Surgical Contraception

By
Mustefa A. ( BSC, MPH)
Objective
At the end of this session, you will be able to,
• Describe male and female sterilization.
• Identify mechanism of action, effectiveness, benefits and
complication of female & male sterilization.

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Surgical Contraception
• It is permanent method of contraception.
• It is also known as voluntary sterilization.
• Types:
1.Vasectomy and
2. Bilateral Tubal Ligation.

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1. Vasectomy
• Permanent contraception for men who will not want more
children.
• Also called
• Male sterilization and
• Male surgical contraception.

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Procedure
• Through a puncture or small incision in the scrotum, the
provider locates the 2 tubes (vas deferens) that carries sperm
to the penis.
• Then cuts or blocks the vas deferens or
• Cutting and tying it closed or by applying heat or electricity
(cautery).
Procedure takes 15 minute or less.

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Mechanism of action
• Works by closing off each vas deferens keeping sperm out of
semen.
• Semen is ejaculated but it cannot cause pregnancy.

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How effective
• Highly effective.
• 2 to 3 pregnancies per 1000 women over the first year after
partners have had a vasectomy.
• Not effective immediately.
• If the partner of a man who has had a vasectomy becomes
pregnant, it may be because:
a. The couple did not always use another method
during the first 3 months after the procedure,
b. The provider made a mistake or
c. The cut ends of the vas deferens grew back together.

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Side Effects, Known Health Benefits and Health Risks:
• None

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Complications
Uncommon:
• Severe scrotal or testicular pain that lasts for months or
years.
Very rare:
• Infection at the incision site or inside the incision.
Rare:
• Bleeding under the skin that may cause swelling or bruising
(hematoma).

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Conditions requiring delay or special precautions
• Local infection or systemic infection
• Previous scrotal injury
• Large varicocele or hydrocele
• Local pathological condition such as mass

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2. Bilateral Tubal Ligation
• Permanent contraception for women who will not want more
children.
• Also called
Female sterilization
Tubal sterilization,
Tubal ligation,
Tubectomy, etc

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Procedure
• Simple surgery usually performed under local anesthesia
and as an out patient.
• Types:
 Minilaparotomy
• 3-5cm incision is made in the abdomen.
a. Suprapubic: appropriate for interval & post abortion and
b. Subumbilical: appropriate for postpartum procedures.
 Laparoscopy
• A laparoscope is inserted into the abdomen through a 1-cm
incision.
 Cesarean section

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Mechanism of action
• Works because the fallopian tubes are blocked or cut,
• Eggs released from the ovaries cannot move down the tubes
• The eggs that released do not meet sperm.

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Who can use?
Who:
• want highly effective, permanent protection against
pregnancy,
• are certain that they have achieved their desired
family size and
• understand and consent to procedure.

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How Effective?
• Highly effective immediately.
• Over the first year of use:
Less than 1 pregnancy per 100 women.
5 pregnancies per 1,000 women.
• Over 10 years of use:
Risk of becoming pregnancy ~ 2%.
Risk varies by method and age, higher in younger
women.

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Side Effects
• None
Known Health Benefits and Known Health Risks:
• Helps protect against:
Risks of pregnancy
Pelvic inflammatory disease (PID)
• May help protect against:
Ovarian cancer

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Complications
• Procedural complications:
Bleeding or hemorrhage
Infection
Anesthesia related complications (if general used)
Trauma: tears or perforations to abdominal organs
(bladder, bowel, uterus)
• Ectopic pregnancy:
risk is lower than for nonsterilized women.

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Conditions warranting delay of surgery
• Pregnancy and postpartum (7-28 days)
• Severe preeclampsia or eclampsia
• Severe antepartum or postpartum hemorrhage
• Severe trauma to the genital tract
• Postabortion or puerperal sepsis
• Unexplained vaginal bleeding
• Malignant gestational trophoblastic disease
• Cervical, endometrial or ovarian cancer
• PID

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Summary
Male sterilization is very safe, convenient, highly effective
and simple surgery.
But, regret some times in young age, marital instability and
decision made under pressure.
Vasectomy is not castration, it does not make weak.
Female sterilization is highly effective and safe means of
contraception.
No medical condition absolutely restricts a person's
eligibility.
Clients age < 35 years may regret in the future.

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