The long-term objective of this controlled, prospective study is to better understand the consequences of female sterilization in order to reduce negative sequelae.
The specific aims are to 1) determine if, during the first 5 post-surgical years, women undergoing tubal sterilization (TL) experience, physical (primarily menstrual disturbances and increased rates of hysterectomy) or psychosocial changes different from those experienced by control subjects, i.e. vasectomy wives (VAS) and women not planning sterilization (NPS); 2) identify and characterize these changes; 3) compare patterns of regret experienced by TL and VAS subjects; 4) identify antecedents for changes and regret and construct a screening instrument to identify women at high risk for regret; 5) identify antecedents to the timing and choice of male or female sterilization among NPS women who subsequently select sterilization; and 6) maintain contact with the sample should a future follow-up (FU) year be pursued. Initial (pre-sterilization) and five years of FU data have been collected from over 600 women, as scheduled, and preliminary analyses have been performed on the first three FU years. Supplemental funding is being requested primarily to analyze the complete six-year data set, with special emphasis on the fourth and fifth FU years. Data analysis will focus on measuring changes in each group between initial intake and FU years and then comparing such changes across groups, using analyses of variance with repeated measures, preceded by backward stepwise multiple regression to identify significant covariates. Multiple regression and discriminant function analyses will be the primary methods used to construct the screening instrument. The hysterectomy analysis will employ logistic regression and Cox's proportional hazards model. Antecedents to choice of sterilization by NPS women will be determined through multiple regression; if findings justify further causal analyses, LISREL will be used. LISREL will continue to be used for modeling regret. Results of this study will: 1) provide patient and physician with needed information regarding likely physical and psychosocial consequences of sterilization so that informed decisions can be made and 2) help identify women at high risk for regret, and thus in need of special pre-surgical counseling.
