Female Sterilisation

Question 1

Briefly describe the mechanism of female sterilisation

Answer 1

• Surgical interruption of the fallopian tubes:
  
  • Tubal ligation with or without partial salpingectomy
  • Partial destruction of oviduct with electrocoagulation
  • Clipping or banding of the fallopian tubes

Question 2

What are the advantages of female sterilisation?

Answer 2

• Tubal occlusion is very effective in preventing pregnancy
• It is permanent
• Sex need not be interrupted to use contraception

Question 3

What are the disadvantages of female sterilisation?

Answer 3

• Tubal occlusion requires a surgical procedure
• People may regret having had the procedure
  
  • The assessment process is designed to ensure that people at risk of regret are identified and fully informed about alternative long-acting reversible contraceptive methods
• It cannot easily be reversed, and the NHS does not routinely offer reversal procedures
• It does not protect against sexually transmitted infections
• It can fail, but this is uncommon

Question 4

What risks are associated with female sterilisation?

Answer 4

• Tubal occlusion is performed using laparoscopy (or laparotomy)→ risk of a major complication with laparoscopy (injury to bowel, bladder, or blood vessels requiring laparotomy or leading to death)
• If tubal occlusion fails → resulting pregnancy may be ectopic
• Women should be reassured that tubal occlusion is not associated with an increased risk of heavier or irregular periods when performed after 30 years of age
• The procedure requires a general anaesthetic

Question 5

What is the efficacy of female sterilisation?

Answer 5

Tubal occlusion has a lifetime failure rate of about 1 in 200 women.

Question 6

Briefly describe how to assess someone who is considering female sterilisation

Answer 6

• Check the World Health Organization (WHO) Medical Eligibility Criteria for contraceptive use to ensure that sterilization is a suitable choice for the person.
• Assess the person’s:
  
  • Mental capacity
  • Level of understanding of the advantages, disadvantages, procedures involved, and relative failure rates of a vasectomy or tubal occlusion
  • Risk for later regret
  • Cultural, religious, psychosocial, psychosexual, and psychological issues
• Also assess their partner’s suitability for sterilization, as the couple’s clinical history, present symptoms, or abnormal examination findings may influence which partner goes forward to have sterilization
• On female, perform bimanual pelvix exam

Question 7

Which group of people may require additional care when counselling people who are considering steriliation?

Answer 7

• Younger than 30 years of age
• Without children
• Taking decisions during pregnancy
• Taking decisions in reaction to the end of a relationship
• Possibly at risk of coercion by their partner, family, or health or social welfare professionals

Question 8

How can female sterilisation fail?

Answer 8

• Surgical error