STERILIZATION METHODS

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