Male and female sterilization
Introduction: Sterilization is the most widely used method of
irreversible contraception worldwide. Approximately 180 million women and 42
million men are using this method of family planning1. In less developed
countries the prevalence of female sterilization is 22% compared to 11% in more
developed countries. The prevalence of male sterilization is 4% in less
developed countries compared to 6% in more developed countries2.
sterilization: Female sterilization is usually an intra-abdominal surgical
procedure. Both Fallopian tubes are blocked either by ligation, coagulation,
suturing or application of rings or clips, mostly by laparoscopy under general
anaesthesia. Short stay hospitalization is required.Recently developed
hysteroscopic procedures like the Essure®, Adiana® and Ovabloc® methods can be
performed in an outpatient setting under local anaesthesia.The method of choice
for male sterilization is the no-scalpel vasectomy in an outpatient setting also
under local anaesthesia.
Efficacy: The efficacy of all methods is high, but
varies depending of the skills and experience of the surgeon. In the case of
failure after tubal occlusion, ectopic pregnancy must be considered. The
efficacy of alternative longterm –reversible- methods such as the subdermal
implant Implanon®, the intrauterine system Mirena® and the intrauterine copper
implant Gynefix® is comparable to the efficacy of sterilization (table).
and facts: There are many myths and fears especially concerning male
sterilization. These include associations with atherosclerosis, osteoporosis,
cancer of the testis, prostatic cancer and impotence. None of these fears are
|cumulative percentage of pregnancies after 10 years3
0,128 (5 yrs)
Table: efficacy of sterilization and alternatives
The complication rate of
intra-abdominal female sterilization is much higher than the complication rate
of the simple outpatient procedure of male sterilization. Fatal complications
occur in 1,7-4/100.000 in female sterilization versus zero in male sterilization.
Complications after hysteroscopic female sterilization are rare and restricted
to incorrect placement of the intra tubal devices.
Legislation: Several European
countries are violating the basic human rights in freedom of choice of the
method of contraception as it is stated in the Programme of Action of the UN
International Conference on Population and Development: ‘couples and
individuals must be enabled to decide freely and responsibly the number and
spacing of their children, to have the information and means to do so, to ensure
informed choices and to make available a full range of safe and effective
In some European countries sterilization remains an illegal
procedure except for sterilization for strictly medical reasons and in several
European countries there are a number of legal restrictions such as age and
number of children. In other countries sterilization is a basic human right,
where the only factor is the wish of the patient.
Guidelines: The Royal College of
Obstetricians and Gynaecologists published an excellent evidence-based clinical
guideline on male and female sterilization4.
Sterilization: Global Issues and Trends, ®2002 Engenderhealth www.engenderhealth.org
Population Reference Bureau, Family Planning Worldwide 2002
Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after
tubal sterilization: Findings from the US Collaborative Review of Sterilization.
Am J Obstet Gynecol 1996;174:1161-70