1. Permanent. Intended to provide life-long, permanent, and very effective protection against pregnancy. Reversal is usually not possible.
2. Involves a physical examination and surgery. The procedure is done by a specifically trained provider.
3. No long-term side effects.
4. Surgical methods are available for both male and female.
A- Female sterilization:
♦ ♦♦ ♦ Also called tubal sterilization, tubal ligation, and tubal occlusion.
♦ ♦♦ ♦ Forensically, the procedure of female sterilization is provided only when medical indications exist to justify such procedure.
1. Not wanting children and being unable to use other methods of contraception.
2. Health problems that make pregnancy unsafe.
3. Genetic disorders.
4. Grand multiparous women, with repeated C.S. deliveries (more than 4).
♦ ♦♦ ♦ No contraindications for the procedure, but some considerations may be respected.
♦ ♦♦ ♦ It is not preferred to discuss sterilization for the following group of women.
1. Women who are younger at the time of sterilization.
2. Women who had the procedure immediately after a vaginal delivery.
3. Women who had the procedure within 7 years of having their youngest child.
4. Women in lower income groups.
1- Has no side effects.
2- Permanent, effective (99.5%).
3- Is easy to use, nothing to do or remember.
1- Failure is rare, less than 1%, but can occur. More than half of these pregnancies are ectopic, which require surgical treatment.
2- Serious surgical complications are uncommon – most likely to occur with abdominal procedures- e.g. include bleeding, infection, or reaction to the anesthetic.
3- After any of the procedures, a woman may feel tired, dizzy, nauseous, bloated, or gassy, and may have minor abdominal and shoulder pain. Usually these symptoms go away in 1 – 3 days.
4- Relatively has high initial cost.
5- Provide no protection against STDs.
1. During C.S. called caesarian sterilization.
2. After vaginal delivery; preferred during the 1st week.
3. Any time remote from deliveries (avoid the period of 7 days to 7 weeks post partum).
♦ Abdominal; laparoscopy and mini- laparotomy.
♦ Vaginal; Hysteroscopy and posterior colpotomy.
– Cauterization of segment of the tube.
– Application of Fallop ring.
– Application of Hulka clips.
♦ Mini laparotomy:
– Sub- Umbilical incision; post partum.
– Suprapubic ; remote from delivery
a- Pomeroy’s technique:
– A loop from the tube is ligated by absorbable (WHY?!!) sutures,
– Then resection of the loop.
b- Uchida’s technique:
– A loop from the tube is cut.
-The cut ends are buried within broad ligament leaflets preventing new canalization.
c- Irving’s technique:
– The cut ends are buried in the posterior wall of the uterus.
– Excision and ligation of the fimbrial end of fallopian tube.
♦ Hysteroscopic route
– Essure method (approved in 2002) uses a small spiral-like device to block the fallopian tube.
– A hysteroscope is used. Once the device is in place, it expands inside the fallopian tubes. During the next 3 months, scar tissue forms around the device and blocks the tubes. This results in permanent sterilization.
♦ Posterior colpotomy,
– Douglas pouch is opened and get access to the tubes.
* Long-term health effects:
♦ After female sterilization, some health benefits may be gained, and some wrong believes corrected.
1. No post-sterilization syndrome;
– Research shows that sterilization does not cause women to experience what previously called post-sterilization syndrome.
– It was wrongly claimed that sterilization may cause,
– Menstrual irregularities, – Painful menses,
– Heavy bleeding, and
– Changes in cycle length.
2. No effect on normal sexual drive.
3. Gain some health benefits,
– Decrease incidence of cancer ovary among sterilized women.
– Protects from Pelvic Inflammatory disease (PID).
B- Male sterilization:
♦ Also called male sterilization and male surgical contraception.
♦ Permanent contraception for men who will not want more children.
♦ Vasectomy is technically simpler than female sterilization, however the method is not liked in Egypt.
♦ Through a puncture or small incision in the scrotum, the provider locates each of vas deferens and cuts or blocks it by cutting and tying it closed or by applying heat or electricity (cautery).
♦ Works by closing off each vas deferens, keeping semen deprived of sperms.
♦ Semen is ejaculated, but it cannot cause pregnancy.
♦ 3-month delay in taking effect. The man or couple must use condoms or another contraceptive method for 3 months after the vasectomy.
* Correcting misunderstanding:
– Does not remove the testicles. The testicles remain in place.
– Does not decrease sex drive.
– Does not affect sexual function. A man’s erection is as hard, it lasts as long, and he ejaculates the same as before.
– Does not cause a man to grow fat or become weak, less masculine, or less productive
. – Does not cause any diseases later in life.
– Does not prevent transmission of sexually transmitted infections.
Surgical contraceptive methods PPT ( power point presentations):
Surgical contraceptive methods videos: