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TERMINAL METHODS
(STERILIZATION)
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WHAT IS STERILIZATION??
Is permanent method of birth control
In certain cases, sterilization can be reversed
Mainly meant or men and women who do notintend to have children anymore in the future
Male sterilization & female sterilization
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Male sterilization
Procedure: vasectomy
Involves cutting the vas deferens in orderto close off the tubes that carry spermfrom the testiclesprevents the releaseof sperm when a man ejaculates
is done only when a man asks for it and it
should be considered only when a manwants to be permanently sterile.
Vasectomy can sometimes be reversed,but the reversal procedure is not alwayssuccessful.
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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 incisionsin the skin of the scrotum.
-pull each vas through the opening and cut the vas (remove a small sectionof 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 withstitches
**done under local anesthesia (to numb the scrotum)
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b) No scalpel vasectomy (NSV)
- scrotum is shaved and aseptic procedure is done
- gently finding the vas deferens on one side and bringing itto 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 theskin
- 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 stitchesmaybe needed.
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After the procedure
The acceptor is not immediately sterile after the operation
For 2 to 4 months use other birth control methodsuntil your semen testshows 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 ofthe 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 oneside
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Advantages
Compared tofemale
sterilization,vasectomy is
simpler
highly effective,one-time procedure
that providespermanent
contraception.
more effective
can be performedon an outpatient
basis,
has fewercomplications
less expensive
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Complications
Earlycomplication:pain, scrotal
haematoma &local infection
Spermgranules
Spontaneousrecanalization
Autoimmunerespose dueto blocking of
VD
Psychological common inmale
undergonevasectomy
underpressure
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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.
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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 becarefully considered
You can decide against procedure
any time before surgery Are you ready to choosthis method?
Want to know more abothe procedure?
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a) laparoscopy
Laparoscop
yElectrocoagulation
- Monopolar
- bipolar
Mechanical devices
- Falope ring
- Hulka clip
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Briefly about the procedure
done through abdominal approach with a specialized instruments calledlaparascope
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
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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 afterthe operation
Complications:
Very uncommon
If occur, may be of serious nature (may require surgicalintervention)
Ex: puncte of large blood vessels
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b) Minilaparotomy
is done using general or regional (eg, spinal) anesthesia.
The physician makes a small incision (one to three inches) in theabdomen
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
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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 thefallopian tubes
After the coils are placed, scar tissue
develops around them causing the tubesto become sealed shut.
This process happens gradually over time
woman must therefore use another form of
birth control for three months after thecoils are placed
x-ray test called a hysterosalpingogram(HSG) is performed to confirm that the
tubes are blocked.
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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
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Parks textbook of preventive and social medicine
http://my.clevelandclinic.org/
http://www.tawakal.kpjhealth.com.my/
http://theturekclinic.com/
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