Risk of regret and denying women sterilisation

[DisappearingGirl]

BBC article - some interesting parallels ...

Risk of regret used to deny women NHS sterilisation

https://www.bbc.co.uk/news/articles/cp8p1q207mzo

"A woman who was refused a form of permanent birth control by an NHS body over fears she may regret the procedure has won her case with the health ombudsman...

Her request had been refused over concerns regarding potential regret and cost-effectiveness, despite the ICB regularly funding vasectomies for men without applying the same criteria....

Spasova said she had been enquiring about sterilisation for 10 years...

The decision "did not follow the widely recognised principle that clinicians provide advice, but patients ultimately make decisions about their own bodies"," she said....

In issuing its judgement on the case, the ombudsman said: "At the time, the ICB did not routinely fund female sterilisation and cited the risk of regret as a reason for refusing women the procedure." ..."

Depressing article. But not surprising from reading some of the threads on here.

Back in the 60s, my mum needed permission from her husband to go on the contraceptive pill. Sad to think that all these years later women are still being denied autonomy over their own bodies.

And yet I know a 19 year old girl who’s just had her breast cut off to become a man and “regret” wasn’t considered at all. Shocking.

Playing devil's advocate but I do kind of think that risk of regret should be taken into account with sterilisation/vasectomy, especially at a young age.

But I do think that if risk of regret is a consideration here, then it should definitely be a consideration in gender reassignment surgery / medical treatment.

Children can take responsibility for their choices about themselves if they are considered competent to understand the consequences. Gender critical people generally consider that children are never competent to understand the consequences of sterilisation. I would maintain that, despite the age of majority in the UK being 18, sterilisation should never be carried out on women or men below the age of 25, except in dire medical need.

We know that adolescents are very poor at assessing risk and at understanding that their attitudes and beliefs are not fixed. The decade after the main hit of puberty, so 14/15 - 24/25, is the time when young people take the most risks with things such as diabetes control and allergies resulting in anaphylaxis. How many 21y olds are certain they will never have children, onIy to change their minds once they meet the right person or settle down into the world of work?

After 25, after people have had a chance to mature, a person’s request to be sterilised should be explored in case it is not the best treatment for them. But the presumption should be that the woman does know her own mind. Not that men can consent, but women cannot.

The same should apply for gender-affirming body modifications.

Sterilisation should be available on the NHS. It may enable women to be economically productive. It may reduce the burden on the NHS - repeated births, treatment for chronic gynaecological conditions etc.

Gender-affirming body mods should not be available on the NHS, for so many reasons that it would amount to a derail of this thread.

After complications with the birth of my son and the aftercare I received i was told I'd never be able to carry a child past 12 weeks.
I also cant use hormonal contraception nor iuds so I asked to be sterilised.
My gp agreed it was for the best and referred me. The male gynecologist refused because I might regret it and want more children. I pointed out that whether or not I wanted more I couldn't have them due to the damage done to my womb and cervix, his response was yes but you may regret it 😡
So I went back to my gp who referred me to a female gynecologist who had read my notes and sterilised me the next week.
I was lucky that nhs scotland fund female sterilisation but the male drs still use regret as an excuse to refuse, its medical misogyny at its best

Was this an NHS procedure?

It is hard to compare female sterilisation to vasectomies though - it is much more invasive and more likely to fail. I know a couple of people including my partner’s mother who got pregnant after being sterilised!

And with women it cannot be reversed whereas with men the reversal success is fairly high. I get the frustration as it can feel like “regret” is how they justify the refusal, but there are medical reasons why doctors usually recommend the male partner to have vasectomy. Unless there is a medical need....

I struggle with this as I had it done and really regret it. I was getting a c section and thought I may as well instead of taking hormonal contraception or dh getting the snip seeing as they were already there. I had two appointments with a consultant to make sure I wanted a c section but they didn’t question if I was sure about this. I accept that it was my choice but I think that it needs to be strict as I know others have also regretted it.

I agree that potential regret needs to be considered, but it shouldn't be an automatic 'no, you silly women don't know what's good for you'.

Perhaps 2 appointments a set period of time apart to discuss it, then go ahead.

Especially if a woman is over , eg 25 and already has kids.

Not wanting to derail but apparently the GP talked my dad out of a vasectomy in the 80s. I don't know how hard dad would have tried to argue though!

My husband had a vasectomy and I wasnt allowed in for support as they had a chat first about consent/ regret - which seemed well pitched and appropriate from his report afterwards. He went ahead and no one tried to talk him out of it, let alone veto it.

Although a vasectomy is in theory reversible I’ve read that sperm production starts to decline post vasectomy so a man’s fertility may be affected even if the tubes are reattached.

I'd asked several times before getting a practitioner nurse (or nurse practitioner whatever) explain that the new procedure was vile and she wouldn't wish it on anyone. They insert blocking pellets into the fallopian tubes . The give you tramadol and valium for the procedure but it's awful she said. I wasn't 100% sure if she wasn't speaking directly from experience.

My MIL was quite vocal after she'd had her second child and was sterilised (tubal.ligation I believe) without too much bother.

Their body, their choice.... The doctors body that is

I think the concern about regret is reasonable - simply because it does in fact happen and it's not uncommon for younger women to think they don't want kids, and change their mind later.

A doctor not allowing it for 10 years of asking is going rather far though. I think it would be very reasonable to have guidelines for best practice - say, not in the 20s if a woman has no kids, unless there is a real medical reason. Or a wait period, or some sort of counselling discussion, or a combination of those things. I think that's just good medical practice.

As for comparing it to young people being allowed to make irreversible decisions about gender reassignment, yeah, it makes no sense, but that is because they are being irresponsible with that whole branch of medicine.

It's difficult. I'm the first the point out sexism in medicine and I believe this was the reason for refusing sterilisation in the past. Now I think it's more due to defensive medicine - this is practicing medicine not in a way that necessarily best for the patient, but in a way that no one could possibly sue you for. Most people wouldn't regret their decision but what if one did, what if the doctor ends up with a malpractice suit, what if, what if (not saying I agree with this but it's one way of thinking).

For men it's one thing, because it's currently the only long term option. For women, long acting reversible contraception such as the iud or rod, are available and are actually more effective. (They aren't suitable for everyone, including me, but again from the doctors perspective).

I have no words. I’m so sorry this happened to you.

What exactly did that gynae think you were going to regret? The opportunity to have multiple miscarriages? What an idiot.

Do you have the same response to implants and plastic surgery?

I know someone who was denied a hysterectomy on the basis that she might change her mind. When she pointed out that she's a lesbian the doctor told her she might divorce her wife and marry a man one day.
She needed the operation as pmdd and hormones etc made her suicidal.

I’ve advised my daughters against long term implanted protection too - on the basis that they are far safer utilising a form of contraception that they control and not doctors.

@TempestTost
”As for comparing it to young people being allowed to make irreversible decisions about gender reassignment, yeah, it makes no sense, but that is because they are being irresponsible with that whole branch of medicine.”

The issue here is that gender medicine affects men too. And the medical profession treats the wants of men seriously. Women are too silly to know their own minds and interests.

Gender medicine works completely outside normal medical considerations, in many ways.

To some extent, and I'd say increasingly, so does a lot of cosmetic surgery. And we've become very blase about accepting this new model of medicine as a form of self-fulfilment.

People will often say things like "Well, it's up to the individual if they want to get their nose changed//ears cut off/tits blown up to the size of beach balls/penis removed" but that's actually not been the normative model for what is ok for doctors to do, even for adults, which is more around medical benefit vs risk.

Sterilisation itself is different than a lot of medical procedures because it's not actually repairing or even compensating for something that is wrong with the body. It's actually destroying a working, healthy, body part. This is another reason medicine has historically looked at it as something to be very careful about.

I think we often underestimate the degree to which the current consumer vision of medicine, where doctors are there to simply fulfil the wishes of the patient, no matter whether there is any heath benefit, comes into play with gender medicine. Reducing it to "doctors take men seriously" I don't think really accounts for what is going on there.

Aside from that - it is actually true that there is often a significant change in attitude about having children between people's 20s and 30s, so it would be iresponsible not to take that into account. It's true for men as well but I don't think many are asking about being sterilised at that stage of life.

There is research on regret rates for sterilisation for women, it is significantly higher in younger women than older ones.

This is likely founded as an other poster said on defensive medicine. Low chances of reversal, higher chances of regret in female sterilization versus alternatives available. In the case of men the only alternative are condoms so higher level of user error and needs addressed each time they have sex.

No doubt it was patronising and denied this woman her choice in this case.

I agree though that life changing body modifications that are irreversible shouldn’t be funded on NHS where there are risk factors.

• So cutting off healthy tissue in adolescents- definitely not.
• Treating an autistic 18 year old with cross sex hormones because they are uncomfortable in their sexed body - nope not wise
• Sterilizing 20 year old female when long lasting contraceptives are available - I’d have a wait period and counselling.

Cutting off breasts in women who have gender dysphoria isn’t treating the root cause of the medical problem.

Breast implants in teenagers on the NHS - can’t imagine it’s funded but for well evidenced cases - and if dealing with a psychological issue - won’t resolve the problem as many documented issues with breast implants/ needs repeated / reality not likely to match expected outcome etc.

I am 35 and have two children (10&16). The doctor refused me sterlisation because "what if something was to happen to one of your children" - like I could just replace one. My DH was told his vasectomy would take a while, 2 weeks later he was sorted. No "permissions" needed.
I really wish I could donate the whole thing. Give it all to someone who wants children. I know thats not really a possibility at the moment.
My 16yr old DD is determined to get sterilsed as soon as she is able to. I told her to save up if she is certain because the NHS would likely refuse.

I disagree.
I know women who have needed a hysterectomy for medical reasons and they have been denied the medical procedure.
They were told no, so had to live with immense pain.
Men on the other hand are treated differently.
When I spoke to the doctor about changing my HRT, due to issues surrounding sleepless nights, anxiety, fear and generally making my working life extremely difficult, etc, the only symptom the male gp asked about was vaginal dryness. When I told him that no, that wasn’t an issue, he wasn’t interested in changing my HRT. The message was clear, despite me being the patient, dh’s sex life was more important.

What a bewildering interaction - on both sides. What does being lesbian have to do with a hysterectomy? Lesbians start families all the time. And why didn’t the doctor seeking to dissuade simply point that out, instead of making a misogynistic and homophobic suggestion?

Counselling is the right way to deal with the risk of regret of female sterilisation. That was the guidance that the local NHS in the OP failed the follow, and they’ve rightly been pulled up. But counselling is in short supply in the NHS, and doctors often fall back on misogynistic prejudices.