Abstract

PIP: Various psychological aspects of voluntary surgical sterilization are examined. Women's own bodies are protected through sterilization from all the risks of pregnancy, but there is an altruistic element of vasectomy which may be perceived by men either positively or as a sacrifice or mutilition. The greater prevalence of female sterilization thus seems logical. Some psychologists view vasectomy as representing the realization of castration fantasies, but despite occurrence of cases which might seem to legitimate this view, most vasectomized men are married adults who have fathered several children and have otherwise proven their maturity. The status of voluntary sterilization appears to differ in the Third World, where rapid population growth threatens collective survival, and in developed countries whose growth rates are low or negative. Requests for reversal are increasingly frequent as women undergo sterilization at younger ages. Remarriage, a change of mind by the couple, or death of a child are the most frequently cited reasons for reversal requests. Reports of the psychological consequences of sterilization tend to vary in different studies, largely because of differences in the socioeconomic and cultural status of the populations studied and also perhaps because some studies are more superficial than others. In numerous questionnaire surveys mostly done in Anglo-Saxon countries, typically 90-99% of subjects have reported themselves satisfied with the results. The great majority report no regrets, an unchanged or improved marital relationship, and an increase in sexual pleasure. Less heterogeneous samples of persons undergoing sterilization for reasons other than simple contraceptive convenience have sometimes given less positive results. Age, economic status, number of children, marital relationship, educational level, religious and moral convictions, and history of medical or psychological problems can all affect satisfaction with sterilization. Men in developing countries who consent to vasectomy in return for some inducement such as a transistor radio may be less satisfied with the outcome. Indepth individual clinical psychological studies appear to indicate that the immediate aftermath of sterilization brings a minor emotional crisis, usually silent, in which grief is worked through at a not fully conscious level. The crisis is normal and resolves spontaneously. Following vasectomy, some men are reported to become obsessed with avoiding "feminine" activities such as washing dishes. More serious sexual and psychiatric complaints including functional somatic manifestations have also been observed, but it is not always possible to determine from case descriptions whether the patient was poorly selected for sterilization, whether the indication was inappropriate, or wheather there was a preexisting psychological disturbance. It has been suggested that on a deeper level, sterilization reactivates castration anxiety, represents self-punishment, or is imposed by castrating women, but in fact ignorance and superstition have probably influenced reactions to sterilization in some individuals. Routine psychological evaluations before vasectomy are unlikely to be done in sufficient depth to uncover latent problems or examine motivation in detail. Simple sociological criteria may be the most helpful in weeding out inappropriate candidates.