Q:In vol 4 no 2, a Q & A brought me up short. In the answer to the problem of long term side effects from female sterilization, you state “. . . when you clip the tubes closed, you block the supply of blood to the ovaries.”

I would be most grateful if you would give me more conclusive evidence of your statements, perhaps with references in medical books or journals. L S, Leeds.

A:The following are all medical references of problems caused by “band aid sterilization” cited by experienced American gynecological surgeon Vickie Hufnagel, who now refuses to do tubal ligations because of the number of cases of “post tubal ligation” syndrome. In her book No More Hysterectomies (Thorsons 1990), she first recommends as general reading Huggins, G R and Sondheimer, S J “Complications of Female Sterlizations, Immediate and Delayed” (Fertility and Sterility, March 1984).

For evidence that this form of surgery can aggravate existing menstrual problems, see, DeStefano, et al, “Long term risk of Menstrual Disturbances After Tubal Sterilization (Am J Obstet Gynecol, 1 Aug 1984).

El Minawi, “Pelvic Venous Changes after Tubal Sterilization” (J of Reprod Med, Oct 1983) is one of many studies, she says, confirming enlarged or abnormal swelling in various veins, hormonal imbalances and fistulas of the fallopian tubes, all associated with endometriosis in women who have been sterilized. See also Cattanch, J, “Oestrogen Deficiency after Tubal Ligation (The Lancet, 13 April 1985) and Hargrove and Abraham, “Endocrine Profile of Patients with Post tubal Ligation Syndrome” (J Reprod Med July 1981) Alvarez-Sanchez, et al “Pituitary Ovarian Function after Tubal Ligation” (In Fertil Steril, 1981, vol 36) and Rock et al, “Endometriosis and the Development of Tuboperitoneal Fistulas after Tubal Ligation” (Fertil Steril Jan 1981).

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