Sterilisation

Popular ‘permanent’ method of contraception for couples who are certain their family is complete or do not wish to have children.  However, many are opting instead to long-acting reversible methods of contraception e.g. implant/coils.

Female sterilisation

There are various laparoscopic and hysteroscopic methods of female sterilisation:

  • Laparoscopic- method of choice for most cases
    • ‘Filshie clips’- a titanium clip is applied at right angles to the isthmus.  Initially blocks the tubes by pressure, but then necrosis takes place and expansive rubber in the clip maintains the blockage
    • Falope rings- the ring is also applied to the isthmal region, works in much a similar way
    • Pomeroy technique- involves tieing off the tubes and cutting them.
    • Irving technique- involves tieing off the tubes and cutting them but then suturing them into the myometrium of the uterus.
  • Hysteroscopic (may be better in obese patients/patients who have had previous abdominal surgery/patients who would not do well under general anaesthetic/patients who would prefer not to have major surgery)
    • Essure- involves inserting a catheter up to the tubes and depositing a solution that causes a fibrotic reaction and ‘plugs’ the tubes.
    • Ariana- involves inserting two small pieces of silicone into the opening of the tubes to block them.

Pros and Cons of female sterilisation

  • Pros
    • Effective immediately
    • Non hormonal
  • Cons
    • Risk of surgery
    • Risk of regret
    • Cannot always be reversed (and rarely on the NHS)
    • Requires specialist skills
    • Relatively high failure rates compared with LARC and vasectomy
  • Complications
    • Short-term: bleeding and infection (rare); pain (tubal ischaemia); damage to other organs e.g. bowel; very small operative mortality (1/10000)
    • Long-term: ectopic pregnancy; regret/psychosocial problems

Contraception should be used until the next period.

Male sterilisation (vasectomy)

  • Diathermy or division of vas deferens and fascial interposition, usually under local anaesthetic.
  • More reliable than female sterilisation (lower failure rate- 1:2000 compared with 1:200).
  • Does NOT always work immediately- contraception required until azoospermia confirmed (2 negative semen samples at 12/16 weeks).
  • Complications include haematoma, infection, chronic pain.
  • Reversal is not usually successful (not available on the NHS)

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