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Am Fam Physician. 2002;66(7):1326

Approximately 4 million men and 10 million women in the United States have been sterilized. Worldwide, this is the most popular form of contraception. Although preoperative counseling should always address regret, little information is available about the proportion of patients who later regret the surgery. Jamieson and colleagues used data from a large national study to identify risk factors for regret in women after tubal ligation or spousal vasectomy.

The study compared 3,672 women who underwent tubal ligation at medical centers in six cities with 525 women whose husbands underwent vasectomy in five of the same cities between 1985 and 1987. All women were interviewed in person before the procedure and by telephone one, two, three, and five years afterward. Women were asked if the procedure was a good choice for them and their husbands. Those who answered negatively were asked whether they had contemplated, requested, or undertaken reversal procedures. Full follow-up was achieved in 82 percent of the vasectomy group and 74 percent of the tubal-ligation group.

More than 90 percent of the women in both groups reported that completion of childbearing was an important reason for sterilization. Women in the vasectomy group were more likely than those undergoing tubal ligation to say that pregnancy would strain their marriage. All of the women in the vasectomy group were married. These women were more likely to have been white and to have more education than women in the tubal-ligation group. Only 61 percent of the tubal-ligation group was married. Women in this group were more likely to have been enrolled in Medicaid and to have had an induced abortion than women in the vasectomy group.

In the vasectomy group, the five-year cumulative probabilities of regret, of women requesting that their husbands have a reversal, of those husbands requesting a reversal from their physicians, and of obtaining a reversal were 6.1, 2.0, 1.4, and 0.4 percent, respectively. Similarly, the cumulative probabilities of regret following tubal ligation, of women requesting a reversal, and of obtaining a reversal were 7.0, 2.2, and 0.2 percent, respectively. Wanting another child, loss of a child, and medical problems were among the reasons women cited for regretting the procedure. No woman reported feeling regret because of loss of sexuality, not understanding that the procedure was permanent, or failure of the procedure.

Young age was a risk factor for regret after tubal ligation but not for regret after vasectomy. The most significant risk factor for regret after both procedures was conflict in the relationship before the procedure. Women who reported substantial conflict with their husbands before vasectomy were more than 25 times more likely to request reversal than women who did not report such conflict. Women who reported conflict with partners before tubal ligation were more than five times as likely to request reversal than women who did not report conflict.

The authors conclude that most women do not regret surgical sterilization, and that only a very small percentage of patients take action to obtain reversal of surgical sterilization procedures. Nevertheless, about 6 percent of those choosing vasectomy and 7 percent of those choosing tubal ligation are likely to regret the decision. Because the most powerful predictor of regret is conflict between a woman and her partner, the authors stress the need to fully explore this issue in counseling before any sterilization procedure.

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Copyright © 2002 by the American Academy of Family Physicians.

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