FAQ - Sterilizations

Sterilizations  

Sterilizations are the surgical procedures for permanent contraception for the couples who have completed their family. The procedure can be performed on the male partner as well as on the female partner.

Eligibility for Sterilization

1. The client must be married. 2. Age of male client should preferably be under 60 years. 3. Female client should be between 22 years to 45 years of age. 4. The number of live children is not a necessary criterion; however, at least one live child above the age of 1 year is preferred. 5. Client’s spouse must not have undergone successful sterilization operation. 6. Client must be in a perfectly balanced state of mind. 7. The consent for the mentally ill patients must be given by the legal guardian or the spouse. Such mental illness should be certified by a psychiatrist.

Counselling

Counseling should be imparting the information which will help the client to take own voluntary decision about the method of contraception. The client should be counselled properly before he / she signs the consent form. Counselling should not be process of promotion of particular method of contraception. 1. Client must be informed about all the available methods of contraception. 2. Client must make an informed decision for sterilization voluntarily. 3. The counselling must-be done in the language the client understands thoroughly. 4. All attempts must be made to impart the knowledge about the surgical procedure to be undertaken, aftereffects of the operation, possible side effects and potential complications. 5. Following features of sterilization operation must be explained to the client a. It’s safety and simplicity b. It is a permanent method of contraception. c. It is a surgical procedure having small risk which may require further treatment. d. It does not affect sexual performance, ability, desire or satisfaction. e. It does not affect the ability and capacity of client to perform normal day to day functions. f. Sterilization provides protection only against the pregnancy. It does not give any protection against any sexually transmitted diseases, reproductory tract infections nor against HIV/AIDS. g. Even at the best of the hands and under optimal conditions, it does carry small chance of failure. 6. Any doubts in the clients mind must be clarified. 7. The clients must have clear understanding that at any moment, she has a right to turn back from the decision of sterilization and due to that, her right to seek for any other reproductive health services will not be affected. 8. The client must be given clear idea that reversal procedure is possible but the success or reversal procedure cannot be guaranteed.

Informed Consent

Consent for the sterilization operation should not be obtained under coercion or when the client is under physical or mental stress. Consent shuold not be obtained when the client is sedated or experiences stress associated with some pregnancy-related events or problems. Client must sign a printed application and consent form for sterilization. Written consent of the spouse is not required for sterilization operation.

Vasectomy

The Surgical procedure performed on male partner for sterilization is called as Vasectomy. Acceptance of vasectomy is much less compared to that of tubectomy, even though it is a far simpler and safer method.

Misconceptions Regarding Vasectomy

In many male dominated cultures, contraception is thought to be a woman’s responsibility. Usually, in most of the families, man is the principle earning member; hence it is felt that he should not be exposed to any health risks or inconveniences. Fear of sexual problems after vasectomy is common. Many men confuse vasectomy with castration and believe that the operation will result in impotence and loss of sexual desire. Some believe that there is a failure to ejaculate after vasectomy. There is a fear that after vasectomy, men loose their physical vigour and capacity to do heavy work.

Counselling

Careful and accurate counselling is essential before any man is submitted to vasectomy. The counselling should take place in a free atmosphere in a language the man fully understands. It should be in the presence of his wife or any other person if he wishes so.

Following information should be delivered to the patient

1. Description of the various temporary and permanent methods of family planning, including the merits and demerits of all. 2. An explanation of the permance of vasectomy; with clear picutre of the scope of the vaso-vasostomy. 3. Necessity to continue some other method of contraception for some time even after vasectomy until the semen becomes azoospermic 4. Contraindications to vasectomy and possible side effects and failure rate of vasectomy 5. Assurance of unprejudiced family planning adivce even if he withdraws his consent for vasectomy.

Contraindications

1. Local skin infections such as scabies or genital tract infections if present, should be treated before surgery. 2. Local pathology, making operation difficult; viz. varicocoele, large hydrocoele, inguinal hernia, filariasis, scar tissue of previous surgery, etc. should be looked for. Such cases should be operated by a specialist surgeon in a well equipped hospital. 3. Disorders of blood coagulation. 4. Cases of diabetes mellitus should be deferred till it is brought under control. 5 Recent attack of coronary heart disease. 6. Marital, psychological or sexual instability.

Types of Vasectomy

Routine Vasectomy : A small incision is taken on the scrotum about 1" away from the start of vas deference on each side. The vas is exposed and a small piece of vas is excised. Both the ends of vas are ligated.

No Scalpel Vasectomy : In this modern technique, incision by scalpel is avoided. A puncture of 1 mm is produced by sharp forceps to reach the vas.

Possible Complications

Swelling Bruising Pain Hematoma Infection Allergic Reactions Sperm Granuloma

Postoperative Instructions

Should take rest for 24 hours. Should not ride astride any vehicle. Should wear scrotal support for three months. • Should not have unprotected intercourse for three months. After this period, before starting the practice of unprotected intercourse, he should get his semen examined to confirm that there are no sperms present in the semen.

Advantages of Vasectomy

1. Simple, safe and short procedure 2. Can be performed under local anaesthesia 3. Person can return home within few hours. 4. Person can resume his normal work after 48 hours. 5. The scar is very minute. 6. Does not lead to any sexual problems or dysfunction or any medical disease in later life. 7. Very low failure rate.

Disadvantages of Vasectomy

1. Since the length of the vas after the site of ligature is quite long, the number of sperms present in the part distal to the site of ligation is considerable. These sperms are capable of fertilizing woman. Therefore, additional contraceptive precaution like condom should be used till these sperms are completely ejaculated. This requires about 15 ejaculations or a period of 3 months. 2. Recanalization, though possible, its, success cannot be guaranteed and is limited. 3. Difficult to promote in male dominated societies.

Female Sterilization

This includes all the procedures that effect tubal occlusion In females-Though there are various approaches for female sterilization, now-a-days, abdominal approach is preferred. There are two types of surgical procedures to perform female sterilization Minilaparotomy and Laparoscopic Tubal Ligation.

Minilaparotomy

This procedure can be done on all women following abortion or menstruation.

Procedure

Abdomen is opened under suitable anaesthesia. Fallopian tubes are identified. A loop of the tube is crushed and ligated with catgut. The loop is then excised. The same procedure is repeated on the other side tube.

Anaesthesia :

Local, Spinal or General 27

Advantages

Can be performed on any woman Can be performed under local anaesthesia Safe & Simple surgical procedure Effective immediately after the surgery Failure rate very low (0.1% - 0.4 %)

Possible Complications Risk of

Injury to urinary bladder, small intestine Infection Wound non-union

Puerperal Sterilization

The sterilization in women can be performed after delivery during puerperal period. It is usually performed 48 hours after the delivery. The principles and steps of this technique are the same as that of Minilaparotomy with the difference that the incision is taken higher up on the abdomen at the level of the fundus of the uterus.

Advantages

Operation is done while the woman is in the hospital and no separate admission for sterilization is required. Technically easier

Laparoscopic Sterilization

This procedure is ideally suitable to performed after the menstrual period after early abortion. When this procedure is to be performed, following delivery or late abortion, the operation should be deferred till the uterus becomes normal size.

Advantages

The operation can be perform through a very small incision which may not require a stitch. It can be performed under local anaesthesia. Woman can go home after 24 hours Rapid postoperative recovery Few complications

Disadvantages Costly equipment required Specially trained surgeon required Complications, although fewer, when occur, can be of serious nature Careful case selection necessary Unsuitable for recently delivered woman, obese woman, women having prior history of abdominal operation (s) and woman suffering from cardiorespiratory disease Recanalization, though possible, its success is limited.

 

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