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Review
. 1984 Dec;11(3):603-40.

Sterilization

  • PMID: 6239731
Review

Sterilization

J R Newton. Clin Obstet Gynaecol. .

Abstract

Male and female sterilization is a safe and effective form of permanent contraception. The number of patients accepting this method has rapidly increased over the last ten years and is likely to continue. In some countries the rate has plateaued out: in the USA it has been 31 per cent of all married women for the last eight years. Before sterilization it is important that adequate counselling is given to both partners and that the decision is not hurried. This is emphasized by the number of women and men requesting reversal of sterilization (thought to be between 0.1 and 10 per cent of all sterilizations). These requests for reversal usually come from couples who have remarried, tend to be younger, have fewer live children, have had more abortions, less schooling and are poor users of contraception. In these high-risk patients counselling and time to make the decision is essential. Other studies indicate that regret after puerperal sterilization may be commoner, but the risks of further pregnancies have to be weighed against sterilization regret. The methodology of male sterilization has changed little in the last ten years; it is simple and usually done under local anaesthesia. In contrast, female sterilization methods are constantly being refined, from laparotomy to laparoscopy and from extensive tubal destruction or excision to minimal tubal damage. The common methods now are mini-laparotomy and laparoscopy under local or general anaesthesia, with tubal occlusion by clips, rings or bipolar or thermal coagulation. There is no place now for unipolar diathermy, because of the higher complication rate, especially for major complications such as bowel burns. Recent multicentre studies comparing different methods give low rates for immediate morbidity and surgical complications (0.8 to 2.5 per cent of cases). Technical failure is rare but often due to a pre-existing condition, for example obesity or previous pelvic disease. Some failures are due, however, to difficulties with the instruments, especially at laparoscopy; here further developments and the use of teaching aids for those in training will help to reduce problems. Mortality from female sterilization is low, at 2 to 10 per 100 000 procedures; however, half is due in part to anaesthetic complications (hypoventilation), which can be avoided by intubation, and others are due to pre-existing medical conditions. Long-term follow-up has now shown that sterilization does not cause an increase in menstrual blood loss.(ABSTRACT TRUNCATED AT 400 WORDS)

PIP: An estimated 1/3 of couples using contraception in the world have selected sterilization. The increased acceptability of this method has produced a need for reliable methods of male and female sterilization with low morbidity and mortality rates as well as for proper counseling regarding the permanency of the method. Current methods of female sterilization include choice of general or local anesthesia, a reduction in the size of the incision (mini-laparotomy), and the use of new occlusive methods such as clips or rings via laparoscopy or mini-laparotomy. In terms of timing, there has been a trend toward sterilization more than 6 weeks after a pregnancy rather than in the immediate postpregnancy state. Pregnancy rates after sterilization differ with the method used, surgical approach, operator skill, and type of patient. Acceptable failure rates are seen with the modified Pomeroy tubal ligation method, the tubal ring, and some clips. Menstrual patterns after sterilization are affected by the type of contraception used before the procedure and the presence of abnormal or irregular cycles. Remarriage is the most common reason for requests for reversal. Since reversal is more often sought by young women with low levels of education and fewer children and more abortions, these women should be sterilized by a method that destroys the least tube. Cutting followed by ligation remains the most frequently used method of male sterilization. Vasectomy has a low morbidity, can be reversed, and does not appear to be associated with endocrine or morphologic changes. There is a growing demand for sterilization by couples with no children; in general, couples are now presenting for sterilization at an earlier age and at lower parity.

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