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Tubal Ligation and Pain:
A Review of Medical Literature

Can women have their tubes tied and experience tubal ligation symptoms?

Pain after tubal ligation has been very well documented within the medical literature as a cause of tubal ligation symptoms.

Below are abstracts I have found to be relevant in supporting observations of pain being associated with tubal ligation.

Articles were found by searching PubMed in January of 2015 using the key words “pain” and “tubal ligation”. Only articles with abstracts are shown. It is important to note many other  reports of tubal ligation and pain were identified but these articles were not included because they were lacking a descriptive abstract.

Pain after Hulka clip tubal ligation

A case report of an isolated hydrosalpinx resulting from the placement of two Hulka Clips on the same fallopian tube is presented. This is a previously unreported complication of mechanical sterilization and is suggested as a possible cause of chronic pelvic pain.

Hulka Clip application as a potential cause of chronic pelvic pain. Frishman GN, Brest NA, Contraception. 1992 Apr;45(4):325.

Pain and tubal ligation and endometrial ablation

Operative resectoscopy and endometrial ablation are often performed to treat abnormal uterine bleeding, but little is known about the potential late complications of these procedures. We reviewed the records of 305 women who underwent endometrial ablation at a midwestern obstetrics and gynecology group practice and teaching hospital between July 1990 and October 1995. For 71 women, tubal ligation, salpingectomy, or tubal sterilization was performed at the time of ablation. Of these, six (8.4%) developed intense cyclic pain 5 to 40 months after surgery. Four subsequently underwent exploratory laparotomy and hysterectomy, and two others underwent laparoscopic tubal resection and destruction. Gross pathologic findings revealed hematosalpinx, and microscopic examination showed endometriosis, acute and chronic inflammation of the fallopian tubes, and acute and chronic myometritis. We believe these characteristic clinical and pathologic findings are consistent with postablation-tubal sterilization syndrome, a distinct clinical entity arising as a late complication of endometrial ablation in patients with a history of tubal ligations and/or obstruction.

Postablation-tubal sterilization syndrome. Bae IH, Pagedas AC, Perkins HE, Bae DS, J Am Assoc Gynecol Laparosc. 1996 May;3(3):435.

Pain after Filshie clip tubal ligation

Tubal clips for female sterilization account for about 10 to 40% of the contraceptive methods used throughout the world. Clip migration is an unusual complication which may lead to chronic unexplained abdominal pain. We report here the case of a 44-year-old woman who suffered from chronic abdominal pain. The diagnosis of intraperitoneal migration of the Filshie clip fixed five years earlier was made. Cure was achieved with ablation of the clip. Late complications of Filshie clips are uncommon and non-specific. They include tubal necrosis and section, sterilization failure (0.7%), and migration (0.6%). Rare migrations into the bladder, the peritoneum, the appendix, or the vagina have been reported. When investigating chronic abdominal pain in a female patient, the clinician should inquire about sterilization history and carefully examine plain x-rays of the abdomen in women with tubal clips.

Intraperitoneal migration of Filshie tubal sterilization clips: an uncommon cause of chronic abdominal pain. Konaté A, Rauzy V, Chalon S, Ceballos P, Rivière S, Ciurana AJ, Le Quellec A, Gastroenterol Clin Biol. 2002 Jun-Jul;26(6-7):630.

Pain and tubal ligation from retrograde menstruation

Case: A woman 10-year status-post bilateral tubal ligation suffered from dysmenorrhea and menorrhagia that began within 1 year after sterilization. At the time of bilateral tubal ligation, no endometriosis was observed. A recent magnetic resonance imaging scan showed no pelvic abnormalities, and the patient underwent a diagnostic laparoscopy in anticipation of finding endometriosis, yet none was found. At laparoscopy performed on day 3 of her menstrual cycle, the proximal segments of her occluded fallopian tubes were dilated with blood. As this was the only abnormality found, we postulated that her dysmenorrhea might be related to the dilated proximal tubal stumps. We evacuated the bloody fluid and occluded the proximal tube at the cornua with Filshie clips. One year after surgery, the patient remains asymptomatic.

Conclusion: This case is unique because bilateral tubal ligation combined with retrograde menstrual flow appears to have caused dysmenorrhea. Women who have undergone tubal ligation and who have dysmenorrhea may benefit from a diagnostic laparoscopy during menstruation to evaluate the possibility of retrograde menstruation dilating the proximal tubal stumps.

Dysmenorrhea after bilateral tubal ligation: a case of retrograde menstruation. Morrissey K, Idriss N, Nieman L, Winkel C, Stratton P, Obstet Gynecol. 2002 Nov;100(5 Pt 2):1065.

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