In the United States, 26 percent of women 15 to 44 years of age who had ever married chose tubal ligation for contraception. Studies on how this procedure affects sexual activity and satisfaction have given mixed results and generally have involved too few patients to allow reliable conclusions to be drawn. Costello and colleagues used data from the U.S. Collaborative Review of Sterilization to study the impact of tubal ligation on sexual interest and pleasure.

The U.S. Collaborative study enrolled more than 12,000 women who underwent sterilization at one of the 15 participating medical centers between 1978 and 1987. Extensive data were collected on participants before surgery. Participants were interviewed one month after surgery and annually thereafter until 1994. Women who were enrolled before September 1983 were asked about sexuality in annual follow-ups until 1985.

Data were available on 4,576 women for two years following planned interval tubal ligation. The majority (75 percent) were 35 years or younger, had completed high school (82.8 percent), were married (63.9 percent), and were white non-Hispanic (65.8 percent). Sexual interest was reported to be unchanged by 80 percent of women. Overall, 18.3 percent reported increased sexual interest, with the greatest increase reported by white women (20.1 percent) and those who had attended college (20.4 percent). Decreased sexual interest was reported by 1.7 percent of all respondents, with the highest rates among women who had never married (4.2 percent) and those with fewer than 12 years of formal education (4.2 percent).

Sexual pleasure was unchanged in 81.7 percent of women, with 17.2 percent reporting an increase and 1.1 percent reporting a decrease. Increased sexual pleasure was highest in white non-Hispanic women (18.9 percent), married women (18.1 percent), and those who had attended college (18.1 percent). The highest rates of decreased sexual pleasure were reported by women with fewer than 12 years of education (2.3 percent), those with four or more children (2.1 percent), and never-married women (2.0 percent).

A multivariate analysis of several clinical and other factors associated with sterilization showed that regret about the procedure was the only factor associated with a poststerilization decrease in sexual pleasure or interest. Of the 147 women who reported regret, 6.8 percent experienced decreased sexual interest, and 5.6 percent had decreased sexual pleasure. Even in this group, the vast majority reported no change (86.4 percent for interest and 88.8 percent for pleasure), and increased and decreased interest or pleasure were reported equally.

The authors conclude that the majority of women experience no change in sexual interest or pleasure after interval tubal sterilization. Those who do report change are more likely to report positive rather than negative changes.

editor's note: Even if she does not ask, the woman contemplating tubal ligation (and her partner) may well be worried about the possible effect on sexuality. This study gives us data to positively address the issue. We should routinely discuss the effects of tubal ligation on sexuality during pre-procedure counseling, even if the patient does not express concerns. This study reinforces the value of such counseling, because the effect of regret is striking. Sterilization is an exquisitely personal choice and must never be undertaken unless the woman is certain that it is her best choice. Family physicians can help patients make good decisions and address fears in this most private, yet highly important, area of human behavior.—a.d.w