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PubMed1993

Vasal sterilization in China.

Vasal sterilization has become the most popular method of contraception in many countries since the 1960's. In China, an estimated 30 million men have undergone voluntary sterilization. There have been two major developments in vasectomy technique, the no-scalpel method and the percutaneous chemical vas occlusion. These methods have significantly increased the acceptability of male sterilization in some cultures since no incisions in the skin are required. The effective rate is over 98% for both methods. The clients experience less pain, fewer complications and more rapid recovery. Epidemiological studies of large numbers of volunteers receiving no-scalpel or chemical vas occlusion procedures have resulted in a clearer picture of their safety, effectiveness, simplicity and economy. Meanwhile, some promising reversible vasal sterilization techniques have also been studied.

China↗

PubMed1983

The safety and efficacy of tubal sterilization: an international overview.

This article presents a synthesis of some of the major published studies on the efficacy and safety of tubal sterilization. The conclusions of this overview are that tubal sterilization is a safe operation, long-term sequelae of tubal sterilization have not been well documented, and the risk of pregnancy following tubal sterilization is less than 1 in 100. Continued study is needed to determine how to make a safe and effective procedure even safer and more effective.

Female↗

PubMed1984

Sterilization-associated deaths: a global survey.

Except for data from several geographically limited studies, little is known globally about the number and causes of death associated with surgical sterilization. To identify clinical characteristics and problems leading to deaths related to the procedures, the International Planned Parenthood Federation ( IPPF ) and the Centers for Disease Control (CDC) in the United States collaborated in a global mail survey of 4642 physicians. Usable responses were received from 1298 physicians (28%) in 80 countries. Fifty-five sterilization-associated deaths which occurred from January 1, 1980 to June 30, 1982 were reported. The most frequently reported causes of death were infection, anesthetic complications, and hemorrhage. There were some regional differences in the relative frequencies of these causes. Most cases did not involve surgical accident. The characteristics most frequently associated with the reported fatal procedures were: interval sterilizations, minilaparotomy incision, tubal ligation and general anesthesia. Most deaths were attributable to the surgical sterilization procedure.

Adolescent↗

PubMed1985

Psychological adjustment to and recovery from laparoscopic sterilization and infertility investigation.

One hundred and thirty-one patients undergoing elective laparoscopic surgery for sterilization or infertility investigations were examined in a prospective study. Firstly, the contributions of the reason for undergoing the operation to the patients' psychological adjustment and recovery, is examined. Measures were taken of personality, mood, physical symptoms, vital signs and the patients' speed of returning to normal activities. The reason for laparoscopy does not appear to influence the amount of fear immediately before and after the operation, post-operative physical symptoms, nor the majority of mood states at follow up. There were significant differences between infertility and sterilization patients on state anxiety on the morning of surgery, vital signs, post-operative intramuscular analgesia, and the speed of returning to normal activities. In particular, sterilization patients did not report greater pain but received more analgesia, and returned to their normal activities more rapidly than infertility patients. Secondary infertility patients showed the slowest rate of return to normal activities, and reported more adverse mood states at 1 week follow up. The investigation of patients' attitudes to the operation revealed that patients undergoing sterilization and infertility investigation are concerned about the costs and benefits of the operation which include not only influencing fertility, but influencing menstruation and sexual activity. Patients misunderstood information about surgery, and the majority of patients welcomed additional psychological preparation. Suggestions concerning the management of patients undergoing laparoscopy for different fertility reasons are discussed.

Analgesia↗

PubMed1989

Ectopic pregnancies due to contralateral fistulas after sterilization by electrocoagulation; case reports.

Three cases of post-sterilization tubal pregnancy are discussed. The sterilizations were performed by bipolar electrocoagulation. The location of the pregnancy was distal to the site of sterilization. There was no continuity between the segment containing the ectopic pregnancy and the uterus. Spermatozoa reached the site of fertilization via a tuboperitoneal fistula. The existence of the fistulas was confirmed by a methylene blue test. In two cases fistulas existed on the contralateral side to the ectopic pregnancy. In the third case, bilateral fistulas were found. So, on performing a salpingectomy for ectopic pregnancy after sterilization failure, we have to be aware of contralateral fistulas. Also good understanding of the mechanism of extra-uterine pregnancy secondary to transperitoneal migration of spermatozoa is important when doing conservative tubal surgery.

Adult↗

PubMed1984

Tubal polyps, epithelial inclusions, and endometriosis after tubal sterilization.

Histologic findings in 133 previously ligated fallopian tubes of women who underwent subsequent hysterectomy and bilateral salpingectomy were compared with those of 50 normal fallopian tubes and related to four surgical procedures for sterilization. Dilatation of proximal tubal lumen, flattening of the folds, polyps, and increase of mitotic activity of the epithelium was subsequent to tubal occlusion in any case, regardless of the type of sterilization. After sterilization by ring, ligation, and coagulation, the incidence of epithelial inclusions was significantly different from that observed after sterilization by clips. Focal endometriosis was only found after tubal ligation and coagulation. It is suggested that epithelial inclusions were the result of surviving fragments of tubal epithelium translocated in the tubal wall during the procedure, and that endometriosis was caused by implantation of expelled menstrual products through the open lumen into the healed ligation area.

Endometriosis↗

PubMed1985

Regret after decision to have a tubal sterilization.

To determine characteristics associated with regretting sterilization that can be determined preoperatively, we analyzed data from the Collaborative Review of Sterilization (CREST), a multicenter, prospective, observational study. Of 5022 women, 2.0% regretted having had a tubal sterilization at 1 year after the procedure and 2.7% did so after 2 years. Using a multivariate analysis to identify risk factors for regret, we found that almost all characteristics were more closely associated with regret at 1 year than at 2 years postoperatively. Of the characteristics we examined that could be objectively determined preoperatively, we considered only age less than 30 years and (for whites) a concurrent cesarean section to be risk factors for regret at 2 years after sterilization. However, in absolute terms, less than 10% of women with both those risk factors regretted having the procedure.

Adolescent↗

PubMed1986

A study of women requesting interval contraceptive sterilization who do and do not return for surgery.

With the use of initial records of 1128 women who presented for interval tubal ligation, characteristics of those who were sterilized were juxtaposed with characteristics of those who did not return for surgery. Follow-up telephone interviews were conducted to explore regret after sterilization among 268 sterilized women. The subsequent histories of 144 women who did not return for surgery were examined, to determine whether failure to return might have screened, selectively, the women at greatest risk of regret. High levels of subsequent unwanted conception and pregnancy wastage were found in the nonreturn group. Institutional factors were often implicated in failure to return. Variables available at initial presentation are proposed to identify women who risk adverse consequences of postponed sterilization, to facilitate return without increasing regret.

Adult↗

PubMed1988

Hysterectomy, tubal sterilization, and the risk of breast cancer.

Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.

Adult↗

PubMed1984

Ectopic pregnancies following female sterilization. A matched case-control analysis.

The present study compared 15 ectopic pregnancies occurring after female sterilization (EPs) with 30 non-pregnant control patients who had also undergone female sterilization (NPCs) for a history of induced abortion, any pelvic surgery, abdominal surgery, or pelvic infection. EP cases and controls were individually matched for clinic, surgeon, surgical approach, tubal occlusion technique, and date of operation, as well as patients age and parity. The only significant difference was the greater proportion of EP patients, reporting a history of induced abortion (matched triplet odds ratio = 9.0, 95% confidence limits = 1.39, 58.26). Women with EPs were further compared with 78 women with post-sterilization intra-uterine pregnancies (unmatched). Results again show a significantly greater risk of conceiving an EP following previous induced abortion (odds ratio 5.8, 95% confidence limits = 1.78, 18.60). Women with previous abdominal surgery also ran a significantly higher risk of post-sterilization EP (odds ratio 10.0 95% confidence limits = 2.45, 40.83). Limitations of the data and clinical implications of the results are discussed.

Abdomen↗

PubMed1986

Laparoscopic sterilization with the Falope-ring technique in the puerperium.

One hundred and forty-one women were planned to be sterilized by the Falope-ring technique after vaginal term delivery. Two pregnancies (1.55%) occurred during an average observation period of 43.2 months. Tearing of the mesosalpinx with bleeding requiring laparotomy occurred in 2 cases, and was the major operative complication seen. In 3 cases, laparotomy was performed because of reduced visual field caused by the enlarged uterus and in 2 cases because of technical problems with maintaining pneumoperitoneum. In 10 patients, hysterosalpingography was performed. In 2 cases leakage was demonstrated and these patients were readmitted to laparoscopic sterilization in the interval phase. One woman was admitted to the hospital with acute lower abdominal pain one year after sterilization; laparotomy showed the salpinx to be twisted three times around the ring. The Falope-ring technique is recommended as a safe, easy and quick method for sterilization in the puerperium.

Adult↗

PubMed1980

Ectopic pregnancy after sterilization.

In a retrospective survey of 24 cases of ectopic pregnancy after sterilization it was found that, in most cases, there was a delay in diagnosis of ectopic pregnancy because of the history of previous sterilization. The sterilization operation was commonly performed post partum or after abortion. Patients who had been sterilized by laparoscopic tubal cautery were more likely to have ruptured ectopic pregnancy with acute blood loss and shock than those who had open tubal ligation which was associated with a more chronic form of this condition.

Adult↗

PubMed1977

The snare method of laparoscopic sterilization: an analysis of 1,000 cases with 4 failures.

The snare method has proven to be an effective method of tubal resection for sterilization. In the most experienced hands, significant complications are indeed rare. However, the failure rate appears to be higher than that of the coagulation-alone method, at least in the postabortal patient. The necessity for pathologic confirmation, a tradition of surgery, is critically questioned. Additional coagulation of the tubal ends after resection is now recommended, especially in the patient seeking abortion as well as sterilization. The authors await the comparative long-term results of bipolar forceps and the newer mechanical methods of laparoscopic tubal sterilization. It is conceivable that the snare and other unipolar electrosurgical instruments designed for female sterilization will become obsolete.

Adolescent↗

PubMed1964

LEGAL IMPLICATIONS OF STERILIZATION.

Sexual sterilization is legal when it is an integral part of a procedure for the preservation of the life or health of a patient. Done for other reasons it may not be illegal, but this has not been tested in Canadian courts. It is, broadly speaking, a surgical procedure; it is commonly, but not always, successful; complications, while rare, do occur; the results tend to be irreversible. The same end, the prevention of pregnancy, may be attained by other methods which are safer, less liable to complications, less permanent and so should be used unless contraindicated. Patients' statements that they do not like contraceptives should not be accepted as a reason for sterilization. Sexual sterilization should be reserved for those occasions when it is necessary for the preservation of the health or life of the individual who is to be sterilized.

Canada↗

PubMed1991

[Laparoscopic sterilization of women under local anesthesia].

Ten women were sterilized via a laparoscope under local anaesthesia (paracervical blockade and periumbilical infiltration anaesthesia). Sterilization was carried out with simultaneous video monitoring. One patient, in whom termination of pregnancy was performed simultaneously at the end of the first trimester, experienced discomfort. The remaining nine sterilized women were extremely satisfied with the procedure. Laparoscopic sterilization of women in local anaesthesia is a rapid, safe and pleasant procedure for the patients.

Abortion, Induced↗

PubMed1991

Prevalence and severity of premenstrual changes after tubal sterilization.

Many women report an association between tubal sterilization and the premenstrual syndrome. While early reports suggested such a linkage, more recent studies failed to confirm this association. In an attempt to elucidate the alleged association of tubal sterilization with premenstrual changes, we compared the severity of symptoms and their possible correlates with hormonal levels in 78 sterilized and nonsterilized women with prospectively confirmed premenstrual syndrome. No significant difference could be demonstrated between the groups in both the retrospective and prospective evaluation of the severity of premenstrual syndrome symptoms as well as in luteal hormonal levels. Our data confirm that premenstrual symptoms probably are not associated with tubal sterilization.

Adult↗

PubMedDate not supplied

How and why women choose sterilization: results from six follow-up surveys.

Follow-up surveys were carried out in six countries (Bangladesh, Columbia, El Salvador, Guatemala, Indonesia, and Tunisia) between 1984 and 1986 to assess client decision-making regarding sterilization. The results revealed that women made well-informed, voluntary decisions to be sterilized. They were knowledgeable about other family planning methods and made the decision to be sterilized after consulting their partners, friends, relatives, or other sterilized women. Although their decisions were voluntary, other findings revealed areas for improvement such as client information and education about the risks of the procedure. These data were used to improve program services by emphasizing the need for better information, education, and counseling programs.

Adult↗

PubMed1989

[Extrauterine pregnancy after sterilization via a laparoscope].

Information was collected from the Danish National Patient Register and the Danish Board of Health about the frequency of rupture of extrauterine pregnancies among a normal population and among women who had previously been sterilized via a laparoscope. Significantly fewer extrauterine pregnancies were observed among the group of women who had undergone sterilization. Ruptured tubal pregnancies were significantly more frequent among women who had previously been sterilized as compared with the remainder of the fertile female population. It is therefore important that women who have previously undergone laparoscopic sterilization should contact their general practitioner if the slightest suspicion of pregnancy arises.

Female↗