Sterilisation: What does female sterilisation involve?

What does female sterilization involve?

The majority of female sterilisations involve techniques for blocking the Fallopian tubes (Figure 18.1). This prevents the sperm from reaching the egg. Human eggs are tiny (smaller than the point of a needle). If they are not fertilised the body's natural mechanism is to destroy and remove them they do not accumulate within the blocked tube. The majority of female sterilisations are undertaken laparoscopically (laparoscopy). The Fallopian tubes are visualised by the surgeon and a second tube is introduced into the abdomen to allow the sterilisation (Figure 18.1). At one time heating (diathermy) sealed a section of the tube but occasionally this could damage an adjacent structure such as the bowel. The majority of laparoscopic sterilisations nowadays involve the application of a clip or ring to each tube. A section of the Fallopian tube may be removed (tubal ligation) at open surgery Figure 18.2. Examples of indications for open surgery by mini-laparotomy would include previous surgery, which would make laparoscopy more dangerous or if the abdominal wall is too thick due to excess weight. When laparoscopic sterilisation is planned, it is appropriate to realise that should there be any difficulty, such as the tubes being stuck to other structures, open sterilisation could be required. Laparoscopic sterilisation can usually be undertaken as a day case whereas open sterilisation requires one or two extra days in hospital.

Figure 18.1

Figure 18.2

ESSURE PBC (PERMANENT BIRTH CONTROL)

1 June 2001

A new method of contraception has been developed for those women seeking permanent contraception without the need for a general anaesthetic and major surgery.

The method is called the Essure pbc (permanent birth control) system and comprises an inner wire surrounded by a larger coil or wire with a layer of synthetic fibre between.

The device is loaded into a standard hysteroscopy tube (Figure 24-02) and the majority of insertions can be safely and comfortably performed under local anaesthesia.

The inserter device flattens the coiled spring so that the device can be inserted through the cervix and uterine cavity and into the entrance of the fallopian tubes. About 5-10 mm of the device remains within the uterine cavity but as the inserted device is withdrawn the coiled spring uncoils and lodges firmly in the tube. This is then repeated on the other side.

The presence of the synthetic fibre encourages the growth of fibroblasts (a cell found in connective tissue, which can form collagen fibres) into the device so that in time the sections of the fallopian tubes where the device lies are completely and irreversibly blocked.

The advantages of this form of permanent contraception are the fact that it leaves no scars, and that it can be performed under local anaesthetic with less post-operative side effects than could be expected from conventional tubal ligation procedures, that is, from having your tubes tied.

According to FPA Health, the Essure pbc system represents a new and exciting option for women re questing permanent sterilisation. Outpatient hysteroscopic sterilisation using the Essure system without sedation or general anaesthesia is a successful and safe procedure associated with high rates of patient satisfaction. If practical, women should be scheduled to have their procedures in the proliferative phase of the menstrual cycle to optimise successful placement of Essure devices, especially if the uterus is clinically enlarged.0701

Hysteroscopic placement of tubal microinserts for sterilization may occasionally be associated with intractable pelvic pain requiring removal of the devices.0801

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.