Male and female sterilization

Male and female sterilization

R.J.C.M.Beerthuizen

gynaecologist,

The Netherlands

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.

Methods of

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).

Fears

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

real.

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

methods’.

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.

References

1. Contraceptive

   Sterilization: Global Issues and Trends, ®2002 Engenderhealth www.engenderhealth.org 

2. Population Reference Bureau, Family Planning Worldwide 2002

3. Peterson HB,

   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

4. http://www.rcog.org.uk/index.asp?PageID=699