonal birth control until menopause? Second, these are far from 100%, especially if you opt not to use hormonal methods and elect to use barrier methods. Third, constantly having to worry about birth control for the 30+ years of your sexually active life when there is a viable permanent solution just because you "might change your mind" down the road is a ridiculous solution. When I lost my virginity, I was paranoid and excessive about birth control. With every partner I have had since then, I have been incredibly vigilant. I think about birth control more than any of my friends do, because I do not have that thought that “if I get pregnant, it won't be ideal but it won't be that bad either.” For me, it would be devastating. While I am very much pro-choice, I am not certain I would have the strength to make the decision to terminate and I don't ever want to have to be in that position. I also don't think that relying on abortion as a backup to birth control when there is a far better solution remotely comes close to being a solution. So, in the long term, a sterilization procedure seems like a pretty minor way to fix this unyielding concern that my damn uterus might someday betray me (tongue in cheek of course, I don't actually fear my lady bits).

[Hostile Dialect]

This is a fascinating question for me, since I'm a childless male considering a vasectomy and I run into the "But what if you change your mind?" thing as well.

I don't doubt the figure, but how does one qualify this? Everyone has regrets. But since there is no real way to see if they really regret it enough to fix it, the question is not valid.

You raise an interesting point. We should also consider the fact that voluntary sterilization patients might not actually lead happier, more fulfilling, and/or all-around better lives with children later--and what of the hypothetical children, who might themselves not lead happy, productive, fulfilling lives? If we start playing guessing games and peering into our crystal ball, we should be willing to drop the other shoe. When we realize that it doesn't sound much better when it hits the ground, we can go back to trusting a generally sane, rational adult to make his/her own healthcare decisions.

In fact, I would go a step further and say that, from a public health perspective, it's morally questionable to deny sterilization to any sane/rational adult who wants it. With a top-heavy distribution of wealth and a world food and water crisis, we should be more than willing to allow adults the choice not to participate in the problem.

We don't judge any other surgery based on whether the doctor thinks the patient will later regret it. That insulting and paternalistic bullshit is reserved solely for women who want control over their reproductive future.

That raises another question: Do childless men (especially young ones) have problems getting a vasectomy? Society in general certainly hammers home the idea that we'll regret it later and want kids, but I have no idea whether doctors do. (I know I said that I'm considering the procedure, but I'm waiting a few years because my interest has been fairly recent.)

I even had one lovely doctor ask me to consider what this will do when I "settle down" with a nice man and he decides he wants to have kids.

:eek:

The only way I can see this as even remotely acceptable in a professional environment is if the doctor meant "meet a nice man who wants kids, who you love so much that you would consider revisiting the question because he really, really wants kids and you can't see yourself being with anyone else". Even then, though, how is that a surgeon's business?

Hell, there is a protocol for a person in their early twenties to get a sex change

Early 20s? You can do it before you're in high school, if you and your family are really, really, really sure. Isn't sterilization assumed as a side effect of most sex change procedures?

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

Thanks for shitting in the thread. Please wipe before you leave, especially if you intend to let the door hit you on the ass.

[Jillyvn]

That raises another question: Do childless men (especially young ones) have problems getting a vasectomy? Society in general certainly hammers home the idea that we'll regret it later and want kids, but I have no idea whether doctors do. (I know I said that I'm considering the procedure, but I'm waiting a few years because my interest has been fairly recent.)
Depends on how young is young. When I spoke with the folks at Planned Parenthood in Canada, the list they gave me included doctors willing to perform vasectomies, and I asked them if it was difficult for men to get the procedure done. They indicated that, for young men, multiple visits may be necessary but not always. I'd suggest planting the seed now – so to speak. I would tell your doctor that you're thinking about it, but want to give it a few years to be sure, that way it won't come “out of the blue”.


The only way I can see this as even remotely acceptable in a professional environment is if the doctor meant "meet a nice man who wants kids, who you love so much that you would consider revisiting the question because he really, really wants kids and you can't see yourself being with anyone else". Even then, though, how is that a surgeon's business?
I think this was the intent, sort of. He didn't seem to budge when I explained that any man I wind up with learns very early on that I'm not the childbearing kind. It's one of the critical “getting to know you” pieces I insert very early into dialogue in a new relationship, so the man I fall in love with would surely support this fundamental lifestyle choice that I have made, or it wouldn't be fair to either of us. It would be highly unfair of me to about face on such a fundamental decision, and it would be just as unfair of my partner to expect it of me. The doctor didn't buy this though. I think he was a really nice man who seriously believed I hadn't found my soul mate yet.

[I Love Me, Vol. I]

Would you have elected to be sterilized at 22? I would have, and eight years later, I can tell you my decision remains the same. And even if your decision eight years later would not have been the same, you still should have been able to be sterilized at 22 without any trouble.

[matt_mcl]

Living in Canada throws another wrench into the issue for women here. I'm given to understand that, in the US, patients have choice of doctor. Here, once you get referred to a specialist, and wait the requisite period of time to get in, the chances of changing to another specialist are very slim. For reasons that are TMI, I wanted to change gynes once. I was basically told by my family doctor to be very subtle about it because I did not want to get a repuatation as a "high maintenance" patient, but that he would help me out b/c the particular gyne I wanted to switch from had a bad rep.

So, unless things are radically different in other parts of Canada, women here don't have the option of asking "well, who will?"

Who in the world are you dealing with, and what exactly were you told?

You have the absolute right to change physicians, specialists included, and the only limiting factors are practical ones: the number of specialists in that field in your area and their waiting lists. If physicians are being unprofessional to you because you want to change physicians, that's exactly what they're doing: being unprofessional. Unless I'm very much mistaken, this has nothing to do with health policy in Canada or B.C.

[Jillyvn]

I suspect it's not a policy issue but more indicative of a small town community, where specialists are few and far between and wait lists are long. I've never "chosen" my doctor - I've always just wound up with the specialist they assigned me to. For the most part, it works, except for this one fellow. I did switch with relatively little inconvenience, except for the talk from the doctor who suggested it was uncommon. Perhaps it is a rural/small town versus urban divide here?

[matt_mcl]

I suspect it's not a policy issue but more indicative of a small town community, where specialists are few and far between and wait lists are long. I've never "chosen" my doctor - I've always just wound up with the specialist they assigned me to. For the most part, it works, except for this one fellow. I did switch with relatively little inconvenience, except for the talk from the doctor who suggested it was uncommon. Perhaps it is a rural/small town versus urban divide here?

That makes sense, since there is likely to simply be a very small number of specialists practising any given specialty in a small town. So less a matter of lacking freedom of choice than having a limited pool of choices. Admittedly the result is the same, but I do have to spend time convincing people that no, we aren't assigned a doctor by the government, and yes, if you think your doctor is a cock, you can tell him/her to take a hike.

[Jillyvn]

I agree with what you've said. I didn't think of my statement in the larger context of the common misunderstandings of our universal healthcare . In retrospect, I should have framed my anecdote a little more clearly.

[Rune]

Ever ask a gay person if they might be straight later on in life? Ever ask a straight person if they might be gay later on in life?Why? That’s not rude. Not that it has much relevance to not wanting children. Do very many gay or lesbians regularly change they mind later on in life and become hetros? No, probably not. A large number of people who don’t want children do change their mind though.

Or it means that humanity will continue to breed and breed and breed itself into overpopulation and collapse.Perhaps. Although I guess for those not having and not wanting children, it doesn’t matter much either way.

And since when has a desire for children had anything to do with loving them, or even treating them well ?I assume, that on average people who don’t want to be parents are less loving parents than people who have the children they wish.

[Essured]

I researched this fairly thoroughly approximately 7 years ago and thought I'd dig up the info again, in response to some of the posts regarding the issue of regret. There isn't a lot of firm data out there, however I was able to find these interesting and relevant articles:

The study found the proportion of women who experience regret was essentially the same — about 6 to 7 percent — five years after their husbands' vasectomy or their own tubal sterilization. The study also found that substantial conflict between a woman and her husband increases the risk of regret after either vasectomy or tubal sterilization.
http://www.nih.gov/news/pr/jun2002/nichd-17.htm

Parity, once considered important in determining eligibility for sterilization, does not correlate with sterilization regret and is not a reason to deny the procedure
The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child. Regret also has been shown to correlate with external pressure by the clinician, spouse, relatives, or others. Interestingly, marital status at the time of the operation, level of education, and the absence of children do not, in many studies, correlate with regret.
Regret is difficult to measure because it encompasses a complex spectrum of feelings that can change over time. This helps to explain that while some studies have shown "regret" on the part of 26 percent of women, fewer than 20 percent seek reversal and fewer than 10 percent actually undergo the reversal procedure

http://www.aafp.org/afp/20030315/1287.html

...the cumulative probability of regret <snip> was lowest among women with no previous births (6.3%, 95% CI, 3.1-9.4).


Only one group stood out: Women who were under 30 when they'd had their tubes tied were more likely to be sorry; some 20 percent expressed regret, compared to a mere six percent of those over 30. The researchers speculate that the younger women may have remarried when they were still of childbearing age and regretted that they couldn't have children with their new husbands; indeed, a number asked the interviewers about sterilization-reversal procedures.

And the group least likely to have second thoughts? Those who'd never had children. Whatever reasons had influenced them to choose childlessness in the first place seem still to hold true for them, observes lead author Susan D. Hillis, Ph.D., of the Centers for Disease Control and Prevention.
(bolding mine) http://www.goodhousekeeping.com/health/womens/sterilization-tubal-ligation-nov01

Regret was low (5-6%) among childless women, regardless of their age at sterilization

I had the Essure (http://www.essure.com) procedure done 6 years ago, when I was 24 and childless. I consider it the best thing I have ever done.

To those who say "I didn't want children when I was younger either, but now...". I've wanted to be sterile since I knew it was possible. I researched it fairly thoroughly over a period of two years (with gaps, to give myself some mental space from it too). If you never thought about being sterilised, let alone seriously researched it and did extended soul-searching, perhaps you might consider that your "I didn't want children" was of a different quality or intensity than the "I don't want children" that some of us are thinking and feeling?

[Nava]

If lawsuits was the problem, why would someone in a country where suits for medical malpractice are rare (Spain, and the year was 1993 when she finally got the procedure) also refuse to do it?

The patient in question was 40yo when she finally got her tubes tied; she had two children from a marriage whose only two positives were those two children; she became an alcoholic after the divorce. Her second husband (married in 1996) is so anti-children that he's never wanted to be any kind of responsibility figure to his wife's children.

Other anti-baby methods aren't 100% effective and have side effects which in some cases can be extremely nasty. Many women in my mother's side of the family have had serious problems with hormonal medications; Mom got hospitalized for several days as a result of her bad reaction to HRT.


Rune, one of the biggest surprises of parenthood is that you never have the children you wish. You may have the amount you wished, but they're never the way the parents wanted.

[ParentalAdvisory]

Are you a doctor? If so, and that's what you are basing your decisions for women on regarding their reproductive health, than I suppose that's you're right. But if you're not, so? What's that got to do with it? Not everyone veiws the bible as their authority.

I didn't say I agreed with it. I was just pointing out to Catsix that The Bible is one in which it would disapprove of having "the absolute right to self-determination".

[Ají de Gallina]

I have addressed this issue with my doctors and can speak to it from a personal standpoint.

I have wanted to be sterilized since I was about 19. At that age, I knew it was impractical, and I held off doing anything about it since I knew I would be laughed out of the office. My reasons, however, may somewhat complicate the debate since they are medical in nature - I would like to have a hysterectomy to help deal with my endometriosis.

When I was 22, and the pain was so intense I could barely function, I asked about a hysterectomy. I was told that I would need to have a child before they would consider it. I explained that I do not ever intend to have child, which was greeted with much scepticism. I was repeadetly told that I would change my mind when I "settled down". When I was 24, I asked again, and was given the same reason. At 27, I was told they would consider it if I was firmly committed to being childless after 30. All this when I had a sound medical reason for wanting the hysterectomy. I can't imagine what women go through trying to get their tubes tied at a younger age without children.

I wonder if the doctors refuse to do this is based on the numbers of women who later "regret" their decision. I'm not sure of the stats on this. I would be curious to know if a woman can sue a doctor for malpractice for performing a sterilzation at a young age and if this is a factor in the doctor's decision making process?

I fully agree with the OP, and I think this is firmly a women's rights issues. No one but me should be entitled to decide if I have children, and if I make the choice to deal with it permanently before becoming pregnant so much the better. Complications may arise if there are mental health issues, or rash decisions due to sudden life changing events... but on the whole, this one is clear cut for me.

1) I'm not particularly crazy about (mostly) irriversible for birth control, however you should be able to have one if you should want it. But you have a medical condition that seems to justify it.
2) I understand that doctors may think you'd regret it, but if you're 30 and still the "I-wanna-have-kids" gene hasn't kicked in it won't.
3) There are too many 40 year-old women who pay money to have kids after a life of not wanting them, so maybe the doc's trying toavoid litigation 10 years down the road.

Having said all of this, a well-written consent form should ease any legal fears.

[KarlGrenze]

The key factor there is that she had children.

Entirely because they had already fulfilled their womanly duty -- they already had kids.


I was not addressing your part, I was addressing Lamia's and other's posts about the procedures being denied to people who already had kids (even apparent medically indicated histerectomy). I was suggesting if that was something that varied by culture, since in some places, female sterilization is more common and apparently less denied and less of a hassle to get than in others.

[Chief Pedant]

There are several issues being conflated here.

The first: Should an adult woman have absolute authority to decide she wants to be permanently sterilized? That answer is easy: yes, she should.

The second: Should a physician be required to perform a procedure she/he does not think is in that patient's best interest? That answer is easy: no, she/he shouldn't.

The third: Should it be easy for a patient to get a procedure done if that procedure is medically available in general? That answer is easy, too: yes, it should be easy, and the fact that it is not is frustrating, I agree.

I think sterilization should be readily available to all, with a simple process that defines the patient as the one held responsible for the decision and a straightforward consent process that eliminates any physician-side culpability for the physiciand (and I don't have the sense that litigation is the big concern, anyway).

I understand the annoyance of those of you who don't think the physician should be making decisions for the patient. When it comes to procedures, though, it is different (like it or not ) and the physician's judgment is usually based on quite a broad experience with patients that tends to reinforce that judgment. So it is perfectly fair to say that you as an individual, rational woman are suffering from being lumped into your larger cohort.

Consider a (very limited) analogy: Your adult friend or perhaps your adult child may want you to do something for them. You think it over and you decide you are not going to do it because you unilaterally think it is unwise for them to do so. Your experience has been that too many people undertaking that particular decision have regretted it. Your advice to them is to partner with someone else. You may be wrong but that doesn't mean your motivation is suspect.

[catsix]

even sven said:
The first reason is that, as mentioned before, there many birth control options. It would be a rare woman who could not tolerate hormonal birth control AND all of the variety of barrier methods available. Any doctor is always going to push non-invasive and reversible options over major surgery no matter what the problem is. Only when it becomes clear that nothing else is going to work will they look towards such major procedures.

In the long run it's less expensive for someone who never wants kids to pay 2500$ for Essure at 25 and not by 30 years worth of birth control pills at 30$ a month. At 34$ a month (which is what I pay), birth control pills from age 25 to 55, if the price never changes, is 12,240$. More than twice as expensive.

The fact remains that it would run a very good chance of keeping me from living "a normal life" and I would run a good chance of regretting it.

The job of protecting a person from doing something they will regret is supposed to be performed by that person's parents, and it's not supposed to continue once that person is an adult.

One reason why women who already have children have an easier time is that they are more likely to have made a decision with an established partner and will be less likely to face the changes of circumstances and heart that might lead to regret.

You do realize this sounds exactly like 'You don't know what you want until you are with a man who can help you figure it out.'

Nine years ago I was in a relationship with a man and the topic of marriage and kids came up. He wanted kids. I broke up with him so that he could have them. This decision that I made was not whether or not I want children, it was how to go about ensuring that my unwanting of children was best acheived.

It does not, in any way, depend upon what any man wants. It is, in fact, the first and most immediate deal breaker.

Hostile Dialect said:
The only way I can see this as even remotely acceptable in a professional environment is if the doctor meant "meet a nice man who wants kids, who you love so much that you would consider revisiting the question because he really, really wants kids and you can't see yourself being with anyone else". Even then, though, how is that a surgeon's business?

I was once in that situation, the 'nice man who wants kids'. I never seriously considered having them. It was more of a case where I knew what I had to do, and I ended the relationship.

Parental Advisory said:
I didn't say I agreed with it. I was just pointing out to Catsix that The Bible is one in which it would disapprove of having "the absolute right to self-determination".

If my doctor brings up the bible at all they're fired.

[WhyNot]

Essured, thank you for bringing some actual numbers (and context for the 20% number) to the thread. I was about ready to scream with all the assumptions without cites going on!

So, Chief Pedant, assuming that the 5-6% regret number (which unfortunately still doesn't differentiate between, "Oh, well, I suppose maybe kids wouldn't have been so bad..." and "OMG! Essure RUined my LIFE, WTF was I THINKing?!"), do you think doctors are correct in withholding these procedures as the general rule?

How does the 5-6% regret number compare to the percent of people who regret having children, I wonder? Do infertility specialists have any sort of process for determining whether or not the people seeking their procedures are unlikely to regret their decision to have children?

Fact is, you're going to regret some things in life. Some of the things you do in life that you regret are going to be aided and abetted by other people. I still haven't heard a good reason to not at the very least establish a screening process to help separate the catsixes from the whimsical.

And please remember that we're not all calling for legislative action forcing compliance here. I for one would be delighted if the aforementioned Boards simply made a recommendation of specific counseling and/or rubric for appropriateness of the treatment other than Woman => Protect Fertility At All Costs. That's the sexist part - assuming that all young women who say they don't will eventually change their minds and want to bear babies (not be parents, but bear babies) when the statistics seem to show that only 5-6% of them do.

Remember when they used to do the same for men with prostate cancer? When they'd do everything they could to remove only part of the prostate, so that his potential fertility would go on, even if it meant that they missed part of the cancer and he died as a result? Yeah, they don't do that anymore. They don't value his ability to be a biological parent over his health. Why are they still doing it to women? (And yes, I realize that oncologists are not obstetricians, and "they" is a category broad enough to warrant a tinfoil hat here, but surely the change in one field means that change in another is not impossible or impractical.)

[catsix]

WhyNot said:
So, Chief Pedant, assuming that the 5-6% regret number (which unfortunately still doesn't differentiate between, "Oh, well, I suppose maybe kids wouldn't have been so bad..." and "OMG! Essure RUined my LIFE, WTF was I THINKing?!"), do you think doctors are correct in withholding these procedures as the general rule?

If there is a general rule to be made based upon statistics it would stand to reason that we base it upon the 94-95% who do not regret a decision they made as an adult of sound mind. And by 'decision', I hope that all the others in this thread understand that my decision was never whether or not I wanted kids, it was how to go about ensuring that I don't have any.

Fact is, you're going to regret some things in life. Some of the things you do in life that you regret are going to be aided and abetted by other people. I still haven't heard a good reason to not at the very least establish a screening process to help separate the catsixes from the whimsical.

I would think that there is a process somewhat better than 'Come back when you are 35 or 40, married, and have two kids.' I can understand 'Go home and think about this for 6 months, and if you are still sure, we will do the procedure.'

It's not a whim for me. Whims don't last through twelve years of active searching for a doctor to perform the procedure.

You're right, somehow the board that oversees gynecologists and obestetricians should be able to come up with a process that they can use to determine that is not some spur of the moment decision I made while drunk and/or high. (Which is exactly how some people become parents.) I think though, whoever said that the fact that these are obstetricians who do these procedures hsa bearing on their willingness to do it was right.

They make a lot more coin off me if I pop out some kids than they do if I get fixed. Also, I can't imagine they went into obstetrics because they dislike babies, so there is a lot of baggage there. They focus so hard on helping people to reproduce that they are unable to wrap their heads around the idea that fertility is something some of us see as a big problem.

[Steve MB]

I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

If someone contemplating this decision wants your opinion, they'll read it in your entrails.

[maggenpye]

If someone contemplating this decision wants your opinion, they'll read it in your entrails.

Stands, claps, cheers.

It's my mother who had the hysterectomy refused when it was medically indicated.

To be clear, she was also refused a tubal ligation (because she might need to 'replace' either existing child) even though the same GYN told her she should not have more children as my birth had been so difficult.

It was based on the fact that she was young (21) and 'only had two' children.

I asked about sterilization in my early 20's and was told to wait until I was over 30. At 30 I was told to wait until I was 35. At 35 I'd had an unplanned child - none of the doctors have taken any responsibility for her upkeep.

If I'd tried harder I might have found a doctor willing to do the procedure, I know of women in their mid-late 20's who've managed - they were all put through the ringer and told all the same crap that's gone on here. You'd better believe they don't regret their decision after having been through so much psychological abuse by the people who've take an oath to 'do no harm'.

While I love my kid unreservedly, acceptance is not the same as choice. Had I not had my child, my life would have been different, there would be drawbacks (and regrets) and advantages to either situation.

I fully support anyone's right to decide on their own fertility.

[Chief Pedant]

Essured, thank you for bringing some actual numbers (and context for the 20% number) to the thread. I was about ready to scream with all the assumptions without cites going on!

So, Chief Pedant, assuming that the 5-6% regret number (which unfortunately still doesn't differentiate between, "Oh, well, I suppose maybe kids wouldn't have been so bad..." and "OMG! Essure RUined my LIFE, WTF was I THINKing?!"), do you think doctors are correct in withholding these procedures as the general rule?

How does the 5-6% regret number compare to the percent of people who regret having children, I wonder? Do infertility specialists have any sort of process for determining whether or not the people seeking their procedures are unlikely to regret their decision to have children?

Fact is, you're going to regret some things in life. Some of the things you do in life that you regret are going to be aided and abetted by other people. I still haven't heard a good reason to not at the very least establish a screening process to help separate the catsixes from the whimsical.

And please remember that we're not all calling for legislative action forcing compliance here. I for one would be delighted if the aforementioned Boards simply made a recommendation of specific counseling and/or rubric for appropriateness of the treatment other than Woman => Protect Fertility At All Costs. That's the sexist part - assuming that all young women who say they don't will eventually change their minds and want to bear babies (not be parents, but bear babies) when the statistics seem to show that only 5-6% of them do.

Remember when they used to do the same for men with prostate cancer? When they'd do everything they could to remove only part of the prostate, so that his potential fertility would go on, even if it meant that they missed part of the cancer and he died as a result? Yeah, they don't do that anymore. They don't value his ability to be a biological parent over his health. Why are they still doing it to women? (And yes, I realize that oncologists are not obstetricians, and "they" is a category broad enough to warrant a tinfoil hat here, but surely the change in one field means that change in another is not impossible or impractical.)

I am not an Ob-Gyn myself, but if I were my personal position would be to sterilize everyone who asks that it be done, assuming there was no strong evidence they weren't a nutcase. I come down overwhelmingly on the side which says the patient should decide, and I don't really personally care if they regret it or not. My personal opinion would not be different if the number was 50%, I don't think, as long as the patient was given the information about the high incidence of regret.

I think, as I said in earlier posts, that the principal reason so many Ob-Gyns are reluctant is as much tradition as anything else, along with the various other reasons advanced. In my opinion they are generally well-meaning but wrong. Wrong in their perception of how common regret is, and wrong in the tradition of trying to make the decision for the patient.

[WhyNot]

I am not an Ob-Gyn myself, but if I were my personal position would be to sterilize everyone who asks that it be done, assuming there was no strong evidence they weren't a nutcase. I come down overwhelmingly on the side which says the patient should decide, and I don't really personally care if they regret it or not. My personal opinion would not be different if the number was 50%, I don't think, as long as the patient was given the information about the high incidence of regret.

I think, as I said in earlier posts, that the principal reason so many Ob-Gyns are reluctant is as much tradition as anything else, along with the various other reasons advanced. In my opinion they are generally well-meaning but wrong. Wrong in their perception of how common regret is, and wrong in the tradition of trying to make the decision for the patient.
Thank you for your answer.

[even sven]

So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

You do realize this sounds exactly like 'You don't know what you want until you are with a man who can help you figure it out.'

No. It works both ways. Indeed I imagine it is far more common for "committed childfree' men to change their mind based on new relationships. In committed relationships priorities change and you start taking your partner's desires into consideration and making decisions together. Since the majority of people do want children, to have preemptively and unilaterally made this decision could cause problems.

Again, I think this procedure should be available and there should be a clear and reasonable set of guidelines for when it is offered. But I think there are some good reasons why other options should be thoroughly explored first, just like they are for any other surgery that has major lifestyle implications (sex changes, weight loss surgery, etc.)

[Blalron]

So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

Why not? They can give birth to an irreversable child based on nothing more than "I just felt like having a kid."

[maggenpye]

Or they could have an irreversible child based on being on antibiotics, getting drunk, being lied to about their partner's fertility, rape, forgetting the pill, condom failure etc etc.

If someone feels strongly enough to get sterilised, why can't their partner take that desire (not to have children) into account? Because it's more common? So? Globally it's more common to raise children in abject poverty, but I've still cooked dinner for my well dressed and (relatively) affluent child.

What basis (apart from 'I imagine") are you using for the probability of men changing their mind about wanting kids more than women?

[Essured]

In committed relationships priorities change and you start taking your partner's desires into consideration and making decisions together. Since the majority of people do want children, to have preemptively and unilaterally made this decision could cause problems.


I agree that the other partner's desires are taken into consideration in a good relationship, but everyone has deal breakers. Some things are up for negotiation and some things just aren't. This usually isn't a mere preference, where the 'right guy' might make me rethink it.* This is a serious non-negotiable issue, where he just isn't the right guy if he isn't ok with the fact that I'm sterilised.

*Hypothetically. I'm actually married. But it's the same thing. If it was an issue, the marriage would've ended (after he tried counseling) - the sterilisation would still have gone ahead.

Again, I think this procedure should be available and there should be a clear and reasonable set of guidelines for when it is offered.
I'm not sure what you mean by a "set of guidelines for when it is offered". What guidelines are you thinking of? Sterilisation isn't "offered" to young women. And definitely not "offered" to young childless women. It's not something that is being pushed onto people and we need to be concerned about restricting how it is "offered" to them - it's something that a small minority of people are actively seeking and being continually denied.* Mainly through misconceptions and prejudice (in my opinion).

*In general - I got mine done quite easily.

But I think there are some good reasons why other options should be thoroughly explored first, just like they are for any other surgery that has major lifestyle implications
Sure. And once the other options have been tried, or discounted as unsuitable for various reasons, then what? Well, then we're right where we are now. Unless you think people who are trying to get sterilised aren't already aware of the most common and effective methods available - they've just one day decided to get sterilised?

[Nava]

In committed relationships priorities change and you start taking your partner's desires into consideration and making decisions together. Since the majority of people do want children, to have preemptively and unilaterally made this decision could cause problems.

I won't ask any SO of mine to share or practice my religion. But I demand that he respect it.

I won't ask any SO of mine to share my dietary restrictions and will respect his, whether they are for medical reasons or a matter of taste. "My milk and your milk" isn't a problem. But if he ever makes a derogatory remark about lactose-free milk, he's out the door so fast there will be a sonic boom.

I've never filtered my SOs by income or training. But anybody who started making plans for "when I am rich and you can stop working and raise our kids" never got another date with this engineer (nobody gets through engineering school because of "not knowing what else to do with her time").

Why would "one absolutely requires bio-kids and the other absolutely doesn't want them" be a situation where the second one must bend over? It seems like breaking up is very much the most sensible solution.

[Jillyvn]

So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

I can see valid medical reasons for not immediately agreeing to sterilize a person without first knowing their full medical history and assessing their competance to make such a decision. So, my answer to this would be that it depends on the 18 year old. Two hypotheticals... Woman A has a long history with her doctor, is now the age of majority, and has decided to be sterilized due to a serious genetic illness that runs in her family. She should be given this option with little barrier. Woman B has no relationship with the doctor, seems to be mentally distraught and is making the decision after a traumatic personal event. In this case, I would suggest a doctor using his/her discretion to suggest postponing the surgery would be a valid medical assessment. I would not argue that doctors have their medical discretion completely removed. However, at a certain point – like in Catsix's case – it does get a little ridiculous. This, I think, is where the line between medical discretion and unsupported biases and misunderstanding about women is crossed. Why can't we have a clear assessment criteria that doctors are trained to follow? And, this criteria should not be “come and see me when you've got two kids or hit 35”.

No. It works both ways. Indeed I imagine it is far more common for "committed childfree' men to change their mind based on new relationships. In committed relationships priorities change and you start taking your partner's desires into consideration and making decisions together. Since the majority of people do want children, to have preemptively and unilaterally made this decision could cause problems.

I would never, ever be in a serious long term relationship with someone without them knowing from the onset that I do not want to bear a child. My decision to not bear a child is no more preemptive and unilateral than people who decide they want to have kids and make this a priority in selecting a partner. Would you expect someone to not have a child they have always wanted just because their partner doesn't want one? I wouldn't, just as I would expect my partner to not force my hand into bearing a child just to make them happy. I have vetted, and will continue to vet, my partners on how seriously committed they are to biologically reproducing. My decision is very much a fundamental aspect of who I am, and to admit anything other than this would be deceptive and downright manipulative.

[even sven]

Why would "one absolutely requires bio-kids and the other absolutely doesn't want them" be a situation where the second one must bend over?

It totally doesn't. But it's nice to have the option to work it out and choose together. People do some extreme stuff for love. Sure, maybe you won't. But people do. People move to new countries for love. They change religions. I've seen straight guys go gay and gay goes go straight because they fell in love. Who knows what crazy stuff lies in your future? If there are options that aren't cutting out possibilities, isn't that a better plan? We already lose so many options and futures every day that passes. It just doesn't make sense to me to further limit your options in life except under the most dire of circumstances.

Anyway, I gotta bow out on this. I'm said my piece and I gotta admit that I don't really have strong feelings either way. I'm very child-agnostic and can't picture abhorring the idea of having kids any more than I can picture seeking it out. My position is not that the current situation is reasonable, just that I can kind of see the rational behind it and I think we need to come up with a better model based on equivalent procedures. I really don't think that is all that different than what you all are arguing.

[catsix]

even sven said:
So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

That is generally the driving reason behind irreversible sterilization.

No. It works both ways. Indeed I imagine it is far more common for "committed childfree' men to change their mind based on new relationships. In committed relationships priorities change and you start taking your partner's desires into consideration and making decisions together. Since the majority of people do want children, to have preemptively and unilaterally made this decision could cause problems.


You seem to misunderstand the choice I made. I never decided that I don't want children. I have always known this in the way that I have always known I am straight, and an atheist. I could no more have a relationship with a man who wants kids and is unwilling to bend on that issue than I can with a woman or a religious fundamentalist. What you imagine aside, kids are not something anyone should have because of a compromise.

But I think there are some good reasons why other options should be thoroughly explored first, just like they are for any other surgery that has major lifestyle implications (sex changes, weight loss surgery, etc.)

So then as long as the hypothetical 18 year-old woman remains childfree for a year and still expresses a desire to remain so for the rest of her life, she goes under the knife?

Essured said:
I agree that the other partner's desires are taken into consideration in a good relationship, but everyone has deal breakers. Some things are up for negotiation and some things just aren't.

And that's why I've brought it up early in every relationship. Once, I didn't, and there was considerable pain in ending that one. After that, my childfree stance was front and center. I'd make it clear that if the guy wants kids, or even wants the possibility of kids, he should find someone else.

even sven said:
It totally doesn't. But it's nice to have the option to work it out and choose together.

Choose together? This is not something that is an option for me. It's no more an option than being straight or an atheist. Nice to have the option? There is nothing nice about the fact that I have spent my entire sexually active life dreading an accidental pregnancy and having an emergency plan in place to get to a doctor for an abortion.

We already lose so many options and futures every day that passes. It just doesn't make sense to me to further limit your options in life except under the most dire of circumstances.

The fundamental disconnect here is that kids/no kids were not two options that I chose from. My entire life I have always just known that I did not want anything to do with having any kids. I just know this.

[jsgoddess]

So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

On the contrary, I believe someone should be given irreversible sterilization at the age of 18 based on nothing less than "I don't want kids."

[cruel butterfly]

Except that hormonal birth control has significant side effects for many women--and yes, you can always try a wide variety of types and find an option that works better for you, but that can literally take years -- that's years of significant weight gain and a cratered libido, and there's no promise that you will actually find anything that works in the end. If a woman is positive she won't ever want to have kids, why should she have to go through all that?

Here's a different take:

I've had kids...two, to be exact. My pregnancies were welcome reprieves from what have always been horribly painful, highly irregular mentrual cycles which have wreaked havoc on me physically and mentally since I was a teenager. It's actually amazing that I even got pregnant in the first place. I might start my period in 15 minutes. I might start next week. I might not have one for six months.

I am one of those women whose physiology reacts badly to hormonal birth control. I've tried probably 6 types of oral contraception, each of varying degrees of hormone levels and types, and the patch. They all make me sick. Like throwing up sick.

I asked my OB/GYN about the possibility of having my uterus removed (leave the ovaries, please). He may as well have patted me on my little head and told me to get back to my embroidery for all the help and compassion he offered.

He did say that he could tie my tubes, then lightly chuckled when I pointed out that tying my tubes would have zero effect on my mentstrual cycle.

[curlcoat]

The second: Should a physician be required to perform a procedure she/he does not think is in that patient's best interest? That answer is easy: no, she/he shouldn't.

If, in the case of Canada and I believe the UK, the woman doesn't have the ability to doctor shop, the doctor should not have this choice. It is none of his business if sterilization is in the woman's best interest because it isn't a medical choice (most of the time). When it isn't a medical choice, no doctor has any idea if the surgery is or is not in the patient's best interest. Despite what they tend to think, doctors are not God.

The third: Should it be easy for a patient to get a procedure done if that procedure is medically available in general? That answer is easy, too: yes, it should be easy, and the fact that it is not is frustrating, I agree.

No, not just frustrating, it is also dangerous. I was on the Pill for 16 straight years, back in the day when there was only one strength (strong) because I wasn't able to tolerate any other sort of birth control that was likely to work. 16 straight years of high dose hormones messed up many things in my body with others possible to come and all because I didn't "know my own mind" and "would regret it". Sorry folks, I hate children and the younger they are the less I am able to tolerate them. Do ya think I'd ever change my mind? And what finally got me my tubal at 33 was going completely bonkers insane in the doctors office (another thing 16 years of hormones will do to you) and committing violence on his person, then - er - asking him if he thought I'd be a fit mother. None of that should have had to happen.

I understand the annoyance of those of you who don't think the physician should be making decisions for the patient. When it comes to procedures, though, it is different (like it or not ) and the physician's judgment is usually based on quite a broad experience with patients that tends to reinforce that judgment. So it is perfectly fair to say that you as an individual, rational woman are suffering from being lumped into your larger cohort.

I seriously doubt this is true (and it certainly isn't any definition of fair). Women who are 14 can ruin their lives by having and keeping a baby, but physicians seem to have no trouble with it. The fact is that women are expected to adore babies of all shapes and sizes, and this is reinforced every day of a woman's life. Women who do not leap up from their desks to coo at a baby brought into the office, or who do not melt at their pictures or sonograms are at best ignored and at worst shunned. Day time ads aimed at women always have a child(ren) in them, usually a baby, no matter what is being advertised. So, doctors who get a woman in who wants a tubal and has never had a child are assumed to be temporarily insane and all they need is "the right man".

Consider a (very limited) analogy: Your adult friend or perhaps your adult child may want you to do something for them. You think it over and you decide you are not going to do it because you unilaterally think it is unwise for them to do so. Your experience has been that too many people undertaking that particular decision have regretted it. Your advice to them is to partner with someone else. You may be wrong but that doesn't mean your motivation is suspect.

Why not? Folks try to make decisions for others all the time for all the wrong reasons. Look at those that are trying to force me to say Merry Christmas for example. If this is something only you can do for your friend or child and they really want it, why are you forcing your opinion on them? Why should any adult assume they know better than any other adult?

[curlcoat]

Originally Posted by kanicbird
I think women who have this done early in life have a very good chance to greatly regret it. I feel that women are naturally 'wired' to desire to have children, it is only the lies of this world that has many convinced they can really be happy without them.

The lies of the old world - that the only way to happiness for me was a husband, 2.5 kids and a white picket fence - did not convince me that was true for me. I grew up in a world and a family that expected that all women would have children as soon as they got married, which was preferably young. The belief that only abnormal women would refuse to do this was so strong that I no longer speak to my family. I was in no way "wired" to desire children in any form, despite the time frame that I grew up in. The "lies" you speak of these days are simply the realities being openly spoken of - women do not have to be slaves to ancient expectations.

[Essured]

So you believe someone should be offered irreversible sterilization at the age of 18, based on nothing more than "I don't want kids"?

On the contrary, I believe someone should be given irreversible sterilization at the age of 18 based on nothing less than "I don't want kids."

Beautifully put, jsgoddess.

I know evensven has posted that she's left the thread, but for the others who feel similarly - on what basis do you think people should be able to be sterilised? I'm not talking about forcing doctors to do the surgery, I'm talking about what guidelines do you think our doctors should be using (guidelines, not rules - they aren't going to be forced)? What do you think should be considered 'best practice'? What are your concerns about sterilisation being freely available and accessible? I've already posted regret statistic, so I could understand if people thought that a scenario of a shaky marriage, under 30 and one child showed statistically enough increased risk to warrant a 6 month waiting period. Or am I off the mark here and there are other concerns I'm not addressing?

IMO, being legally an adult, and informed about the procedure and its permanent nature pretty much covers it for me.

[lavenderviolet]

When this topic comes up, people often act as if doctors all share a brain. There are some docs out there who won't sterilize anyone who is under 30, but there are definitely doctors out there who will sterilize young people with no kids (here's an example of a list compiling such docs: http://community.livejournal.com/cf_resources/ - a small list due to its obscurity, but just showing that these docs do exist if one wants to find them). If you really are serious about getting sterilized, making an effort to seek out a doctor who is like-minded will go a long way towards showing you really do mean it. It could be that the fact that one must be a bit persistent and aggressive in seeking sterilization out if you are a nulliparous youngster is why the regret rate is so low among the sterilized childfree: maybe that process weeds out those who don't want it badly enough and would turn out to be regretful later.

It is offensive to me when people talk about trying to force doctors to perform certain procedures without regard for the physician's clinical judgment. I don't think most people would want me to dictate to them how I think they should do their jobs, yet a lot of people think that having read an article on WebMD means they know as much as their doctor. Sometimes, a medical issue is not as straightforward as it seems without the benefit of years of medical training and experience dealing with patients.

A few reasons I can think of for why a doc might not want to sterilize someone that have nothing to do with sexism:
1. Forced sterilization has in the recent past been used as a tool of eugenics (http://en.wikipedia.org/wiki/Compulsory_sterilization), and it is possible that some of the trend towards being hesitant to sterilize people lightly is a pendulum effect from that.
2. There ARE many reversible birth control options nowadays that are quite effective. The Mirena IUD is in fact more effective than the traditional tubal ligation, so it is quite reasonable for a doctor to suggest it to someone who is serious about not wanting to have kids.
People tend to think of tubal ligation as permanent, and most of the time it is, but fallopian tubes can sometimes grow back together over the years, especially when a tubal is done in younger patients who have more potentially fertile years ahead of them. For that reason alone, a doctor might make a judgment call that tubal ligation is not in the best interest of a young woman who is at a higher risk of experiencing an ectopic pregnancy years down the road from a failed tubal than a 35 year old whose fertility is tapering off anyway.
3. While the issue of litigation is definitely a huge one in ob/gyn, it may not be the only reason a doctor doesn't want to deal with regretful patients. Regrets after tubals do occur. While I do not think there is any scientific credibility to their claims, just do a google search on "Post tubal syndrome" to find a lot of hysterics from women who regret getting sterilized. Even IF a doctor can show such patients a legal waiver and say, "Tough shit, you ASKED me to sterilize you, so live with it, fool!" (paraphrasing of course ;) ) most doctors do have some desire to "help people" and don't want to lead people into situations that might cause them regrets. "First, do no harm" is kind of a big thing to some docs.

Personally, if I were an ob/gyn, I'd be willing to sterilize pretty much anyone over the age of 21 years who could demonstrate a serious understanding of sterilization's risks and benefits, and who could coherently explain why reversible birth control is unacceptable to them. However, I don't blame other docs for simply making the decision that they do not feel comfortable being involved in a permanent procedure on someone they are not convinced is going to benefit from it. Again, there is that "First, do no harm" thing. Doctors go through a lot of years of training so that they are able to make decisions for their patients. If you don't trust your doctor's judgment, find a different one. If you don't have freedom to choose a doctor who has compatible views about sterilization, that's a failure of the system, not of the doctor.

[curlcoat]

It is offensive to me when people talk about trying to force doctors to perform certain procedures without regard for the physician's clinical judgment.

How is telling a 32 year old woman she doesn't know her own mind a doctor's clinical judgment? What about elective sterilization requires any clinical judgment other than whether or not the patient is healthy enough to survive the procedure?


I don't think most people would want me to dictate to them how I think they should do their jobs, yet a lot of people think that having read an article on WebMD means they know as much as their doctor.

WebMD has zero to do with whether or no a woman can get sterilized without a fight. As for whether most people would want you to dictate to them how to do their job? If I am not doing my job the way that I signed up to do it, you had better believe quite a few people would be happy to tell me what I am doing wrong, and they would probably be right.


Sometimes, a medical issue is not as straightforward as it seems without the benefit of years of medical training and experience dealing with patients.

Can you come up with any medical reason why a healthy young woman should not get a sterilization if she wants one?



A few reasons I can think of for why a doc might not want to sterilize someone that have nothing to do with sexism:
1. Forced sterilization has in the recent past been used as a tool of eugenics (http://en.wikipedia.org/wiki/Compulsory_sterilization), and it is possible that some of the trend towards being hesitant to sterilize people lightly is a pendulum effect from that.

Oh please.


2. There ARE many reversible birth control options nowadays that are quite effective. The Mirena IUD is in fact more effective than the traditional tubal ligation, so it is quite reasonable for a doctor to suggest it to someone who is serious about not wanting to have kids.

Mirena says right in their ads that it is for women who have already had at least one kid. Plus it is hormonal birth control. Why should a woman who knows she never wants any children be forced to put up with the side effects of hormonal birth control for decades, until some doctor finally decides that she actually knows her own mind enough to "allow" her to be sterilized?


People tend to think of tubal ligation as permanent, and most of the time it is, but fallopian tubes can sometimes grow back together over the years, especially when a tubal is done in younger patients who have more potentially fertile years ahead of them. For that reason alone, a doctor might make a judgment call that tubal ligation is not in the best interest of a young woman who is at a higher risk of experiencing an ectopic pregnancy years down the road from a failed tubal than a 35 year old whose fertility is tapering off anyway.

I had my fallopian tubes completely removed, nothing left to grow back together.



3. While the issue of litigation is definitely a huge one in ob/gyn, it may not be the only reason a doctor doesn't want to deal with regretful patients. Regrets after tubals do occur. While I do not think there is any scientific credibility to their claims, just do a google search on "Post tubal syndrome" to find a lot of hysterics from women who regret getting sterilized. Even IF a doctor can show such patients a legal waiver and say, "Tough shit, you ASKED me to sterilize you, so live with it, fool!" (paraphrasing of course ;) ) most doctors do have some desire to "help people" and don't want to lead people into situations that might cause them regrets. "First, do no harm" is kind of a big thing to some docs.

I can google probably just as many hysterics from folks who regret getting plastic surgery, and a goodly number who regret having children. Why is patient regret only considered in sterilization? How about the women with endometriosis and other issues that are crippling and could be cured by a hysterectomy, but the doctors decide they haven't had enough children yet? Should we talk about the regret those women feel?


If you don't have freedom to choose a doctor who has compatible views about sterilization, that's a failure of the system, not of the doctor.

How is that going to make a woman refused sterilization by the only doctor she can see feel any better? There are whole countries where the woman has no choice of doctor, and large areas of the US where there are very few doctors willing to do any female sterilizations.

[Jillyvn]

It is offensive to me when people talk about trying to force doctors to perform certain procedures without regard for the physician's clinical judgment. I don't think most people would want me to dictate to them how I think they should do their jobs, yet a lot of people think that having read an article on WebMD means they know as much as their doctor. Sometimes, a medical issue is not as straightforward as it seems without the benefit of years of medical training and experience dealing with patients.

I think the problem is not that we are asking physicians to disregard their own clinical judgement. We are questioning the biases and misconceptions that inform some, not all, physicians basis for making a decision. I can see no valid reason why, out of all the gynes I have seen since being diagnosed at around age 20 with endometriosis, I should have had to jump through inumerable hoops all in the hope of preserving my fertility. That the Mirena worked for me is more a stroke of luck than anything, I've had gynes suggest using drugs to put me into early menopause, I've been on year round birthcontrol pills to stop my period, I've taken depo provera and had the commensurate terrible side effects. There is evidence that pregnancy can help endo symptoms, and so one doctor suggested that I have a baby first before getting a hysterectomy to see if that would fix the problem. This, in spite of my repeated assertions that I was not trying to preserve my fertility. I was emphatic that I would not have children. Something is askew here, and I am not alone in this experience.

Mirena says right in their ads that it is for women who have already had at least one kid. Plus it is hormonal birth control. Why should a woman who knows she never wants any children be forced to put up with the side effects of hormonal birth control for decades, until some doctor finally decides that she actually knows her own mind enough to "allow" her to be sterilized?

I completely agree with you here. I wanted to add, however, for the interest of any women reading this thread, that while Mirena is recommended for women with at least one child (like other IUD's), some doctors are willing to insert it in women who have not had children. The concern my gyne had was about the pain level (this is the same doctor who was willing, if this failed, to do the hysterectomy). This blessed woman, hands down the greatest gyne I've seen, actually inserted my Mirena when she was on a surgery day at the hospital – she put me under so I wouldn't have to feel the pain, and told me that when it comes time to take it out, she will do the same. I miss her so very much. A good doctor is worth her weight in gold.

[curlcoat]

I completely agree with you here. I wanted to add, however, for the interest of any women reading this thread, that while Mirena is recommended for women with at least one child (like other IUD's), some doctors are willing to insert it in women who have not had children. The concern my gyne had was about the pain level (this is the same doctor who was willing, if this failed, to do the hysterectomy). This blessed woman, hands down the greatest gyne I've seen, actually inserted my Mirena when she was on a surgery day at the hospital – she put me under so I wouldn't have to feel the pain, and told me that when it comes time to take it out, she will do the same. I miss her so very much. A good doctor is worth her weight in gold.

What? You have to, er, stretch if you haven't had any children?

squick

[Jillyvn]

I won't lie to you, it was not a comfortable procedure. Iwas in a great deal of pain for a few days after. I can't imagine how much it would have hurt without the kindness of being put under for the procedure.

I also wanted to add - re: Mirena being more effective than a tubal ligation. Some women experience horrible side effects with the Mirena. I, for example, had terrible lower back pain. However, it was so minimal compared to the pain I had been having that it was worth the trade off for me. Also, there is apparently some risk of rejection (term?), where the IUD can come out or "drift". Once it is out, it cannot be put back in, so you're out the money it cost - which, for me, was about $600 as I recall.

Some women just don't respond well to horomonal birth control, and if they arent planning on having kids, why subject them to it for an unnecessary length of time?

[Manda JO]

If you don't have freedom to choose a doctor who has compatible views about sterilization, that's a failure of the system, not of the doctor.

That's what we are talking about--that the system itself is misguided. When dealing with psychological fallout, there have been many standard medical practices which we now see as outdated and counterproductive: doctors used to keep women from ever seeing their stillborn babies, they used to present only what they considered the best alternative when talking to women about cancer treatments or birth procedures, they used to unilaterally make decisions about circumcision and vaccinations without any discussion about alternatives. And in many cases they were right, their judgment was better than that of their patients, they were working from the purest of motives. But it is still wrong.

Doctors are not bad people if they don't do sterilizations on women. However, it's a bad system that has no protocol, no policies, no mechanism for a woman to make this choice--instead, we have a bunch of traditional, conventional wisdom, a handful of doctors who may well be performing sterilizations unwisely, and women forced to rely on word of mouth to find them. It's a relic of an earlier, unfortunate era in heath care, and it ought to be changed.

[WhyNot]

When this topic comes up, people often act as if doctors all share a brain.
Well, the complaint here is about those doctors who think women all share a brain. I don't think anyone is accusing those doctors who do sterilization on request of being sexist or outdated, or even those doctors who clearly take each request on its individual merits.

(We really need to make this an internet axiom: If you're (or your doctor or your child or your pit bull are) not the kind of person named in the thread, then we're not talking about you!)

All of your reasons are perfectly possible. But none of them apply to every woman. And it's the forming a predetermined position on that woman there based on what you think you know about women in general that is sexist. Pure and simple.

[Jayn_Newell]

Also, there is apparently some risk of rejection (term?), where the IUD can come out or "drift". A risk which is, I believe, higher in childless women than for those who have already reproduced. Also, haven't there been a number of doper women complaining about how hard it is to get an IUD if they're young and childless? "Come back when you have children" isn't exactly the best thing to tell a woman who is asking for a way to avoid getting pregnant. You might as well tell a depressed patient to come back when they're feeling better.

[Khadaji]

As a single male age 35 I asked for the big V and was denied, the doc saying there was too big a risk that I would change my mind later and sue.

At 45 when I asked, my doc told me he knew surgeons who would do it. (I didn't get it done at that time because I was not sexually active. But if I find a woman, I will think about it.)

[olivesmarch4th]

The first reason is that, as mentioned before, there many birth control options. It would be a rare woman who could not tolerate hormonal birth control AND all of the variety of barrier methods available. Any doctor is always going to push non-invasive and reversible options over major surgery no matter what the problem is. Only when it becomes clear that nothing else is going to work will they look towards such major procedures.

It's worth noting that for men there is only one birth control option, and it comes with some major drawbacks. A man who does not wish to have a child does not have the plethora of options that we have. I imagine if a woman's only other option had such problems we would see a lot more acceptance of surgical sterilization. And imagine if men had more options we wouldn't be as quick to cut.


Something is being overlooked here, which is that hysterectomies are often about more than just birth control. Try to imagine you were suffering from a painful disease, one that robbed you of your quality of life, was unpredictable, caused extreme mood swings, severe depression, irrationality, rage. On top of all that there was actual physical pain that was very difficult to eradicate. Say you went to your doctor because you were absolutely miserable, you had tried multiple different medications for years in an attempt to treat it, some of them with painful consequences that rivaled the original disease, and nothing worked.

However, there is this one procedure that could absolutely make your horrible symptoms go away, but it has the side-effect of causing permanent sterility.

Your doctor looks at you with a straight face and tells you that in spite of all your suffering, this obvious cure is not an option because there's a chance you might want to have kids some day.

Now maybe you understand where some of us are coming from. At this point the quality of my life is so poor that the issue of having children is a secondary concern.

I know from experience, from my family history, that these problems are only going to get worse. Both my mother and my grandmother had the procedure after they had children--my mother was 40 and she still had to fight, her doctor was extremely condescending but she badgered him into the procedure. He went so far as to tell her that after they were done he would show her how she had imagined everything... and inside he found a world of horrors. She was originally supposed to have both of her ovaries left intact, but one of them could not be saved due to the severe endometriosis and tumors. I don't want to tell you what hell it was to live with her until she had this procedure--she was absolutely insane in addition to the fact that she was constantly suffering physically.

I have a close friend who is a lesbian with no interest in having kids. She is 28. She has endometriosis as well as some other horrible uterus disease that makes her bleed constantly. She has had three surgical procedures, all the same procedure, to do ongoing ''maintenance'' of this problem. Basically they let it build until she is constantly bleeding and in severe pain, then they let her do this procedure and wait until she is really suffering to consent to it again. She cannot find a doctor who will consent to a hysterectomy, because she is of childbearing age and may change her mind about having children later.

My latest attempt to fix my own problem was with a Mirena IUD, and that resulted in a year of a whole new kind of pain and suffering. I have not yet broached the subject of a hysterectomy with a doctor because, like many people I know who are childless and in extreme pain because of their uterus, I will probably get laughed out of the office. It doesn't matter that I'm happily married for nearly three years, have always desired to adopt children since I was 9 years old and have a loving husband who is fully on board with my reproduction plans. I have decided I am going to pursue this; I will have to start with Planned Parenthood I suppose, but I am less than optimistic.

So this is what we are really talking about. Do I believe a woman should be entitled to have this procedure just because she doesn't want to have kids? Absolutely. But the point I am trying to make, is that many doctors, even when it is obviously medically necessary, still deny women this treatment option because of their grasp on antiquated ideas about women and reproduction. We are talking about demonstrable cases where women are forced to continue to suffer serious chronic illness because the doctors will not accept that there are some things really a lot worse than never being able to have children. I was outraged about this before I came to the conclusion that a hysterectomy was a good choice for me. Now it's reprehensible on a whole new level.

[catsix]

olivesmarch4th said:
the doctors will not accept that there are some things really a lot worse than never being able to have children.

Pardon my lame joke.. but yes, there are. Like being able to have children!

[curlcoat]

And it's the forming a predetermined position on that woman there based on what you think you know about women in general that is sexist. Pure and simple.

Exactly. How can essentially trying to force me into pregnancy just because I'm a woman be anything but sexist?

[I Am The Lorax]

Here's a different take:

I've had kids...two, to be exact. My pregnancies were welcome reprieves from what have always been horribly painful, highly irregular mentrual cycles which have wreaked havoc on me physically and mentally since I was a teenager. It's actually amazing that I even got pregnant in the first place. I might start my period in 15 minutes. I might start next week. I might not have one for six months.

I am one of those women whose physiology reacts badly to hormonal birth control. I've tried probably 6 types of oral contraception, each of varying degrees of hormone levels and types, and the patch. They all make me sick. Like throwing up sick.

I asked my OB/GYN about the possibility of having my uterus removed (leave the ovaries, please). He may as well have patted me on my little head and told me to get back to my embroidery for all the help and compassion he offered.

He did say that he could tie my tubes, then lightly chuckled when I pointed out that tying my tubes would have zero effect on my mentstrual cycle.

You're me, aren't you?