TERMINAL METHODS

(STERILIZATION)
WHAT IS STERILIZATION??
Is permanent method of birth control
In certain cases, sterilization can be reversed
Mainly meant or men and women who do not
intend to have children anymore in the future
Male sterilization & female sterilization

Anatomy of male reproductive organs
Testes: formation of sperm &
testosterone
Epididymis: reservoir of sperm and
maturation take place.
Seminal vesicle: secrete a significant
proportion of the fluid that ultimately
becomes semen.
Vas deferens: muscular tube which transmit
spermatozoa from epididymis to the
ejaculatory duct
Ejaculatory duct: During ejaculation, the
ejaculatory duct opens and expels sperm
into urethra


Male sterilization
Procedure: vasectomy
Involves cutting the vas deferens in order
to close off the tubes that carry sperm
from the testicles prevents the release
of sperm when a man ejaculates
is done only when a man asks for it and it
should be considered only when a man
wants to be permanently sterile.
Vasectomy can sometimes be reversed,
but the reversal procedure is not always
successful.



How is a vasectomy done?
Preoperative preparation
- ask the patient to shave the scrotum
- Premedication consists of oral valium 10 mg and paracetamol
a) Conventional vasectomy
- involve making 1 or 2 small incisions in the skin of the scrotum.
-pull each vas through the opening and cut the vas (remove a small section
of each vas.
- The 2 ends of each vas will then be sealed shut, using stitches or cautery
(burning with a hot wire or electrical current)
- put each tube back in the scrotum and close the cuts in the scrotum with
stitches
**done under local anesthesia (to numb the scrotum)



b) No scalpel vasectomy (NSV)
- scrotum is shaved and aseptic procedure is done
- gently finding the vas deferens on one side and bringing it
to a position immediately under the scrotal skin (figure).
- hold them in place
- apply the local anaesthesia
- special instrument is used to make a tiny puncture in the
skin
- stretch the opening so the tube can be cut and tied.

** This approach causes very little bleeding.
**The punctures heal quickly by themselves - so no stitches may
be needed.





After the procedure
The acceptor is not immediately sterile after the operation
For 2 to 4 months use other birth control methods until your semen test
shows that there are no sperm (at least 3-4 successive semen test)
It takes an average of 15 ejaculations for all of the sperm to be flushed out of
the vas tubes
Avoid cycling or lifting heavy weight

Causes of failure
Associated with mistaken identification of
vas deferens
Spontaneous recanalization of the vas
May be more than 1 vas deferens in one
side
Advantages
Compared to
female
sterilization,
vasectomy is
simpler
highly effective,
one-time procedure
that provides
permanent
contraception.
more effective
can be performed
on an outpatient
basis,
has fewer
complications
less expensive


Complications
Early
complication:
pain, scrotal
haematoma &
local infection
Sperm
granules
Spontaneous
recanalization
Autoimmune
respose due
to blocking of
VD
Psychological
common in
male
undergone
vasectomy
under
pressure
Female sterilization
effective and permanent form of contraception
small failure rate
Sterilisation is only for people who have decided they do not want any
children, or further children in the future.
Before you decide
Lets discuss:
Temporary methods are also available
Sterilization is a surgical procedure
Has risks and benefits
Prevents having any more children
Permanentdecision should be
carefully considered
You can decide against procedure
any time before surgery Are you ready to choose
this method?
Want to know more about
the procedure?


a) laparoscopy


L
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Electrocoagulation
- Monopolar
- bipolar
Mechanical devices
- Falope ring
- Hulka clip
Briefly about the procedure
done through abdominal approach with a specialized instruments called
laparascope
abdomen is inflated with gas ( carbon dioxide, nitrous oxide, or air)
Laparoscope is introducd to the abdominal cavity to visualize the tubes
falope rings or clips are applied to occlude the tubes

Suitable time:
At any time other than after delivery

Advantages:
short operating time
Shorter stay in the hospital
Small/minimal scar



Patient selection:
Not advisable for postpartum patients for 6 week following
delivery
Can be done in concurrent procedure to MTP
Hb % should not be less than 8
no associated medical disorders such as heart disease, diabetes
and hypertension
Recommended that the patient is kept minimum of 48 hrs after
the operation

Complications:
Very uncommon
If occur, may be of serious nature (may require surgical
intervention)
Ex: puncte of large blood vessels



b) Minilaparotomy
is done using general or regional (eg, spinal) anesthesia.
The physician makes a small incision (one to three inches) in the
abdomen
then removes a section of the fallopian tubes on each side.

Suitable time:
done one to two days after childbirth.

Advantages:
fallopian tubes have been completely cut, failure rate almost zero

Disadvantages:
greater need for pain medication
slightly longer recovery time
larger surgical incision than with a laparoscopic procedure

c) Hysteroscopic sterilization
2 types:-
1) essure PET fibres (2002)
2) Adiana- non-absorbable silicone
elastomer matrix (2009)
uses very small coils, which are inserted
through the cervix and uterus into the
fallopian tubes
After the coils are placed, scar tissue
develops around them causing the tubes
to become sealed shut.
This process happens gradually over time
woman must therefore use another form of
birth control for three months after the
coils are placed
x-ray test called a hysterosalpingogram
(HSG) is performed to confirm that the
tubes are blocked.

Advantages:
hysteroscopic sterilization are that it can be done without sedation or general
anesthesia
no incisions.
Hysteroscopic sterilization costs less
less severe post-operative pain.

Disadvantages:
possibility that the coils cannot be successfully placed in both tubes
need for another method of birth control for three months after the coils are
placed
need for a test to confirm that the procedure has been successful
Parks textbook of preventive and social medicine
http://my.clevelandclinic.org/
http://www.tawakal.kpjhealth.com.my/
http://theturekclinic.com/