Permanent contraception

VASECTOMY FOR MEN

TUBAL LIGATION IN WOMEN
 Introduction to Permanent Family Planning

 Surgical procedure to permanently and intentionally

terminate male and female reproductive function
 Appropriate for men and women who made a fully
informed and well considered decision
 Most are not reversible

• Vasectomy for men

Permanent
Family • Tubal ligation in women
Planning
 Vasectomy

 For men who do not want more children

 Transection and occlusion of the vas deferens

 Also called male sterilization, male surgical

contraception
 No interference with sexual performance

 Outpatient procedure by local anesthesia

 Facts about vasectomy

It is simple, safe and effective method of permanent

contraception.
Can be done on OPD basis under local anesthesia.
No effect on sexual activity, semen volume and general
physical health.
Sterility doesn't occur immediately. It requires approx 20
ejaculation to completely evacuate vas, which takes
3month. Absence of sperm should be confirmed by
microscopic examination(HSA).
Reversal is possible but sperm recovery rate after
procedure declines with time particularly after 7 years.
 Procedure should be delayed if…

Patient has
 scrotal skin infection
Active STDs
Epididymitis or orchitis
Filariasis
Intrascrotal mass
Coagulation disorders
Psychosexual disorder
 Techniques of Vasectomy

 Scalpel (conventional) and Non-scalpel

 Palpate the vas through the scrotum
 Grasp the vas with fingers or forceps
 Pull loop of vas and remove segment
 Ligate both ends of the vas
 Bury the proximal stump
 Skin stitch and dressing
Vasectomy (cont’d)
 Post surgery care

Painkiller SOS
Antibiotics not required.
Dry dressing only, avoid bath for 24 hours.
Avoid cycling and moderate exercise for 1 weeks.
Scrotal support for initial few days.
Take contraceptive measures for next 3 months or
confirm sperm free ejaculate by 2 separate
microscopic examinations.

 Benefits of Vasectomy

 Failure is less than 1%

 Reason for failure can be:
 Unprotected intercourse soon
 Failure to occlude the vas
 Recanalization
 Safer and more effective than tubal ligation
 0.5 deaths per 100,000 vasectomies
 Complications of Vasectomy

 Side effects are uncommon to very rare

 Testicular and scrotal pain lasting for months
 Surgical site infection
 Hematoma
 Sperm granuloma
Female sterilization
 For women who do not want more children.
 Also called tubal sterilization, tubal ligation or
tubectomy.
 Most widely used procedure globally.
 counselling

About permanent procedure.

Its failure rate.
Alternative methods of long term contraception.
complications
 Different types

According to time
post partum
Interval
Postabortal
According to approach
Abdominal
conventional 3-4 cm
Minilaparotomy2.5 to 3cm
laparoscopic
Vaginal
hysteroscopic
 Procedure

1.Before operations: confirm patient's last menstrual period, exclude pregnancy and take
 necessary consents
 2. Ensure empty urinary bladder
 3. After proper gowning and scrubbing, the operative area is cleaned and draped.
 4. Determine the incision site and size - 2 fingers from the symphysis pubis superiorly.
 5. Make the skin incision about 3 to 4 cm long.
 6. Open the abdomen in layers until the rectus sheath.
 7. Open the rectus sheath using the scissors and push the muscle laterally.
 8. Proceed to open the peritoneal cavity with two artery forcep and the maximburm
 scissors.
 9. By using 2 fingers - identify the uterine body and move laterally to identify the fallopian
 tube.
 10. Grasps the tube using the babcock. The tube can be determined by identifying the
 fimbriae end of the tube.
 11. Lift the tube gently and clamp the area for incision using the artery forceps.
 12. Make a knot on one side and subsequently on the opposite site. Be sure to relief the
 artery forceps temporally when making the knot.
 13. Any absorbable suture size 2/0 can be used - eg. Vicryl or catgut
 14. The tube can then be excised using the scissors.
 15. The stump is then inspected for any residual bleeding.
 16. The same procedure is employed for the contralateral tube.
 18. Finally close the abdomen and skin
 Occlusion methods

Partial salpingectomy
Tubal clip
Tubal rings/fallopes rings
Fimbriectomy
Electrocoagulation or cautrization
Pomeroy Method
kroner method
 Minilaparotomy for Tubal Ligation

 Ligation of the fallopian tubes through 3-4cm incision on

the abdomen, can be done:
 As an outpatient procedure
 By local anesthesia and sedation

 Minilaparotomy following vaginal delivery:

 Enlarged uterus, tubes in the mid abdomen, 3-4 cm sub
umbilical incision

 Interval minilaparotomy:
 Short transverse suprapubic incision

 Uterine elevator used through the vagina

 Laparoscopic sterilization

Simple and effective procedure.

Can be done single port or two port technique,
under local anesthesia.
Position modified lithotomy.
LA infiltrated.
Pneumoperitoneum is created.
Small stab incision given, trocar inserted followed
by loaded laprocater.
Fallope rings or filshie clips are applied bilaterally
 Indications to Delaying lap Tubal Ligation

 Current pregnancy
 Less than 6 weeks postpartum
 Severe postpartum or post abortion complications
 Unexplained vaginal bleeding
 Pelvic inflammatory disease and STIs
 Pelvic malignancies
 Benefits of Female Sterilization

 No known side effect

 Helps to protect against unwanted pregnancy

 Nothing to remember and no worries about

contraceptives again
 Prevents against pelvic inflammatory disease

(PID)
 May protect against ovarian tumor
 Risks of Female Sterilization

Few complications
 Related with surgery, anesthesia, previous surgery,
PID, Obesity, and DM
 1-2 deaths /100,000 cases
 2 pregnancies per 100 women over 10 years
 Possibility of future regret
 Young age

 Lost a child

 Few or no children

 Not married/ Marital problems

Newer methodsESSURE
 Immunocontraceptions /FRV

Fertility regulating vaccines/FRVs

Anti HCG vaccine

Anti zona vaccine
Anti sperm vaccine
 Summary

• Permanent methods are irreversible

• Non-scalpel vasectomy in men and
minilaparatomy for women are preferred
• Permanent methods are less popular in Ethiopia
• Detailed counseling is essential
• Rare complications - not related to method