What methods are available for surgical sterilization?
Male: vasectomy—ligation of vas deferens preventing passage of sperm into seminal fluid
Female: 1. Ligation/removal of a section of the fallopian tube—involves laparotomy or laparoscopy
2. Mechanical blockage— using rings, coils, clips, or plugs
3. Coagulation-induced blockage—usually through cauterization methods
What are the overall risks and benefits of female sterilization?
Risks: 1. Anesthesia/surgical complications
2. Ectopic pregnancy—failed procedures can result in an increased risk of ectopic pregnancies
3. Regret of the procedure (especially in younger people)
4. Does not stop the spread of HIV or other STIs Benefits:
1. Not coitally dependent
2. Decreased risk of ovarian cancer
3. No evidence of menstrual irregularity or dysmenorrhea
What are the risks and benefits of each of the female sterilization procedures?
Ligation is one of the oldest methods of sterilization with the lowest failure rate (0.8%) but it is not easily reversed
Mechanical blockage with a clip is the most readily reversed method but it also has the highest failure rate (3.7%)
Coagulation-induced blockage with electrocautery is the fastest procedure with a low failure rate (2.5%), but there is increased risk of electrical damage to surrounding structures
What are some advantages and disadvantages of a vasectomy?
Advantages: effectiveness is very high—typical first-year failure rate 0.15%; simpler, surgically safer, more cost-effective than female sterilization; Males share contraception responsibility with females
Disadvantages: does not protect against STIs
Is reversibility after a female sterilization procedure and vasectomy possible?
Reversibility after a female sterilization procedure is generally very difficult and has been reported as only 60% effective.
As for vasectomy, men are generally counseled that it is permanent. About 50–70% of men who have a reversal become fertile. The chance of becoming fertile decreases with increasing time after the procedure
If a woman in her early twenties with two children requests tubal sterilization, what is the next appropriate recommendation?
Considering the woman’s age, you must inform her of the risk for regret of the procedure and of the permanence of tubal sterilization/ difficulty of reversal