Q 18. 1 Who can be sterilised?

   Either partner may be sterilised usually by means of a minor operation. Sterilisation is suitable for people who have completed their family or for those who are certain that they never want to have children. The procedure should be regarded as irreversible and therefore permanent. Many surgeons only feel comfortable undertaking sterilisation for patients who have reached a certain age but will make allowance for extenuating circumstances. My own view is that sterilisation is usually not appropriate earlier than 28 – 30 years of age.

Q 18. 2 What does female sterilisation involve?

  The majority of female sterilisations involve techniques for blocking the Fallopian tubes (Figure 18.1). This prevents the sperm from reaching the egg and the embryo (fertilised egg) from reaching the uterus. 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 (Q23.24). 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. 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.

Q 18. 4 How quickly does female sterilisation work?

The operation provides immediate protection. You can make love as soon as you feel ready. It must be stressed that contraception is required before the operation. If there are sperm in the female genital tract before the sterilisation, fertilisation could occur. If you have an IUCD that is to be removed at the time of sterilisation, you should abstain or use a barrier method for at least seven days before the sterilisation. If an embryo has been conceived and it is above the sterilisation point, the pregnancy could implant in the Fallopian tube (ectopic pregnancy) which is dangerous. If the embryo is below the sterilisation point, an ongoing pregnancy within the uterus would not be prevented by the operation.

Q 18. 5 How will I feel after laparoscopic sterilisation?

    It may take a day or two for the effects of the anaesthetic to disappear completely so that you will need to take things easy for at least a few days. There may be some discomfort at the small incision sites but mild pain relief such as paracetamol is probably all that will be required.

   Laparoscopic sterilization will have no effect on your hormones so that your sex drive and enjoyment of intercourse should not be diminished.

Q 18. 6 What are the risks of female sterilisation?

    Even with the greatest care and surgical skill, there are risks with any surgical procedure (Q4.21). When surgery is performed within the abdominal cavity, blood vessels and organs such as the bowel may be inadvertently injured. The majority of female sterilisations are performed with laparoscopy (Q23.24). There is a one in a thousand risk of complications occurring..

Sometimes it may not be possible to visualise the Fallopian tubes adequately and your gynaecologist may decide to transfer from a laparoscopic approach to an open procedure.

Q 18. 7 What effect will female sterilisation have on my periods?

   Many women find that their periods seem to be heavier some time after they were sterilized. Usually this occurs because they had been taking the pill before they were sterilized and the pill had been masking the problem. Others would have developed period problems later in life even if they had not been sterilized. The question as to whether sterilization is a cause of heavy periods remains unresolved although research tends to show no difference in the incidence of period problems following sterilization whether the female or male partner has the operation.

Q 18. 8 Is my partner’s consent required before I am sterilised?

   There is no legal requirement, in the UK, for you to have consent for sterilisation from your partner.

Q 18. 9 My family is complete and I want to stop taking the pill but my periods were previously heavy. What are my options?

• Firstly, there may be no good reason to stop taking the pill. If you are healthy, not overweight, do not smoke, do not have high blood pressure and you have not had a blood clot problem (thromboembolism – Q4.21), there is no medical reason to stop the pill. If you stop taking the pill when you are sterilised, your periods are likely to change back to how they were before the pill was taken. If they were troublesome before, they are likely to cause you problems again (Q15.4).

• You could stop the pill for a few months and use a barrier method (Q13.10) to see what your periods are like before you have a sterilisation operation.

• The LNG-intra-uterine system (Mirena – Q14.26) provides excellent contraception and may reduce period problems. Failure rates with Mirena are lower than with sterilisation (Table 13.1).

• Hysterectomy (hysterectomy) would provide sterilisation and you would no longer have periods. This operation may be a reasonable option particularly if your womb is enlarged with fibroids (Q23.14)

• Endometrial ablation (Q24.28) could be performed at the time of sterilisation if you have heavy periods, no obvious structural problem with your uterus and you do not want to have a hysterectomy. Ablation seems to improve periods in about 80% of cases.

Q 18. 1 Who can be sterilised?

Q 18. 2 What does female sterilisation involve?

Q 18. 3 How failsafe is female sterilisation?

Q 18. 4 How quickly does female sterilisation work?

Q 18. 5 How will I feel after laparoscopic sterilisation?

Q 18. 6 What are the risks of female sterilisation?

Q 18. 7 What effect will female sterilisation have on my periods?

Q 18. 8 Is my partner’s consent required before I am sterilised?

Q 18. 9 My family is complete and I want to stop taking the pill but my periods were previously heavy. What are my options?

Q 18. 10 What is a vasectomy?

Q 18. 11 What are the risks of vasectomy.

Q 18. 12 How effective is vasectomy?

Q 18. 13 How do vasectomy and female sterilisation compare?

Q 18. 14 Which of us should be sterilised?

Q 18. 15 Is it possible for my sterilisation to be reversed?

Q 18. 16 Could I have some useful Web sites?

Q 18. 17 Are there any support groups?

Women’s Health – Home Page

Q 18. 10 What is a vasectomy?

This is an operation on the male partner in which the tubes (vas deferens) carrying the sperm from the testicles are divided and tied. Under local anaesthetic, a small incision is made in the scrotum to provide access to the vas deferens.

Q 18. 11 What are the risks of vasectomy.

Every operation carries a small risk (Q4.21). The specific risks for vasectomy are bruising and pain. This may be helped by wearing tight fitting underpants for seven days and nights after the operation. There have been reports of a possible link between prostate and testicular cancer and vasectomy but this risk remains unproven.

   Following vasectomy, there will still be sperm above the cut in the vas deferens and it will take between 2-4 months for them to disappear. Semen analysis will be arranged about three months following the operation. Intercourse can recommence as soon as the man feels comfortable but additional contraception is essential until there have been two semen tests showing absence of sperm.

Q 18. 12 How effective is vasectomy?

Quoted failure rates vary from 1 in 1,000 to 1 in 7,000. These failures are much lower than with female sterilisation.

Q 18. 13 How do vasectomy and female sterilisation compare?

These are compared in Table 18.1.

Table 18.1 A comparison of female sterilisation with vasectomy.

Female sterilisation

Vasectomy

Usually performed under general anaesthetic.

Usually performed under local anaesthetic.

Requires admission to hospital usually for one day only.

Performed in the clinic.

Effective immediately.

Takes about three months to be effective.

Failure rate 1:400

Failure rate 1:1000 – 7000

More risks than vasectomy.

Operative risks minimal.

Best considered as irreversible.

Also best regarded as irreversible.

Q 18. 1 Who can be sterilised?

Q 18. 2 What does female sterilisation involve?

Q 18. 3 How failsafe is female sterilisation?

Q 18. 4 How quickly does female sterilisation work?

Q 18. 5 How will I feel after laparoscopic sterilisation?

Q 18. 6 What are the risks of female sterilisation?

Q 18. 7 What effect will female sterilisation have on my periods?

Q 18. 8 Is my partner’s consent required before I am sterilised?

Q 18. 9 My family is complete and I want to stop taking the pill but my periods were previously heavy. What are my options?

Q 18. 10 What is a vasectomy?

Q 18. 11 What are the risks of vasectomy.

Q 18. 12 How effective is vasectomy?

Q 18. 13 How do vasectomy and female sterilisation compare?

Q 18. 14 Which of us should be sterilised?

Q 18. 15 Is it possible for my sterilisation to be reversed?

Q 18. 16 Could I have some useful Web sites?

Q 18. 17 Are there any support groups?

Women’s Health – Home Page

Q 18. 14 Which one of us should be sterilised?

You should consider together all the options carefully. Above all you must be absolutely certain that your family is complete. The argument that sterilisation is the most effective contraception is no longer valid as the LNG-intra-uterine system (Q14.26) is associated with a lower failure rate than female sterilisation. From a medical point of view vasectomy is easier and associated with fewer complications than female sterilisation.

One partner may be many years older than the other or have a medical history that would contraindicate parenting a child so this partner may feel that he or she is the least likely ever to regret the operation. There may be an anatomical problem making sterilisation particularly hazardous for one partner.

Q 18. 15 Is it possible for my sterilisation to be reversed?

   Sterilisation should not be regarded as temporary contraception. You should not contemplate sterilisation unless you are absolutely certain that your family is complete.

Doctors, perhaps more than many others, are well aware that life does not always follow an individual’s aspirations. At least six times each year, I see a woman who requests reversal of sterilisation. The notes always document that at the time of counselling before the sterilisation she was absolutely certain that her family was complete. The most common reason for the request for reversal is a change of partner. Clearly the younger the individual at the time of sterilisation, the longer the time for the sterilisation to be regretted.

   There is sometimes a possibility for sterilisation to be reversed but surgery is by no means always successful. Reversal of female sterilisation is only possible when small sections of the Fallopian tubes have been blocked. If all, or a large parts, of the tubes have been removed, reversal would not be possible. If just one clip has been applied to each tube, reversal is successful in about 70% of cases. Medical insurance companies and most purchasing authorities in the NHS are unlikely to fund reversal of sterilisation.

If reversal of sterilisation fails there are still other possibilities. For the woman, pregnancy may still be possible by IVF (Q10.24). For the man, donor insemination (sperm from an anonymous healthy donor with similar physical characteristics) could be inseminated into the female partner. Another option is for sperm to be retrieved from above the sterilisation sight by surgical aspiration. Individual sperm can be injected into individual eggs (ICSI – Q10.25) obtained during IVF.

Q 18. 1 Who can be sterilised?

Q 18. 2 What does female sterilisation involve?

Q 18. 3 How failsafe is female sterilisation?

Q 18. 4 How quickly does female sterilisation work?

Q 18. 5 How will I feel after laparoscopic sterilisation?

Q 18. 6 What are the risks of female sterilisation?

Q 18. 7 What effect will female sterilisation have on my periods?

Q 18. 8 Is my partner’s consent required before I am sterilised?

Q 18. 9 My family is complete and I want to stop taking the pill but my periods were previously heavy. What are my options?

Q 18. 10 What is a vasectomy?

Q 18. 11 What are the risks of vasectomy.

Q 18. 12 How effective is vasectomy?

Q 18. 13 How do vasectomy and female sterilisation compare?

Q 18. 14 Which of us should be sterilised?

Q 18. 15 Is it possible for my sterilisation to be reversed?

Q 18. 16 Could I have some useful Web sites?

Q 18. 17 Are there any support groups?

Women’s Health – Home Page

Q 18. 16 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter:-

Q 18. 1 Who can be sterilised?

Q 18. 2 What does female sterilisation involve?

Q 18. 3 How failsafe is female sterilisation?

Q 18. 4 How quickly does female sterilisation work?

Q 18. 5 How will I feel after laparoscopic sterilisation?

Q 18. 6 What are the risks of female sterilisation?

Q 18. 7 What effect will female sterilisation have on my periods?

Q 18. 8 Is my partner’s consent required before I am sterilised?

Q 18. 9 My family is complete and I want to stop taking the pill but my periods were previously heavy. What are my options?

Q 18. 10 What is a vasectomy?

Q 18. 11 What are the risks of vasectomy.

Q 18. 12 How effective is vasectomy?

Q 18. 13 How do vasectomy and female sterilisation compare?

Q 18. 14 Which of us should be sterilised?

Q 18. 15 Is it possible for my sterilisation to be reversed?

Q 18. 16 Could I have some useful Web sites?

Q 18. 17 Are there any support groups?

Women’s Health – Home Page

Q 18. 17 Are there any support groups?

   The Family Planning Association (FPA) provides information about contraception and details of local clinics:

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