[28] Contraception - Male And Female Sterilisation Flashcards
What is sterilisation?
A surgical means of obtaining permanent contraception
How does sterilisation work?
By occluding the Fallopian tubes in women, and vas deferens in women
What documentation should be done before performing sterilisation?
- Consent form should be signed
- Clear documentation about discussion, information given, and any requests made by the individual
What specific issues need to be covered when obtaining consent for sterilisation?
- Failure rate
- Irreversibility
- Time constraints
- Choice of procedure
- Alternative options
- Limitations
Is sterilisation irreversible?
Yes (well no, but should be seen as an irreversible procedure)
What should the patient be told regarding reversal options for sterilisation?
- Success rate as defined by successful pregnancy is very limited
- Operation is not available on the NHS
When is female sterilisation effective from?
Woman is sterile immediately after operation, but can conceive in pre-operative menstrual cycle
What should the woman be advised regarding being able to conceive in the pre-operative menstrual cycle?
She should avoid sex or use effective contraception until menstrual period following operation
When is a man considered sterile after the operation?
Should not be considered sterile until semen samples with no spermatozoa have been confirmed
When should the man receive a semen sample with no spermatozoa?
Usually 12-16 weeks after the operation
What may be required when confirming a man is sterile after vasectomy?
1 or 2 tests
What should couples be advised of regarding choice of sterilisation procedure?
Vasectomy carries fewer risks as a procedure, and has a lower failure rate in terms of unwanted pregnancies
What alternative options are there to sterilisation?
Long-acting reversible methods of contraception
Give a limitation of sterilisation
Does not protect against STIs
What should ideally happen with counselling for sterilisation?
The couple should be seen and counselled together
What does the patient and their partner need to understand before proceeding with sterilisation?
Need to understand that sterilisation is irreversible
What theoretical situation can be used to ensure the couple are sure about sterilisation?
Even if tragedy were to befall their family, neither would wish to have more children
What things should be considered to reduce regret caused by sterilisation?
- Age
- Family structure
- Relationship stability
- Timing
What age groups are more likely to regret sterilisation?
Young people, especially under 30
What family structures are more likely to experience regret?
Couples with fewer than 2 children
What is there a risk of when a relationship breaks down with sterilisation?
Risk the sterilised partner will wish to have children with a new partner in a new relationship
What should be considered regarding timing of sterilisation?
- Tubal occlusion should be performed after an appropriate interval following pregnancy
- Tubal ligation can be performed at C-section
- Vasectomy in the partners pregnancy should be approached with care
Why should vasectomy during a partners pregnancy be approached with care?
Even if current pregnancy is unplanned, stillbirth and neonatal death can still occur, so better to wait until healthy child is delivered and is several weeks old
What should be done if tubal ligation is performed at C-section?
The obstetrician should ascertain that the paediatrician is happy the baby is healthy before proceeding
What is the limitation of checking that the baby is healthy before proceeding with tubal ligation at C-section?
Problems may not be apparent immediately
When should consent and counselling take place if tubal ligation is to be done at C-section?
At least 2 weeks before the procedure
What is the aim of vasectomy?
Interruption of vas deferens
What anaesthetic is used for vasectomy?
Local
Describe the procedure for vasectomy
The vas deferens is exposed and isolated, and then the lumen is occluded and the vas deferens divided
How is the success of vasectomy confirmed?
Post-operative semen analysis to confirm azoospermia
When is the post-vasectomy semen analysis performed?
12 weeks post vasectomy
What are the complications of vasectomy?
- Bleeding into scrotum and haematoma formation
- Infection
- Epididymitis
- Sperm granuloma
- Persistent pain
- Contraceptive failure
How does a sperm granuloma present?
Tender scrotal swelling near proximal end of vas
How is a sperm granuloma managed?
Requires further excision
Where might persistent pain caused by vasectomy occur?
- Testicles
- Scrotum
- Penis
- Lower abdomen
What % of men experience persistent pain after vasectomy?
1-14%
Is persistent pain following vasectomy severe?
Can be in some men
What is the rate of contraceptive failure of vasectomy after negative sperm count?
1 in 2000
What approaches can be taken to female sterilisation?
- Hysteroscopic
- Laparoscopic
- Open procedure
What is done in hysteroscopic sterilisation?
Micro-inserts are implanted into the Fallopian tubes
What is the result of inserting micro-inserts into the Fallopian tubes in hysteroscopic sterilisation?
Causes scar tissue to form, eventually blocking the ruebs
Do you need to use contraception after hysteroscopic sterilisation?
Yes
How long do you need to continue to use sterilisation after hysteroscopic sterilisation?
Until imaging (x-ray or ultrasound) has confirmed that the micro-inserts are correctly positioned
What may be required to confirm tubal occlusion after hysteroscopic sterilisation in some patients?
Hysterosalpingogram
When should imaging to confirm tubal occlusion be performed in hysteroscopic sterilisation?
3 months after the procedure
Why is hysteroscopic sterilisation a good option?
The procedure has been shown to be safe, with low rates of adverse effects and high rates of patient acceptability
What does laparoscopic sterilisation use?
Clips
What should be done prior to laparoscopic sterilisation?
Pregnancy test
What is the risk with laparoscopic sterilisation?
Risk of damage to the bowel or blood vessels
What factors increases the risk of damage to bladder or bowel during laparoscopic sterilisation?
- Obesity
- Inexperienced operator
- Abdominal adhesions
What is the lifetime failure rate of female sterilisation?
1 in 200
What risk is there with female sterilisation?
If pregnancy does occur, there is an increased risk of ectopic pregnancy
