For such women there is usually no conscious desire for a baby, and they need a reliable method of contraception, but one that can at the same time allow them to fantasize about the possibility of pregnancy. If such a method can be found their sexual responses are likely to remain intact.

Men can have fantasies and feelings about what the operation of sterilization does to the woman, and again these can be difficult to elicit.

A pale and withdrawn woman in her early 30s was referred for counselling as she was unable to allow intercourse. There was a long and sad history of personal tragedy culminating in hysterectomy at 28 years for uncontrolled menstrual bleeding. Following this, the woman had become more and more unhappy, had retreated into a fantasy life of romantic fiction, and when first seen, sat behind a veil of unkempt hair.

It became clear that her partner was angry and unsympathetic, and that he was engaged in a long and serious sexual affair with a colleague. It took many hours of listening before he was able to state that in his opinion, a sterilized woman was by definition a useless sexual partner, and he could see no way forward in his marriage. In fact, once both partners had identified the underlying anger on either side, there was an improvement in their situation and a marked gain of confidence in the wife, who managed to pick up the threads of her life again.

*256/197/1*