Q:What are the long term side effects of sterilization by plastic clamps or cutting women's fallopian tubes and abortion by vacuum suction and general anaesthetic? What can be done to reverse either sterilization and/or side effects from it or reliev

I have had two abortions by vacuum suction, one at age 24 and the other at 36 when I became pregnant and began haemorrhaging after my coil dislodged. After that I was sterilized using the plastic clamps method. I gave birth to my second child (conception very easy) after my first termination, but was diagnosed through internal examination recently as having uterine fibroids, which I believe are a result of the two abortions.

Since my sterilization my ovaries have been tender and sometimes very painful, making sexual intercourse uncomfortable and very painful in certain positions. I have seen my GP about this problem, and she tells me my ovaries are enlarged and swollen, which often happens from time to time. Could this be possible and if so, why do they enlarge? Which is mostly likely to be causing me painful sexual intercourse my fibroids or swollen ovaries? A C, Langport, Somerset......

A:Although both problems could be causing pain, the likely culprit is the swollen ovaries, and both problems have probably been caused by your sterilization.

Having your tubes tied is not the painless and simple form of contraception it's been made out to be. Although hundreds and thousands of women opt for this procedure every year (about half a million in the US alone) many gynaecologists see patients complaining of problems afterward so much so that they've coined a term "post tubal ligation syndrome" to describe it. These include pain with intercourse, pelvic pain or a feeling of pressure, cramping, heavy periods and bleeding between periods. In her book No More Hysterectomies (Thorsons) Dr Vicki Hufnagel cites 12 studies (including those in American Journal of Obstetrics and Gynecology, 1 August 1985 and Journal of Reproductive Medicine, October 1983) proving a host of problems after either method of "band aid sterilization".

The problem is that when you clip the tubes closed, you block the supply of blood to the ovaries. If menstrual blood backs up into the tubes, it can cause them to become inflamed. Without blood, the ovaries can become permanently damaged.

"Many studies confirm finding varicosities (abnormal swelling or enlargements) in ovarian veins, hormonal imbalances, and fistulas of the fallopian tubes, which are associated with endometriosis in women who have been sterilized," says Dr Hufnagel.

Various theories postulate that this cutting off of the blood supply can cause endometriosis, and the extra pressure of backed up blood could possibly alter a woman's hormonal balance. Furthermore, these problems can worsen with time. The Scottish study in the American Journal of Obstetrics and Gynecology mentioned above showed that women who have been sterilized are three times more likely to have hysterectomies than women who haven't.

Perhaps the best solution may be another surgical one. To avoid future problems, it may be prudent to see an experienced consultant gynaecologist with experience in reversing sterilization and discuss with him or her the prospect of having your tubes reopened. Even if your ovaries have suffered some damage, if the blood flow is reestablished, you may suffer less pain. The small inconveniences posed by barrier contraception like the condom or diaphragm, or by even natural family planning, in our view, are a small price to pay compared with the pain and problems associated with everything else coils, sterilization or the pill that medicine has come up with.