Male and female sterilisation
Gorton, E.
Practitioner 238(1541): 576-579
1994
ISSN/ISBN: 0032-6518 PMID: 8072940 Document Number: 276518
Sexual sterilization is the major form of fertility control in women who are more than 30 years old. Clinicians usually use laparoscopy to perform female sterilization. They may occlude the fallopian tubes with a clip or ring or coagulate the tubes using bipolar diathermy. It is usually performed on an outpatient basis. Nonsteroidal anti-inflammatory drugs can generally control the postoperative pain. A serious immediate but rare complication is death, which is often associated with the anesthesia. Complications related to the experience of the surgeon include damage to bowel or blood vessels and tearing of mesosalpinx. Obesity or pelvic adhesions often necessitates either laparotomy or abandonment of sterilization. Some long term complications are hysterectomy and menstrual disorders. Presterilization counseling needs to examine the possibility of regret and to discuss failure rates and complications. Reasons for regret are young at time of sterilization, psychosexual disorder, change of partner, change in financial circumstances, sterilization performed at time of crisis, and death of a child. The failure rate for the Filshie clip is 0.1%. Reasons for failure include pregnant at the time of the procedure, clips placed across the round or ovarian ligament, incomplete occlusion, and fistula formation and recanalization. Failure rates are higher when the sterilization is done during pregnancy because the tubes are thicker and more vascular. Vasectomy involves severing and ligating the vas deferens in both scrotums. Immediate complications are hematoma and infection. Vasectomy patients need to bring 2 semen samples for sperm counts 3-4 months after the procedure. Azoospermia signals a successful vasectomy. If sperm are still present 5-6 months after the procedure, the surgeon should conduct exploratory surgery under general anesthesia. Long term side effects include testicular discomfort and perhaps prostate cancer. The evidence is unclear about the link between vasectomy and prostate cancer, however.