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Female sterilization

Female sterilization

Female sterilization is an effective form of contraception that permanently prevents a woman from becoming pregnant. Sterilization does NOT protect against sexually transmitted infections (STIs), including HIV.

The operation involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb. This prevents the eggs from reaching the sperm and becoming fertilized. It can be a fairly minor operation, with many women returning home the same day.

In most cases, female sterilization is more than 99% effective, and only one in 200 women will become pregnant after the operation.

Almost any woman can be sterilized. However, sterilization should only be considered by women who do not want any more children, or who do not want children at all. Once a woman is sterilized, it is very difficult to reverse the process, so it is important to consider other contraceptive options.

Couples often decide upon sterilization mutually, when they both feel they do not want any more children. If a couple decides upon sterilization as their preferred contraceptive method, either partner could be sterilized. If both options are acceptable, vasectomy is preferable. It is simpler, safer, easier and less expensive.

More frequently, sterilization is performed when women are over 30 years old and have had children, although some younger women who have never had a baby choose it.

Sterilization does not cause weight gain and it does not reduce sexual desire. It does not cause any major change in bleeding patterns.

Methods:

The doctor needs to access the fallopian tubes. S/he will do so via 'laparoscopy' or 'mini-laparotomy'.

Laparoscopy

This is the most common method of accessing the fallopian tubes. A small cut is made in the abdominal wall near the belly button. A small flexible tube that contains a light source and a camera. This is called a laparoscope. The camera relays images of the inside of your body to a television monitor. This allows the surgeon to clearly see the fallopian tubes.

Additional cuts can be made in the abdominal wall if other instruments, such as surgical scissors, need to be inserted.

Mini-laparotomy

This involves making a small incision, usually less than 5cm (2 inches), just above the pubic hairline. The surgeon can then reach into the pelvis and access the fallopian tubes through this incision.

A laparoscopy is usually the preferred option because it is faster. However, a mini-laparotomy may be recommended for women who have had recent abdominal or pelvic surgery, who are obese, or who have a history of pelvic inflammatory disease.

Whether accessing the fallopian tubes via laparoscopy or mini-laparotomy, the procedure followed afterwards is the same. The fallopian tubes will be blocked, either by applying plastic or titanium clamps, by applying rings (a small loop of the fallopian tube is pulled through the silicone ring which is then clamped shut), or by tying and cutting the tube (which destroys 3-4cms of the tube).

Hysteroscopic sterilization (fallopian implants)

Fallopian implants are implants which block the fallopian tubes. They are usually inserted under local anaesthetic.

A narrow tube with a telescope at the end called a hysteroscope is passed through the vagina and cervix. A guidewire is used to insert a tiny piece of titanium metal called a microinsert into the hysteroscope, then into each of your fallopian tubes. This means that the surgeon does not need to cut into the body.

The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tubes. Women who have had hysteroscopic sterilization should carry on using contraception until an imaging test has confirmed that the fallopian tubes are blocked.

The test can be performed via X-ray, ultrasound, or a hysterosalpingogram (HSG) (a type of X-ray that is taken after a special dye has been injected to show up any blockages in the fallopian tubes).

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

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