Female sterilization. General principles of surgical sterilization. Contraindications to sterilization

A woman can become pregnant if a man's sperm fertilizes an egg. Contraception interferes with this by preventing the egg and sperm from meeting or by stopping the production of eggs. One of the methods of contraception is female sterilization.

Female sterilization is usually done under general anesthesia, but can be performed under local anesthesia, depending on the method used. The surgery involves ligating, blocking, or coagulating the fallopian tubes, which connect the ovaries to the uterus.

Sterilization fallopian tubes women prevents the fusion of sperm and egg, that is, fertilization. Eggs will still be released from the ovaries as usual, but they will be absorbed naturally into the woman's body.

Facts about female sterilization

• In most cases, female sterilization is more than 99% effective, and only one woman in 200 can become pregnant after sterilization.
• You shouldn't think about the consequences female sterilization every day, or every time you have sex - it does not affect your sex life.
• Tubal sterilization can be performed at any stage of the menstrual cycle. The procedure will not affect hormone levels.
• You will still get your period after sterilization.
• You will need to use contraception before your sterilization surgery and until your next period or for three months after female sterilization (depending on the type of sterilization).
• As with any surgery, there is a small risk of complications following female sterilization. These include internal bleeding, infection, or damage to other organs.
• There is a small risk that the operation to sterilize the fallopian tubes will not produce results immediately, or the tubes will begin to function years later. But this is a minimal probability.
• If the surgery is unsuccessful, it may increase the risk of an ectopic pregnancy (when a fertilized egg is found outside the uterus, usually in the fallopian tube).
• Female sterilization surgery is almost irreversible, although the possibility of restoring the patency of the fallopian tubes does exist. This is an expensive procedure that is not done in everyone. medical institution and is usually based on tubal repair. The probability of conceiving a child, according to most studies, after restoration of patency of the fallopian tubes is 60-70%.
• Female sterilization does not protect against sexually transmitted infections (STIs), so always use a condom after sterilization to protect yourself and your partner.

How does female sterilization work?

Female sterilization works by preventing eggs from traveling down the fallopian tubes. This means that a woman's egg cannot "meet" sperm, which prevents fertilization.

How is female sterilization performed?

There are three main methods of female sterilization.

Laparoscopic sterilization of fallopian tubes

Laparoscopic sterilization of fallopian tubes through small punctures in the anterior abdominal wall using a special camera and microtools. Advantages of the laparoscopic procedure: minimally invasive, good aesthetic result, small rehabilitation period and low-invasiveness - laparoscopic sterilization of fallopian tubes is quite easily tolerated by patients. However, this procedure is considered expensive.

Minilaparotomy sterilization of fallopian tubes

Minilaparotomy sterilization of the fallopian tubes is carried out by making a small incision in the anterior abdominal wall (just above pubic bone) about 3-5 cm long. Pros: minimally invasive, short rehabilitation period, low cost. Minilaparotomy sterilization of fallopian tubes is actually not inferior to laparoscopic sterilization, but at the same time it is more cost effective.

Colpotomy sterilization of fallopian tubes

Colpotomic sterilization of the fallopian tubes is carried out by making an incision in the vaginal vault, but without touching the abdominal wall. Advantages of colpotomy sterilization of fallopian tubes: complete absence cosmetic defects, general availability and relatively low cost.

You must continue to use contraception until an imaging test confirms that your fallopian tubes are blocked. This can be done using procedures such as:

• hysterosalpingogram
• contrast sonography

Removal of the fallopian tubes (salpingectomy)

If fallopian tube sterilization is unsuccessful, the fallopian tubes may be completely removed. Removing the fallopian tubes is called a salpingectomy.

Video: how female sterilization is done

Preparing for female sterilization

Your doctor will definitely have several consultations before referring you for tubal sterilization. Ideally, this decision should be made by you and your partner, as long as it is appropriate and acceptable. If possible, you should both agree to the procedure, but by law, female sterilization does not require the consent of your husband or partner.

Consulting with a doctor will give you the opportunity to talk about the operation in detail, resolve any doubts and answer all questions.

Your doctor has the right to refuse to perform a procedure or refuse to refer you for surgery if he or she does not believe that female sterilization is in your best interest.

If you decide to have sterilization, you will be asked to use contraception until the day of surgery, and to continue using it:
before your next period if your fallopian tubes are blocked (tubal occlusion)
for approximately three months if you have uterine implants (hysteroscopic sterilization)

Female sterilization can be performed at any stage of the menstrual cycle.

Before you have surgery, you should take a pregnancy test to make sure you are not pregnant. This is very important because when the surgeon blocks your fallopian tubes, there is high risk that any pregnancy will be ectopic (when the fertilized egg grows outside the uterus, usually in the fallopian tubes). An ectopic pregnancy can be life-threatening because it can lead to severe internal bleeding.

Recovery after female sterilization

Once you have recovered from the anesthetic, you will be allowed to go home. If you are released from the hospital a few hours after your tubal sterilization, ask a relative or friend to drive you home or call a taxi.

Your doctor should tell you what to expect and how to take care of yourself after surgery. He can give you a contact number to call if you have any problems or have any questions.

If you have had general anesthesia, you should not drive for 48 hours after it as the reaction time is different than normal.

How will you feel after tubal sterilization?

It is normal to feel unwell and a little uncomfortable for a few days if the surgery was performed under general anesthesia You may have to rest for a few days. Depending on your general condition health and your work, you can return to work five days after female sterilization. However, you should avoid heavy lifting for a week.

After tubal sterilization there may be some slight vaginal bleeding. Use a sanitary pad, not a tampon. You may also feel some pain, similar to period pain. Your doctor may prescribe painkillers. If pain or bleeding gets worse after female sterilization, consult your doctor.

How to have sex after female sterilization

• Your sexual desire and pleasure from sex will not be affected. After tubal sterilization, you can have sex as soon as your condition returns to normal after the operation.
• If you have had a tubal occlusion, you will need to use contraception until your first period to protect yourself from pregnancy.
• If you have had hysteroscopic sterilization, you will need to use another form of contraception for approximately three months after surgery.
• Once imaging tests confirm that the implants are in correct position, contraception will no longer be needed.
• Sterilization will not protect you from STDs, so keep using barrier agents contraception such as condoms if you are unsure about your partner's sexual health.

Who is suitable for female sterilization?

Almost any woman can be sterilized. However, sterilization should only be considered by women who do not want to have any more children or do not want to have children at all. Once your fallopian tubes are sterilized, it is very difficult to reverse the process, so it is important to consider other options before making a decision. Restoring the patency of the fallopian tubes after their sterilization is not done under an insurance policy - this is an expensive operation that you will have to pay for yourself.

Surgeons in to a greater extent are willing to perform sterilization when a woman is over 30 years of age and has a child, although some younger women who have never had a child choose this procedure.

Advantages and disadvantages of female sterilization

Benefits of female sterilization

• female sterilization provides a 99% guarantee in preventing pregnancy
• tubal occlusion (blocking the fallopian tubes) and removal of the fallopian tube (salpingectomy) are effective immediately - however, doctors strongly recommend continuing to use contraception until your next period
• Hysteroscopic sterilization is usually effective after about three months—studies have found that fallopian tubes are blocked after three months in just 96% of sterilized women.

Other benefits of female sterilization are as follows:

• female sterilization has no long-term effect negative effect on sexual health
• female sterilization does not affect sexual desire
• female sterilization does not affect the spontaneity of sexual intercourse or interfere with sex (other forms of contraception may)
• Female sterilization does not affect hormone levels

Disadvantages of female sterilization

• Female sterilization does not protect you from sexually transmitted diseases, so you should still use a condom if you are unaware of your partner's sexual health
• It is very difficult to reverse a tubal occlusion - the operation involves removing the blocked part of the fallopian tube and joining the ends, and restoring the patency of the fallopian tubes is rarely free of charge.
• Approximately 1 in 50 women who undergo hysteroscopic sterilization require further surgery due to complications such as persistent pain

Risks of female sterilization

Female sterilization has a very small risk of complications, including internal bleeding and infections or damage to other organs
tubal sterilization may fail - the fallopian tubes may become functional again and return fertility, although this is rare (about one in 200 women will become pregnant in their lifetime after sterilization)

If you become pregnant after sterilization, there is increased risk that it will be an ectopic pregnancy

• Hysteroscopic sterilization has a small risk of pregnancy even after your tubes have been blocked. Research data has shown that possible complications after uterine implants may include:
• pain after surgery - in one study, nearly eight out of 10 women reported pain
• implants are not inserted correctly - this happens to two out of 100 women
• bleeding after surgery - many women have had light bleeding After surgery, nearly a third bled for three days.

Denial of responsibility: The information presented in this article about female sterilization is intended to inform the reader only. It is not intended to be a substitute for advice from a healthcare professional.

Sterilization of women – surgical method contraception, which consists in artificially blocking the patency of the fallopian tubes, preventing the fusion of the egg with the sperm. Sterilization of women can be carried out by ligation (ligation), electrocoagulation, clipping of the fallopian tubes with special staples, etc. Sterilization operations for women can be performed through minilaparotomy, laparoscopic or transvaginal access. Contraceptive result various methods sterilization of women is 99.6-99.8%.

Indications and contraindications

Sterilization in women is carried out with the consent of the patient if she does not want to have any more children, provided she is over 35 years old and has 2 or more children; if there is a danger of pregnancy and childbirth due to health reasons (if severe forms cardiovascular, nervous, endocrine and other diseases, anemia, heart defects, etc.), with contraindications to the use of other methods of contraception. A woman's decision to undergo sterilization is documented in legal documents.

Absolute contraindications to tubal sterilization of women are pregnancy, the active stage of inflammation or infection of the pelvis. Relative limitations include significant obesity, which complicates minilaparotomy or laparoscopy, severe adhesions in the pelvic cavity, and chronic cardiopulmonary pathology. When planning sterilization of women, it should be taken into account that such an operation can aggravate the course of arrhythmia, anemia and arterial hypertension, the development of pelvic tumors, inguinal or umbilical hernias.

Sterilization surgery in women can be performed in the second phase of the menstrual cycle, during a cesarean section, within the first 48 hours or 1.5 months after natural birth, immediately after an uncomplicated abortion, in the process gynecological operations. Sterilization does not lead to damage menstrual function and sexual behavior. The operations are performed under epidural or general anesthesia.

Types of sterilization

The Pomeroy and Parkland sterilization methods involve ligation of the fallopian tubes with catgut followed by dissection or resection of a segment of the tube. During sterilization using the Pomeroy method, the fallopian tube is folded into a loop in its middle part, then tied with catgut and excised near the ligation area. The Parkland technique is based on the application of ligatures in 2 places of the tube, followed by resection of its internal segment. Sterilization of women using the Irving method is carried out by sewing the distal ends of the fallopian tubes into the wall of the uterus.

Mechanical methods of sterilization involve blocking the fallopian tubes with special rings and clamps (Filshi clips, Hulk-Wulf spring clamps). Mechanical devices are applied to the tubes, 1–2 cm away from the uterus. Advantage mechanical methods sterilization of women is less traumatizing the tubal tissue, making it easier to perform reconstructive interventions if it is necessary to restore fertility. As a method of sterilization, coagulation of the fallopian tubes, the introduction of special plugs or chemical agents into them that cause scarring stricture of the tubes are used.

Methodology

Minilaparotomy for sterilization can be performed a month or more after birth; access to the tubes is through a suprapubic incision 3-5 cm long. Minilaparotomy is difficult to perform if the patient is significantly obese or has adhesions in the pelvic cavity. Through minilaparotomy access, sterilization is carried out using the Pomeroy and Parkland methods, Filshi clamps, fallopian rings or spring clamps are also used.

Laparoscopic sterilization is minimally invasive, can be performed under local anesthesia, and short rehabilitation. During laparoscopic sterilization, clamps, rings, and electrocoagulation of tubes are applied. Transvaginal sterilization can be performed by colpotomy using optical device- culdoscope or transcervically by hysteroscopy. Hysteroscopic sterilization allows the introduction of occlusive drugs (methyl cyanoacrylate, quinacrine, etc.) into the fallopian tubes.

In 1% of cases after sterilization operations, complications occur in the form of wound infections, intestinal trauma, Bladder, perforation of the uterus, unsuccessful blockage of the fallopian tubes. Reversibility of tube sterilization is possible, requires micro surgical intervention and tubal plastic surgery, but is often accompanied by

Healthy women are fertile until the age of 50-51. Healthy men are capable of fertilization throughout their lives. Since most couples already have the desired number of children by the age of 25-35, they need effective pregnancy protection during the remaining years.

Currently voluntary surgicalcontraception(or sterilization) (DHS) is the most common method of family planning in both developed and developing countries.

DHS is an irreversible, most effective method pregnancy protection not only for men, but also for women. At the same time, this is the safest and most economical method of contraception.

Frequent use of local anesthesia with minor sedation, improved surgical technique and better qualifications medical personnel— all this has contributed to increasing the reliability of the DHS over the past 10 years. When performing DHS in postpartum period Experienced staff under local anesthesia, a small skin incision and improved surgical instruments, the duration of the mother's stay in the maternity hospital does not exceed the usual length of bed days. Suprapubic minilaparotomy(usually performed 4 or more weeks after birth) can be done in outpatient setting under local anesthesia, as with the laparoscopic method surgical sterilization.

Vasectomy remains a simpler, more reliable and less expensive method surgical contraception than female sterilization, although the latter remains the more popular method of preventing pregnancy.

Ideally, a couple should consider using both irreversible methods of contraception. If female and male sterilization were equally acceptable, then vasectomy would be preferred.

First surgical contraception began to be used for the purpose of improving health status, and later for broader social and contraceptive reasons. In almost all countries, sterilization operations are performed according to special medical indications, which include uterine rupture, several previous caesarean sections and with other contraindications for pregnancy (for example, serious cardiovascular disease, multiple births and a history of serious gynecological complications).

Voluntary surgical sterilization in women is safe method surgical contraception. Most data from developing countries indicate that the mortality rate for such operations is approximately 10 deaths per 100,000 procedures, while for the United States the same figure corresponds to 3/100,000. Maternal mortality in many developing countries ranges from 300 to 800 deaths per 100,000 live births. From the above examples it follows that DHS almost 30-80 times safer than repeat pregnancy.

Mortality rates for minilaparotomy and laparoscopic sterilization methods do not differ from each other. Sterilization can be performed immediately after childbirth or termination of pregnancy.

Female sterilization is the surgical blocking of the fallopian tubes in order to prevent the fusion of sperm with the egg. This can be achieved by ligation (ligation), the use of special clamps or rings, or electrocoagulation of the fallopian tubes.

Frequency of method failure DHS significantly lower than other contraceptive methods. Contraceptive failure rate when used conventional methods occlusion of the fallopian tubes (Pomeroy method, Pritchard method, silastic rings, Filshi clamps, spring clamps) corresponds to less than 1%, usually 0.0-0.8%.

For the first year postoperative period the total number of cases of pregnancy is 0.2-0.4% (in 99.6-99.8% of cases pregnancy does not occur). The incidence of “contraceptive failure” in subsequent years after sterilization is significantly lower.

Pomeroy method

The Pomeroy method uses catgut to block the fallopian tubes and is a fairly effective approach to DHS in the postpartum period.

In this case, the loop of the fallopian tube is tied with catgut in its middle part and then excised.

Pritchard method

The Pritchard method makes it possible to preserve most of the fallopian tubes and avoid their recanalization.

In this operation, the mesentery of each fallopian tube is excised in an avascular area, the tube is ligated in two places with chromium catgut, and the segment located between them is excised.

Irving method

The Irving method consists of suturing the proximal end of the fallopian tube into the wall of the uterus and is one of the most effective methods of sterilization during the postpartum period.

It is important to note that when conducting DHS Irving's method reduces the likelihood of developing an ectopic pregnancy significantly.

Filshi's Clips

Filshi clips are applied to the fallopian tubes at approximately a distance of 1-2 cm from the uterus.

The method is used mainly in the postpartum period. It is better to apply the clips slowly in order to evacuate the edematous fluid from the fallopian tubes.

Suprapubic minilaparotomy

Suprapubic minilaparotomy or "spaced" sterilization (usually performed 4 or more weeks after birth) is performed after complete involution of the uterus after childbirth. At this method sterilization, a skin incision is made in suprapubic region 2-5 cm long. Minilaparotomy can become difficult to perform with significant overweight patients, adhesive process pelvic organs due to surgery or inflammatory disease of the pelvic organs.

Before the procedure, pregnancy must be excluded. Mandatory laboratory research usually include analysis of hemoglobin in the blood, determination of protein and urine glucose.

Procedure. You should empty your bladder before surgery. If the uterus is in the aneversio position, during minilaparatomy the patient is usually in the Trendelenburg position, otherwise the uterus should be lifted manually or with a special manipulator.

Place and size of incision for minilaparotomy. Placing a skin incision above the line makes the fallopian tubes difficult to access, and placing a skin incision below the suprapubic line increases the likelihood of bladder damage.

A metal lift lifts the uterus so that the uterus and tubes are closer to the incision

When sterilizing using the minilaparotomy method, the Pomeroy or Pritchard method is used, and they also resort to the use of fallopian rings, Filshi clamps or spring clamps. The Irving method is not used for minilaparotomy due to the impossibility of approaching the fallopian tubes during this method operations.

Complications. Typically, complications occur in less than 1% of all surgical cases.

The most common complications include complications associated with anesthesia, infection of the surgical wound, trauma to the bladder, intestines, perforation of the uterus during its elevation and unsuccessful blocking of the patency of the fallopian tubes.

Laparoscopy

Technique of the operation. DHS Laparoscopic method can be performed either under local anesthesia, and under general anesthesia.

The skin is treated accordingly, while Special attention is given to the treatment of the umbilical area of ​​the skin. To stabilize the uterus and its cervix, special single-tooth forceps and a uterine manipulator are used.

A Veress needle for insufflation is inserted into the abdominal cavity through a small subumbilical skin incision, after which a trocar is inserted through the same incision towards the pelvic organs.

The patient is placed in the Trendelenburg position and approximately 1-3 liters (the minimum amount required for good visualization of the abdominal and pelvic cavities) of nitrous oxide, carbon dioxide, or as a last resort, air. The trocar is removed from the capsule, and the laparoscope is inserted into the same instrument. When using bipuncture laparoscopy, a second skin incision is made under laparoscope control from the abdominal cavity, and in the case of monopuncture laparoscopy, manipulators and other appropriate surgical instruments are inserted into the pelvic cavity through the laparoscopic channel. Varieties of the latter method include the so-called. " open laparoscopy", during which the peritoneal cavity is opened visually in the same way as with subumbilical minilaparotomy, after which a canula is inserted and the laparoscope is stabilized; this method of operation prevents blind insertion of the Veress needle and trocar into the abdominal cavity.

When using fallopian tube clamps, it is recommended to apply them to the isthmus of the fallopian tubes at a distance of 1-2 cm from the uterus. Silastic rings are placed at a distance of 3 cm from the uterus and electrocoagulation is performed in the middle section of the tubes to avoid damage to other organs. After completing this stage of the operation, complete hemostasis should be ensured; the laparoscope, and later the insufflated gas, is removed from abdominal cavity and suturing the skin wound.

Complications. Complications with laparoscopy are less common than with minilaparotomy. Complications directly related to anesthesia may be aggravated by the consequences of insufflation of the abdominal cavity and the Trendelenburg position, especially during general anesthesia. Complications such as damage to the mesosalpinx (mesentery of the fallopian tube) or fallopian tube may follow the application of fallopian rings to the fallopian tubes, which may require laparotomy to monitor hemostasis. In some cases, an additional ring is applied to the damaged fallopian tube for complete hemostasis.

Uterine perforation is treated conservative method. Damage to blood vessels, intestine or other organs of the peritoneal cavity can be caused by manipulation of the Veress needle or trocar.

Transvaginal laparoscopy

The transvaginal sterilization method is one of the laparoscopic sterilization methods. The operation begins with a colpotomy, i.e., an incision is made in the mucous membrane of the posterior vaginal vault under the control of direct visualization (colpotomy) or a culdoscope (a special optical instrument).

The transvaginal method of sterilization should be used in exceptional cases, and must be performed by a highly qualified surgeon in a specially equipped operating room.

Transcervical surgical sterilization.

Most hysteroscopic sterilization techniques using occlusive agents (hysteroscopy) are still in the experimental stage.

Hysteroscopy is considered an expensive operation and requires special training of the surgeon, while the success rate leaves much to be desired.

Some clinics are experimentally using a non-operative sterilization method, which consists of using chemical or other materials (quinacrine, methyl cyanoacrylate, phenol) to occlude the fallopian tubes using a transcervical approach.

Sterilization and ectopic pregnancy

An ectopic pregnancy should be suspected whenever signs of pregnancy are observed after sterilization.

According to the USA, 50% and 10% of all cases of ectopic pregnancy after sterilization occur with the electrocoagulation method of occlusion of the fallopian tubes and the method of using fallopian rings or clamps, respectively.

The consequence of the Pomeroy method in the form of ectopic pregnancy occurs with the same frequency as when using fallopian rings.

The occurrence of an ectopic pregnancy can be explained by several factors:

1. development of uteroperitoneal fistula after sterilization by electrocoagulation;
2. inadequate occlusion or recanalization of the fallopian tubes after bipolar electrocoagulation, etc.

Ectopic pregnancy accounts for 86% of all long-term complications.

Menstrual cycle changes. The development of changes in the menstrual cycle after sterilization was assumed, and the term “post-occlusive syndrome” was even proposed. However, there is no convincing and reliable data on the presence of a significant effect of sterilization on menstrual cycle women.

Contraindications to sterilization

Absolute contraindications:

Tubal sterilization should not be performed if:

1. active inflammatory disease of the pelvic organs (must be treated before surgery);
2. if you have an active sexually transmitted disease or other active infection (must be treated before surgery.)

Relative contraindications

Required special care woman with:

1. severe excess weight (minilaparotomy and laparoscopy are difficult to perform);
2. adhesive process in the pelvic cavity;
3. chronic heart or lung disease.

Laparoscopy creates pressure in the abdominal cavity and requires tilting the head down. This may obstruct blood flow to the heart or cause the heart to beat regularly. Minilaparotomy is not associated with this risk.

Conditions that may worsen during and after DHS:

1. heart disease, arrhythmia and arterial hypertension;
2. pelvic tumors;
3. uncontrolled diabetes mellitus;
4. bleeding;
5. severe nutritional deficiency and severe anemia;
6. umbilical or inguinal hernia.

How to prepare for sterilization

1. Once you decide to undergo surgical sterilization, you must be confident that you want to use an irreversible method of birth control. You can cancel your decision at any time or postpone your scheduled surgery if you need more time to think about it.
2. Take a bath or shower immediately before surgery. Pay special attention to the cleanliness of the umbilical and pubic areas.
3. Avoid food and liquids for 8 hours before surgery.
4. It is recommended that you be accompanied to the clinic on the day of surgery and escorted home after surgery.
5. Take a rest, please at least, within 24 hours after surgery; Try to avoid physical activity during the first week after surgery.
6. After surgery, you may experience pain or discomfort in the surgical wound or pelvic area; they can be eliminated by taking simple painkillers in the form of aspirin, analgin, etc.
7. Rest for two days after surgery.
8. Avoid sexual intercourse for the first week and stop if you complain of discomfort or pain during intercourse.
9. To speed up the healing of your surgical wound, avoid heavy lifting for the first week after surgery.
10. You should consult a doctor if the following symptoms develop:
11. If you complain of pain or discomfort, take 1-2 tablets of an analgesic at intervals of 4-6 hours (it is not recommended to take aspirin due to increased bleeding).
12. Taking a bath or shower is allowed after 48 hours; at the same time, try not to strain the abdominal muscles and not irritate surgical wound during the first week after surgery. After taking a bath, the wound should be wiped dry.
13. Contact the clinic 1 week after surgery to monitor wound healing.
14. At the first signs of pregnancy, consult your doctor immediately. Pregnancy after sterilization occurs extremely rarely and in most cases it is ectopic, which requires urgent measures.

Beware:

1. increased body temperature (up to 39° and above);
2. dizziness with loss of consciousness;
3. persistent and/or increasing pain in the abdominal area;
4. bleeding or constant discharge fluid from the surgical wound.

Restoring fertility after sterilization

Voluntary surgical sterilization should be considered an irreversible method of contraception, but despite this, many patients require restoration of fertility, which is a common occurrence after divorces and remarriages, the death of a child or the desire to have next child. You need to pay special attention to the following:

• restoration of fertility after surgery DHS is one of the most difficult surgical operations requiring special training of a surgeon;
• in some cases, restoration of fertility becomes impossible due to the patient’s advanced age, the presence of infertility in a spouse, or the impossibility of performing an operation, the reason for which is the method of sterilization performed;
• the success of the reversibility of the operation is not guaranteed even if there are appropriate indications and a highly qualified surgeon;
• the surgical method of restoring fertility (for both men and women) is one of the most expensive operations.

In addition, there is a possibility of complications associated with anesthesia and the operation itself, as with other interventions on the abdominal and pelvic organs, as well as the occurrence of an ectopic pregnancy when fertility is restored after female sterilization. The incidence of ectopic pregnancy after restoration of patency of the fallopian tubes after sterilization by electrocoagulation is 5%, while after sterilization by other methods it is 2%.

Before making a decision to conduct surgical restoration patency of the fallopian tubes is usually performed by laparoscopy to establish their condition, and the condition is also determined reproductive system both the woman and her husband. In most cases, the operation is considered ineffective if there is less than 4 cm of the fallopian tube. Maximum efficiency has a reverse operation after sterilization using the method of using clamps (Filshi and spring clamps).

Despite the possibility of restoring fertility, DHS should be considered an irreversible method of contraception. If there are insufficient indications for plastic surgery in women, you can resort to expensive extracorporeal method fertilization, the efficiency of which is 30%.

During these operations, a small segment of the fallopian tube is affected (only 1 cm), which facilitates the restoration of tubal patency. At the same time, the frequency of development intrauterine pregnancy after this operation is 88%. In the case of the use of fallopian rings, a segment of the fallopian tube 3 cm long is damaged and the effectiveness of plastic surgery is 75%. The same figures for the Pomeroy method are 3-4 cm and 59%, respectively. During electrocoagulation, a segment of the fallopian tube approximately 3 to 6 cm long is damaged, and the incidence of intrauterine pregnancy corresponds to 43%. When conducting plastic surgery To restore fertility, modern microsurgical techniques are used, which, in addition to the availability of special equipment, requires special training and qualifications of the surgeon.

Sterilization of women is considered the most effective way birth control, but at the same time the most dangerous.

Definition

Female sterilization involves creating artificial obstruction of the fallopian tubes by cutting them, tying them, or removing parts of them. When carrying out such an operation, due to the resulting barriers, the eggs cannot meet sperm on their way. Despite this, pregnancy still occurs in 3% of 100 cases. Why this happens is still not clear. Now, during the rapid development of medicine, hospitalization for such an operation is not required; the procedure is carried out in medical clinics under general or local anesthesia. After female sterilization, no obvious changes occur in the body: sexual desire remains at the same level, the menstrual cycle occurs according to the deadline.

Sterilization of women: types

IN medical practice There are several types of operations for sterilizing women.

1. Ligation of the fallopian tubes, the essence of which is to remove a fragment of the fallopian tubes. For these purposes, 5 cm long incisions are made in the left or right side of the abdomen. Rehabilitation is 36-48 hours.

2. Laparoscopy - sterilization using punctures in the abdominal cavity. There are three types of laparoscopic sterilization:

1) tubal ligation - the tube is tied into a loop and secured with a self-absorbing clamp;

2) cauterization of the fallopian tubes - the tubes are affected by an electric current of medium voltage, resulting in the formation of scars that impede the movement of sperm and eggs;

3) pinching of the fallopian tubes - blocking the tubes using special clothespins; The advantage of this method is that the clothespins can be removed and reproductive function can be restored.

3. This method of sterilization, such as hysterectomy (complete removal of the uterus), has long been a thing of the past. Such operations are performed very rarely and only when it is necessary to save a woman’s life.

Female sterilization: benefits

1) highly effective method of contraception;

2) suitable for women who are contraindicated to use other methods of protection against unwanted pregnancy;

3) short period of postoperative rehabilitation;

4) no effect on hormone levels, libido and menstrual cycle.

Sterilization of women: cons

Despite the presence of significant advantages, such operations have a number of negative features:

1) general anesthesia, which provides negative impact not only affects the entire body as a whole, but also increases the recovery period;

2) lack of protection from sexually transmitted diseases;

3) inability to get pregnant and give birth again;

4) there remains a low probability of becoming pregnant.

Female sterilization: consequences

For a long time after the operation, the woman feels discomfort and a feeling of bruising;

Sutures are removed a week after surgery;

Education on site surgical intervention hematomas that do not always resolve on their own;

When pregnancy occurs, the egg cannot reach the uterus and begins to grow in the tube, which entails ectopic pregnancy which puts a woman's life at risk.

Sterilization in women is the most common method of birth control today. Doctors from both developed and developing countries claim that this method is the most effective and economical, but at the same time the most unsafe. The method of female sterilization is based on artificial creation obstruction of the fallopian tubes surgically. What are its advantages and disadvantages?

Female sterilization methods

The operation is carried out using several methods: laparoscopy, mini-laparotomy or . Today there are 2 methods of female sterilization:

• tubal ligation;
• tube implant method.

How is tubal ligation done:

• laparoscopy– two punctures are made on the woman’s stomach, one for the viewing device and the other for the surgical instrument (clamp);
• mini-laparotomy– one puncture is made in the pubic area, less than 5 cm in size. With this procedure, a woman becomes infertile forever;
• surgical tubal ligation– a large incision is made in the abdomen, the operation is performed under local anesthesia.

To whom do they do it? surgical dressing fallopian tubes:

• if the woman is undergoing another abdominal operation (for example, a caesarean section);
• if a woman has inflammatory diseases pelvic organs;
• if a woman has endometriosis;
• if the woman has had surgery in the abdominal cavity and pelvic area.

What women should do in the postoperative period:

• must be completely eliminated physical exercise, within 2 weeks;
• for the first 2 days after surgery you cannot take a bath or shower;
• use compresses on the site where the operation was performed, this will prevent swelling, pain or even bleeding;
• exclude sexual relations for 2-3 days;
• After the operation, protect yourself with a condom for about 20 more sexual acts (only after 20 ejaculations is complete sterility formed).

• this is an irreversible process, so a woman may have sexual contacts and do not use protection, since pregnancy does not occur;
• The operation is performed once and does not require post-operative costs. And a woman will not have to constantly buy contraceptives ( birth control pills or condoms).

Disadvantages of tubal ligation:

• within 3 months after the operation, the woman will have to use other methods of contraception;
• does not protect against sexually transmitted infections.

Tube implant method

A tubal implant is inserted into the fallopian tubes. The procedure is much simpler than tubal ligation because it is mostly performed in the doctor's office rather than on the operating table. It does not require surgery or general anesthesia and lasts only 30 minutes. After the procedure, the woman does not need to stay in the hospital overnight; after a few hours she can go home.

• using a medical gynecological speculum, the doctor dilates the cervix;
• a thin tube (catheter) is inserted through the vagina, with the help of which the implant is placed, it passes through the cervix, and then into fallopian tube. Using the same method, the implant is placed in the other fallopian tube;
• An x-ray is taken to ensure that the implant is placed correctly.

After tubal implants For 3 months, you should use other methods of contraception (for example, a condom or birth control pills).

When does a woman need sterilization?

• no desire to have children in the future;
• if you have a partner who does not want to have children, but does not have a vasectomy (male sterilization);
• if other methods of contraception are not suitable for a woman;
• if a woman can pass on a hereditary disease to her unborn child.

Who should not undergo sterilization?

• if you are under 30 years old and have never had children;
• women who have had problems with pregnancy;
• women who do not have a permanent relationship;
• You should not undergo tubal ligation because of a sexual partner.