An effective method of contraception. Woman after surgery. Postoperative period and rehabilitation

Female sterilization is a permanent method of contraception, forever eliminating the possibility of becoming pregnant and having a baby. Usually, women who have already given birth, who no longer want to have children, resort to it. The operation involves actions aimed at preventing the fertilization of the egg by the sperm. Artificial obstruction is created through surgical intervention. The efficiency of this operation is 99 percent.

Indications for sterilization

Any woman over 35 who has at least one child can be sterilized. Nevertheless, the issue of the operation should be approached responsibly. If there is no certainty that in the future a woman will not want to have children again, it is better to resort to other, less radical methods of contraception.

An indication for sterilization may be the fact that a woman is contraindicated to become pregnant, as well as the risk of transmission hereditary defects, diseases or anomalies in development, incompatible with life.

How sterilization works

During ovulation, the egg is released from the ovary and travels down the fallopian tube towards the sperm for further fertilization. During sterilization, an artificial obstruction of the tubes is created, which makes conception and pregnancy impossible.

Types

There are two types of sterilization in women:

Blocking the patency of the fallopian tubes by clamping, bandaging, excision.
Installation of a special implant (hysteroscopic sterilization)

Methods

Sterilization in women is carried out in three ways.

Laparotomy. Passed through an incision in abdominal cavity. It is usually performed in conjunction with other abdominal operations, such as a caesarean section.
Laparoscopy. Less invasive and most common method. It is carried out through several small incisions around the navel.
Mini laparotomy. It is performed through a small incision just above the pubic hairline. Most often performed in women with a history of pelvic surgery, inflammatory processes or obese.

Operation

During surgery to create an artificial obstruction with clamps, rings, or tubal ligation, the surgeon makes several small incisions in the abdomen. With the help of a laparoscope, he puts on plastic or titanium clips, silicone rings on the fallopian tubes, ligates them, excised or cauterizes them. This method of sterilization is usually performed under general anesthesia. The sterilization of women takes about half an hour. After a few hours, the patient can go home.

With unsuccessful blocking of the fallopian tubes in the previous way, a salpingectomy is performed - complete removal.

Implants are placed through the vagina using local anesthesia. It is also possible to use sedatives. Using a hysteroscope, titanium implants are placed in each of the fallopian tubes. Obstruction is created by the occurrence of scar tissue.

After sterilization

After undergoing surgical sterilization, women should avoid intense exercise for a week. If you experience pain, you can take painkillers. But if the discomfort increases, you should consult your doctor. If a purulent discharge appears, vomiting persists for more than 24 hours, an elevated temperature exceeds 38 degrees, a feeling of discomfort during urination, you also need to visit a specialist for an in-person consultation.

You can return to work in a few days. sex life can be resumed after feeling better. After 10 days, you should see a surgeon to remove the stitches, and after 6 weeks - for an examination.

Theoretically, sterilization in women has an immediate contraceptive action. However, it is still recommended to use combined hormonal agents contraception, such as oral tablets, within a week after the sterilization.

The effect of hysteroscopic sterilization occurs after 3 months. Therefore, the entire period after the operation should be used additional method contraception. You can refuse protection only after carrying out ultrasound or X-ray to confirm the correct placement of the implants.

Side effects

After the sterilization operation, a woman may experience discomfort, expressed in the following symptoms:

pain and nausea during the first four to eight hours;
convulsions during the first day;
vomit;
temperature.

Advantages of sterilization

There are pros and cons to female sterilization, just like any other operation. In addition to constant contraception and confidence in the absence of the risk of unwanted pregnancy the following positive factors are present during this operation:

fast recovery;
most women can return to normal activities within one day;
the procedure does not take much time;
there is no need to go to the hospital, the procedure can be performed on an outpatient basis.

Consequences of female sterilization

Depending on the methods used, there is a risk of the following complications in women after the operation.

infections;
bladder injury;
major bleeding blood vessels;
intestinal perforation;
abdominal infections;
allergic reaction for anesthesia;
damage to nearby organs, such as the intestines or ureter;
inflammation and pain;
infection of the wound or one of the fallopian tubes;
ectopic pregnancy that develops in fallopian tubes ah, not in the uterus;
irregular and prolonged menstrual cycles;
menstrual pain;
increased menstrual flow;
cervical erosion;
gain premenstrual symptoms;
the risk of cervical cancer;
ovarian tumors.

In addition to all the complications and risks, the main disadvantage of female sterilization is 99 percent effectiveness. There is a less than one percent chance that pregnancy will still occur, and most likely it will be ectopic. The only guaranteed 100% method of contraception is spaying and abstinence.

Contraindications for sterilization

Doubts about the decision made regarding the operation.
Pregnancy.
Allergy to nickel, silicone.
Childbirth, abortion, miscarriage less than 6 weeks ago.
recent inflammatory or infectious diseases pelvic organs.
unknown genesis.
Gynecological malignant processes.

The procedure is carried out as usual, but with additional preparation in the following cases:

young age;
obesity;
operation during caesarean section;
elevated blood pressure;
ischemia, stroke, uncomplicated and congenital diseases history of heart
epilepsy;
depression;
diabetes:
uterine fibroids;
Iron-deficiency anemia;
compensated cirrhosis;
mammary cancer;
liver tumors.

Alternative methods of contraception

In addition to female sterilization, there are less radical methods of long-term contraception, such as the use of subcutaneous implants, the installation of an intrauterine hormonal or non-hormonal spiral. Unlike surgery, these methods also have some advantages, such as the absence of surgical risks and reversibility.

Along with female sterilization, there is also male sterilization - vasectomy. With it, the ligation or removal of the seminal ducts is performed. This operation carries much less risks and complications than surgical sterilization women.

In addition to long-term contraception, combinations can be used to prevent unwanted pregnancies. oral contraceptives, various vaginal creams or suppositories, rings, or patches. The simplest and most affordable is the barrier method - male and female condoms.

Sterilization of women. Reviews

Not everyone will be able to decide on such a cardinal method of contraception as sterilization. Usually, women come to make such decisions after the occurrence of unplanned pregnancies, for example, against the background of the absence of menstruation after a recent birth. There are also situations when one or another method of contraception does not work. Often, having tried almost everything available ways protection from unwanted pregnancy, a woman has no choice but to resort to sterilization.

According to statistics, after the operation, many women experience pain and nausea, which are stopped by medications. After a few days everything is back to normal.

Some women who have undergone sterilization later regret their decision.

Main Aspects

Sterilization in women is almost one hundred percent method of contraception. However, it does not protect against sexually transmitted infections. Therefore, if a woman does not have confidence in her sexual partner, it is worth using a barrier method of contraception - condoms.

Sterilization in women does not cause menopause, nor does it affect a woman's sex drive or enjoyment of sex. After the operation, the ovaries will continue to function normally, as before, menstruation will occur.

Sterilization in women is exclusively voluntary.

Finally

Whatever the benefits of sterilizing women, before accepting such important decision, it is worth weighing the pros and cons. It is important to remember that this method is not reversible. Subsequent pregnancy is possible only with the use of reproductive technologies (in vitro fertilization) or the creation of artificial fallopian tubes. You should not make a decision to get sterilized if a woman is depressed, especially in cases after a recent miscarriage, abortion or childbirth. Before conducting voluntary sterilization of women, you should familiarize yourself with all the advantages, disadvantages of the operation, the risks and possible complications after it.

Sterilization of women- artificial blockage of the lumen of the fallopian tubes in order to prevent pregnancy. This is one of the methods of female contraception, which guarantees maximum, almost 100% protection against conceiving a child. After the procedure, the gonads function in the same way as before the intervention: the woman has her period, her libido and the possibility of obtaining sexual satisfaction are preserved.

There are several reasons for female sterilization. In most cases voluntary sterilization is a way of family planning. This method is chosen by women and couples who do not intend to have children in the future.

The basis for intervention may be medical indications. First of all, sterilization is recommended for women with diseases that are not compatible with bearing a fetus or using other methods of contraception. These include some cardiovascular pathologies, heavy forms diabetes, leukemia, malignant neoplasms in the organs of the female reproductive system. Sterilization is also offered to a woman if she already has two or more children who were born by caesarean section.

The law in Russia provides for the procedure to be carried out both at the request of a woman and forcibly. Article 57 of the Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation” states that forced medical sterilization of incapacitated people is carried out either at the request of a guardian or by a court decision. All other cases of interference are human rights violations.

Contraindications

Sterilization of a woman cannot be carried out if the requirements of the current legislation are not met. Medical institutions can accept patients for the procedure only upon written application. In this case, a woman must be over 35 years old or have at least two children.

If a woman has made the decision to be sterilized, she is advised to medical examination. Only after conducting tests and examining a doctor, a decision is made whether it is possible to perform an operation. Surgical female sterilization has the following absolute contraindications:

pregnancy;
the presence of sexually transmitted infections;
acute inflammatory processes of the organs of the reproductive system.

There are also relative contraindications, which may affect the final conclusion of specialists on the possibility of sterilization. These include:

pathologies associated with poor clotting blood;
the presence of adhesions in the lumen of the fallopian tubes;
severe obesity;
some diseases of the cardiovascular system.

Points for and against

Before turning to this method of preventing unwanted pregnancy, a woman should familiarize herself with the features of the procedure, evaluate its advantages and disadvantages. Only then can the only correct decision be made for each specific situation.

pros

At the moment, human sterilization is recognized as the most reliable method of contraception. The probability of getting pregnant after the procedure does not exceed 0.01%. At the same time, blockage of the fallopian tubes in women does not affect the balance of hormones, the menstrual cycle, sex drive and brightness of sensations during intimacy.

After sterilization, a woman cannot become pregnant naturally, however, she does not lose the ability to bear a child, therefore, if necessary, the IVF procedure can be used.

The advantages of properly performed sterilization include the absence of side effects and minimal risk of complications.

Minuses

The main disadvantage of female sterilization is its relative complexity. At present, thanks to the use of new medical technologies, it has been possible to significantly reduce the invasiveness of the procedure and virtually eliminate complications and Negative consequences for the female body. A small percentage of women who have undergone sterilization may subsequently have an ectopic pregnancy.

Some people (both men and women) after sterilization have certain psychological problems associated with the realization of the impossibility of having children. In such cases, consultation with a professional psychologist is necessary.

Specialists draw attention to the fact that the decision to sterilize a woman should be made deliberately. Important role while playing a psychological state. You should not make a choice during a period of depression or neurosis.

In order to correctly assess the arguments for and against, you can read a specialized forum with topics on the methods and consequences of female sterilization, watch video materials, get acquainted with the opinions of doctors and patients.

Ways

Female sterilization is carried out in several ways. The technique is selected taking into account the condition and wishes of the woman. Traditionally used surgical intervention However, if necessary, other types of reversible and irreversible sterilization can be used: chemical, radiation or hormonal.

Surgical

The choice of method of intervention depends on whether it is a planned operation or it is performed during childbirth. A woman may have a laparotomy (incision into the tissues of the peritoneum), laparoscopy (access to the abdominal cavity through small punctures), or culdoscopy (access to the tubes through the vagina). The first method of sterilization was abandoned in most medical institutions. The exception is when a woman has a caesarean section, and after removing the child, tubal ligation is performed. Laparoscopic surgery makes it possible to minimize tissue damage and significantly reduce the duration of the rehabilitation period.

For direct blocking of pipes, the following methods are used:

Electrocoagulation.

In this case, electrocoagulation forceps are applied to the pipes. As a result, gaps are soldered. To prevent restoration of patency after sterilization, an additional incision can be performed at the site of application of the instrument.

Resection.

This method of female sterilization involves partial or complete removal of the tubes. The cut-off sites are sutured, bandaged or cauterized with forceps.

Installing clips or clips.

The obstruction of the pipes is created by the imposition of rings, clips or other devices designed for this. They are made from hypoallergenic material that does not cause unwanted reactions from the female body.

Chemical

If a woman has contraindications to surgery, non-operative methods of sterilization can be used. One of them is the application chemicals. These may be medications that affect the production of sex hormones. Such sterilization is temporary and in effect on the woman's body is similar to castration.

The second method of chemical sterilization is the introduction of special substances into the lumen of the fallopian tubes that form plugs. The technology appeared relatively recently and belongs to irreversible interventions.

Radiation

Due to the presence of many side effects, ionizing radiation for female sterilization is used quite rarely and solely for medical reasons. The method in the vast majority of cases is used to inhibit the work of the female gonads in the detection of hormone-dependent malignant tumors.

Hormonal

The most common method of temporary sterilization is the use of drugs containing hormones. As a result of exposure to a woman's body of hormonal contraceptives, the ovaries cease to perform their functions. When choosing this method it should also be borne in mind that the terms for restoring reproductive function during long-term hormonal sterilization range from 1 to several years (this depends on the age of the woman).

The complexity of the operation

The complexity of surgical sterilization of women depends on the method of intervention, the state of health of the patient and the presence of certain comorbidities. Most clinics provide women with planned sterilization by laparoscopy, which practically does not leave scars on the body and makes it possible to recover in a short time.

If the operation takes place under proper conditions, and the manipulations are performed experienced doctor, the likelihood of a woman developing complications is minimal. That is why the right choice of clinic is important for a successful outcome of the intervention. Before applying to any medical institution, find out if such operations are performed there, and also take an interest in the qualifications of doctors and how much the procedure costs. Reviews of women who have already used the services of the clinic will help you decide on the choice of a surgeon or gynecologist.

How long does the intervention last

Planned female sterilization, which is performed by laparoscopy, lasts an average of 30-40 minutes. During this time, the woman is given anesthesia, punctures are made in the abdominal cavity to insert the instrument, and the lumen of the fallopian tubes is blocked.

With the introduction of chemicals or tubal implants through the vagina, the procedure takes place in the doctor's office without the use of anesthetics and takes 10-20 minutes. You can find out more precisely how long the operation takes from the doctor who will perform the sterilization.

Cost of the procedure

The price of the operation primarily depends on the method of its implementation. The cost of installing implants starts from 7,000 rubles, and sterilization by laparoscopic access - from 15,000 rubles. The final amount is affected by the need for additional surveys, analyzes, consultations with doctors.

When forming the cost of services, the level of qualification of the personnel, the availability of modern medical equipment and the quality of the materials that are used during sterilization.

Preoperative period

Preparation for sterilization begins with a visit to the doctor and determining the most optimal time for intervention. This takes into account the time that has passed since childbirth or artificial termination of pregnancy, as well as the phase menstrual cycle.

After a preliminary examination of the woman, the doctor determines the need for additional diagnostics, on the basis of which detailed recommendations regarding preoperative preparation.

Postoperative period

In the absence of complications during the operation, a woman can be discharged from the hospital after 1-2 days (with planned intervention). Further rehabilitation can take place at home, but under the supervision of a doctor.

To prevent possible complications, a woman needs a lifestyle correction for some time after sterilization. Approximate recommendations are as follows:

within 10-14 days, any physical activity;
2-3 days after surgical sterilization, you should not take a bath or shower;
a woman is allowed to resume sexual life no earlier than after 4-5 days;
some care is required after sterilization for puncture sites: antiseptic treatment, installation of compresses to prevent swelling and bruising.

In the first days after sterilization for removal pain syndrome anesthetics may be required.

It should be remembered that some methods of sterilizing women do not give an immediate effect and therefore, application will be required for a certain time. additional funds male or female contraception. On the need for protection and duration recovery period must be informed by the physician prior to discharge.

Complications

The likelihood of complications during female surgical sterilization and in the postoperative period is low. Most often in women, hematomas are fixed, adverse reactions on the use of anesthetics, the formation of adhesions in the pelvis. To more dangerous consequences Sterilization doctors refer to an ectopic pregnancy.

According to statistics, these or other complications are recorded in less than 1% of patients. Despite the small likelihood of undesirable consequences, every woman who undergoes surgical sterilization should be aware of what symptoms indicate the need for immediate medical attention.

Anxiety should be sharp increase temperature, sudden weakness, the appearance of purulent or spotting from punctures or vagina, increasing throbbing pain in the lower abdomen.

Sterilization performed qualified specialist under appropriate conditions, does not entail negative consequences for physical health women. That is why the popularity of this reliable and relatively safe way prevention of unwanted pregnancy is steadily increasing in most countries of the world. The only disadvantage of sterilization is its irreversibility. If the procedure is not performed for medical reasons, doctors advise women to carefully consider and weigh all the pros and cons before making a final decision and getting sterilized. Even the slightest doubt about the correctness of the choice should be the reason for choosing another way of female or male contraception.

Healthy women are fertile until the age of 50-51. healthy men capable of fertilization throughout life. Since most couples already have the desired number of children by the age of 25-35, they need effective contraception for 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 effective method protection from pregnancy not only for men, but also for women. At the same time, it is the safest and most economical method of contraception.

Frequent use of local anesthesia with little sedative effect, improvements in surgical technique, and better medical staff qualifications have all contributed to increasing the reliability of 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 length of stay of a woman in labor in the maternity hospital does not exceed the usual length of bed-days. Suprapubic minilaparotomy(usually performed 4 or more weeks after delivery) can be performed on an outpatient basis under local anesthesia, as with laparoscopic 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 contraception.

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 considerations. In almost all countries, sterilizations are performed for special medical reasons, which include uterine rupture, multiple caesarean sections, and other contraindications for pregnancy (for example, serious cardiovascular disease, the presence of 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 is 300-800 deaths per 100,000 live births. From the above examples, it follows that DHS almost 30-80 times safer than a second pregnancy.

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

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

Method failure rate DHS significantly lower than other methods of contraception. The rate of "contraceptive failure" when using conventional methods of occlusion of the fallopian tubes (Pomeroy, Pritchard, Silastic rings, Filshi clamps, spring clamps) corresponds to less than 1%, usually 0.0-0.8%.

For the first year of the postoperative period total number cases of pregnancy is 0.2-0.4% (in 99.6-99.8% of cases, pregnancy does not occur). Significantly less incidence of "contraceptive failure" in subsequent years after sterilization.

Pomeroy method

The Pomeroy method is the use of catgut to block the fallopian tubes and is a fairly effective approach to conducting 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 save most of the fallopian tubes and avoid their recanalization.

During this operation, the mesentery of each fallopian tube is excised in the avascular area, the tube is ligated in two places with chromic 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 ways postpartum sterilization.

It is important to note that when conducting DHS by Irving's method the probability of development ectopic pregnancy decreases significantly.

Clips Filshi

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

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

Suprapubic minilaparotomy

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

Before the procedure, it is necessary to exclude the presence of pregnancy. Mandatory laboratory tests usually include analysis of hemoglobin in the blood, determination of protein and urine glucose.

Procedure. Before the operation, you should empty your bladder. If the uterus is in the aneversio position, the patient is usually in the Trendelenburg position during minilaparotomy, otherwise the uterus should be lifted manually or with a special manipulator.

Location and size of the minilaparotomy incision. When placing a skin incision above the line, the fallopian tubes become difficult to access, and when it is performed below the suprapubic line, the likelihood of damage to the bladder increases.

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

Minilaparotomy sterilization uses the Pomeroy or Pritchard method, and also resorts to the use of fallopian rings, Filsch clamps, or spring clamps. The Irving method is not used for minilaparotomy due to the impossibility of approaching the fallopian tubes with this method operations.

Complications. Complications usually occur in less than 1% of all surgeries.

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

Operation technique. DHS can be performed laparoscopically local anesthesia and under general anesthesia.

The skin is treated accordingly, with particular attention paid to the treatment of the umbilical area of the skin. To stabilize the uterus and its cervix, special single-pronged forceps and a uterine manipulator are used.

The Veress needle for insufflation is inserted into the abdominal cavity through a small sub-umbilical 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 insufflated with approximately 1-3 liters ( minimal amount required for good visualization of the abdominal and pelvic organs) nitrous oxide, carbon dioxide or, in last resort, air. The trocar is removed from the capsule, and the laparoscope is inserted into the same instrument. When using bipuncture laparoscopy, the second skin incision is performed under the control of a laparoscope from the abdominal cavity, and in the case of monopuncture laparoscopy, manipulators and other appropriate surgical instruments injected into the pelvic cavity through the laparoscopic channel. To varieties last method refers to the so-called. " open laparoscopy”, during which the peritoneal cavity is opened visually in the same way as in the subumbilical minilaparotomy, after which the canula is inserted and the laparoscope is stabilized; this method of operation prevents the blind insertion of the Veress needle and trocar into the abdominal cavity.

When using fallopian tube clamps, it is recommended that they be applied 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 segment of the tubes to avoid damage to other organs. After completion of this stage of the operation, complete hemostasis should be ensured; the laparoscope, and later the insufflated gas, is removed from the abdominal cavity and the skin wound is sutured.

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

Treatment of uterine perforation is carried out conservative method. Damage to the 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., a mucosal incision is made posterior fornix vagina 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, while it must be carried out by a highly qualified surgeon in a specially equipped operating room.

Transcervical surgical sterilization.

Most hysteroscopic methods of sterilization using occlusive preparations (hysteroscopy) are still in the experimental stage.

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

In some clinics, as an experiment, a non-operative sterilization method is used, which consists in the use of chemical or other materials (quinacrine, methyl cyanoacrylate, phenol) for occlusion of the fallopian tubes by a transcervical approach.

Sterilization and ectopic pregnancy

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

According to the United States, 50% and 10% of all ectopic pregnancies after sterilization are due to electrocautery tubal occlusion and fallopian rings or clamps, respectively.

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

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

development of utero-peritoneal fistula after electrocoagulation sterilization;
inadequate occlusion or recanalization of the fallopian tubes after bipolar electrocoagulation, etc.

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

Changes in the menstrual cycle. It was assumed the development of changes in the menstrual cycle after sterilization, even the term "post-occlusion syndrome" was proposed. However, there is no convincing and reliable data on the existence of a significant effect of sterilization on the woman's menstrual cycle.

Contraindications to sterilization

Absolute contraindications:

Tubal sterilization should not be carried out if:

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

Relative contraindications

Special care is required for women with:

pronounced overweight(minilaparotomy and laparoscopy are difficult to perform);
adhesive process in the pelvic cavity;
chronic heart or lung disease.

During laparoscopy, pressure is created in the abdominal cavity and a downward tilt of the head is required. This can impede blood flow to the heart or cause the heart to beat irregularly. Minilaparotomy is not associated with this risk.

Conditions that may worsen during and after treatment DHS:

heart disease, arrhythmia and arterial hypertension;
pelvic tumors;
uncontrolled diabetes mellitus;
bleeding;
severe nutritional deficiencies and severe anemia;
umbilical or inguinal hernia.

How to prepare for sterilization

After deciding on surgical sterilization, you must be sure that you want to use an irreversible method of contraception. You can cancel your decision at any time or postpone your scheduled surgery if you need more time to think.
Take a bath or shower just before the operation. Pay special attention to the cleanliness of the umbilical and hairy part of the pubic area.
Do not eat or drink for 8 hours before surgery.
It is recommended that you be escorted to the clinic on the day of the operation and taken home after the operation.
Rest for at least 24 hours after surgery; try to avoid strenuous exercise for the first week after surgery.
After the operation, pain or discomfort may occur in the area of the surgical wound or the pelvic region; they can be eliminated by taking simple painkillers in the form of aspirin, analgin, etc.
Rest for two days after surgery.
Avoid intercourse for the first week and stop if you complain of discomfort or pain during intercourse.
To speed up the healing of the surgical wound, avoid heavy lifting during the first week after surgery.
You should consult a doctor if you develop the following symptoms:
If you complain of pain or discomfort, take 1-2 tablets of painkiller at intervals of 4-6 hours (aspirin is not recommended due to increased bleeding).
Taking a bath or shower is allowed after 48 hours; while doing this, try not to strain the abdominal muscles and not irritate the surgical wound during the first week after the operation. After taking a bath, the wound should be wiped dry.
Contact the clinic 1 week after the operation to monitor wound healing.
At the first sign of pregnancy, contact your doctor immediately. Pregnancy after sterilization is extremely rare and in most cases it is ectopic, which requires urgent measures.

Beware:

increase in body temperature (up to 39 ° and above);

dizziness with loss of consciousness;

persistent and / or increasing pain in the abdomen;

bleeding or continuous discharge of fluid from the surgical wound.

Restoration of 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 divorce and remarriage, 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 DHS is one of the complex surgical operations requiring special training of the surgeon;
in some cases, the restoration of fertility becomes impossible due to the patient's advanced age, the presence of infertility in the spouse or the impossibility of performing the operation, the reason for which is the sterilization method itself;
the success of the reversibility of the operation is not guaranteed even if there are appropriate indications and the surgeon is highly qualified;
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 developing complications associated with anesthesia and the operation itself, as with other interventions on the organs of the abdominal and pelvic cavities, as well as the onset 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 - 2%.

Before making a decision to carry out surgical recovery patency of the fallopian tubes, laparoscopy is usually performed 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. Reverse operation after sterilization by the method of using clips (Filchi and spring clips) has the maximum efficiency.

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

With these operations, an insignificant segment of the fallopian tube (only 1 cm) is affected, which facilitates the restoration of patency of the tubes. The incidence of 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 efficiency of plastic surgery is 75%. The same indicators for the Pomeroy method are 3-4 cm and 59%, respectively. With electrocoagulation, a segment of the fallopian tube with a length of approximately 3 to 6 cm is damaged, and the incidence of intrauterine pregnancy corresponds to 43%. When conducting plastic surgery Fertility restoration uses modern microsurgical techniques, which, in addition to having special equipment, require special training and qualifications of the surgeon.

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 of women can be performed by mini-laparotomy, 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 more children, provided she is over 35 years old and has 2 or more children; with the danger of pregnancy and childbirth for health reasons (with 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 formalized by legal documents.

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

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

Types of sterilization

Sterilization methods according to Pomeroy and Parkland involve ligation of the fallopian tubes with catgut, followed by dissection or resection of the tube segment. During sterilization according to the Pomeroy method, the fallopian tube is folded in the form of a loop in its middle part, then pulled over with catgut and excised near the ligation zone. The Parkland technique is based on the imposition of ligatures in 2 places of the tube, followed by resection of its inner segment. Sterilization of women according to 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, clamps (Filshi clips, Hulk-Wulf spring clamps). Mechanical devices are superimposed on the pipes, stepping back 1-2 cm from the uterus. advantage mechanical methods sterilization of women are less traumatism of tubal tissues, facilitating the performance of reconstructive interventions if necessary, the resumption of fertility. As a method of sterilization, coagulation of the fallopian tubes is used, the introduction of special plugs or chemical agents into them that cause cicatricial stricture of the tubes.

Methodology

Minilaparotomy for sterilization can be performed a month or more after childbirth, access to the tubes is through a suprapubic incision 3-5 cm long. Minilaparotomy is difficult to perform with significant obesity of the patient or adhesion formation in the pelvic cavity. Through minilaparotomic access, sterilization is carried out according to the Pomeroy, Parkland methods, Filshi clamps, fallopian rings or spring clamps are also used.

Laparoscopic sterilization is minimally invasive, can be performed under local anesthesia, and has a short rehabilitation period. During laparoscopic sterilization, clamps, rings are applied, and tubes are electrocoagulated. Transvaginal sterilization can be performed by colpotomy using an 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, trauma to the intestines, bladder, perforation of the uterus, unsuccessful blocking of the fallopian tubes. Reversibility of tubal sterilization is possible, requires microsurgical intervention and tubal plasty, but is often accompanied by

Male sterilization- one of the most reliable methods of male contraception and family planning. The procedure consists in artificial violation of the patency of the vas deferens. Unlike male castration, sterilization does not affect libido, potency, or the ability to have sex. sexual contact.

Male sterilization (vasectomy) can be voluntary or involuntary. In the first case, the reason for the intervention is the unwillingness of the man or married couple to have children. Sometimes you have to turn to this method if you are intolerant to other methods of contraception. Male sterilization is also recommended for couples in whom the onset of pregnancy poses a risk to the health and life of the woman. Since tubal ligation is one of the more difficult abdominal operations, doctors advise a less invasive vasectomy.

Forced male and female sterilization is used to prevent offspring in people with defective genetic traits. In Russia, it is carried out only by a court decision in accordance with the procedure approved at the legislative level. The basis for performing the procedure is medical indications: a person’s mental inferiority or the likelihood of transmitting a dangerous hereditary disease to offspring.

Contraindications

Voluntary male sterilization can be performed if it does not contradict the legislation of the Russian Federation. The law establishes that a vasectomy can be performed on men over 35 years of age or those with 2 or more children.

Since sterilization refers to surgical intervention, before deciding on the possibility of carrying out the procedure, the available medical contraindications: intolerance to anesthetics, the presence of certain organ diseases in a person genitourinary system etc.

Points for and against

When choosing this method of male contraception, it is necessary to take into account its features, as well as the likely risks and possible complications.

pros

The main argument in favor of choosing sterilization as a way to prevent unwanted pregnancy is its reliability: statistics show that the probability of conception does not exceed 0.1%. The onset of pregnancy is recorded in cases where errors were made during the manipulations, or the man has a congenital defect in the form of a bifurcation of the vas deferens.

Eliminating the patency of the vas deferens does not affect the functioning of the gonads of a man and does not affect the sexual desire and the quality of sexual intercourse. Ejaculation occurs in the same way as before the procedure, while even the amount of seminal fluid in men does not decrease.

As evidenced by the reviews of the sterilization of men who have already undergone the procedure, many of them experienced an increase in libido, and sexual contacts began to bring more pleasure. Experts believe that this is due to changes in the male psyche. The absence of fear of pregnancy in a partner allows a man to completely relax.

Minuses

Given the benefits, we should not forget that male sterilization has its own negative sides. They should definitely be taken into account before deciding on a surgical intervention. The disadvantages of the method include the following:

The procedure has irreversible consequences. After 3-4 years, it is almost impossible to restore the impaired patency of the ducts in a man. And those operations that are carried out in the first years are successful only in half of the cases. In this regard, you need to think carefully about your decision, given that life circumstances may change. Usually, men who remarry or have experienced the death of a child resort to repeated assistance from surgeons.
Like any surgical intervention, male surgical sterilization can have negative consequences in the form of complications during surgery or during the rehabilitation period.
Within 1-2 months after the procedure, it is necessary to use additional means of male or female contraception, since spermatozoa that can lead to conception continue to remain in the ducts. In addition, sterile men can contract or infect sexual partners with sexually transmitted bacteria and viruses.

In the 90s of the last century, several medical researchers voiced the assumption that male surgical sterilization contributes to the development of certain diseases associated with autoimmune processes. In the body of a man, before sterilization, spermatozoa do not come into contact with blood, and after blocking the ducts, they begin to penetrate into the tissues and body fluids, causing the production of specific antibodies. Based on the results of surveys of sterilized men, this theory did not receive sufficient factual support.

Only by evaluating all the pros and cons of sterilization, you can make the only right decision, which you will not have to regret later.

Ways

To stop the reproductive function of men, it is most often performed surgery. Along with surgical intervention other methods of sterilizing people, both reversible and irreversible, can be used.

Surgical

The main goal of the procedure is to eliminate the patency of the seed tubes. For this, the following methods are used:

A ligation in which the male vas deferens is tied with surgical thread.
Removal of part of the duct. A more reliable method, in which a small fragment is removed in the middle of the duct, and the resulting sections are cauterized until scars form. The use of this technique subsequently prevents the appearance of microscopic channels in men between the edges of the vas deferens and reduces the likelihood of conception to zero.
Clamp installation. During the sterilization process spermatic cords clamped with special clips.

Manipulations can be performed both through small incisions and through punctures in the scrotum. The second method is less invasive, so the rehabilitation of a man is much faster. Videos posted on the Internet will help you get acquainted with the stages of sterilization in more detail.

Chemical

If a man is not ready for the irreversible cessation of reproductive function, temporary sterilization is recommended. One method is to take medications that inhibit the function of the male gonads. Chemical sterilization of men has several significant disadvantages: drugs have many side effects, their reception is accompanied by sexual dysfunction and causes hormonal imbalance.

Current male sterilization medications It is mainly used to correct the behavior of persons convicted of sexual crimes.

Radiation

Male sterilization by exposure to ionizing radiation leads to complete atrophy of the gonads. After a certain dose of radiation, the testicles gradually cease to function, which leads not only to sterility, but also to a lack of libido and potency. Male radiation sterilization is prescribed only for medical reasons, as radiation adversely affects nearby tissues. In the overwhelming majority of cases, the basis for the course of irradiation is the formation of malignant tumors in the male body. Subsequently, in some men, an independent restoration of reproductive function is observed.

Hormonal

Methods of male contraception also include hormonal sterilization. The components of the drugs affect the pituitary gland, suppressing the production of sex hormones and the formation of spermatozoa. At the same time, necessary for normal potency male hormone testosterone is introduced into the body additionally. After the termination of the course, the reproductive function in men is restored for some time, which is required to normalize the hormonal background.

The complexity of the operation

Surgical sterilization of males is not considered complicated operation. Traditionally, manipulations are carried out under local anesthesia. General anesthesia is used quite rarely and only at the request of the patient.

Despite the relative ease of the procedure, the effectiveness of the result obtained and the speed of recovery male body largely depends on the experience of the doctor. In this regard, preference should be given to proven clinics with a good reputation. Before contacting a specialized institution, take an interest in the qualifications and experience of doctors, read patient reviews. It is also worth clarifying whether operations are performed using more modern techniques.

How long does the intervention last

The duration of sterilization depends on the type of access to the ducts and the method of blocking the internal lumen. Given the complexity of the operation, all stages from preparation operating field before suturing takes an average of 15-30 minutes. More precisely, the doctor will be able to say how long sterilization lasts after a preliminary examination of the man and the choice of the type of manipulation.

Cost of the procedure

The price of the operation is formed taking into account many factors. The cost of services is affected by the qualifications of the staff, the technical equipment of the clinic, as well as the region in which it is located.

Depending on the location and level of services provided, prices can vary from 15,000 to 25,000 rubles. Typically, clinics indicate how much male sterilization costs without taking into account a doctor's examination and laboratory diagnostics. The total cost of the procedure depends on what types of analyzes and diagnostic studies will be required to assess the condition of a man.

Preoperative period

Preparation for the operation begins in a few days. The patient needs to pass general clinical tests and make a cardiogram. In order to prevent complications in the preoperative period, a man must be examined by a urologist. Before surgery, you should also exclude the presence of sexually transmitted diseases.

Postoperative period

In the absence of complications, discharge from the hospital is carried out on the same day. A man, no matter what technique was used during the sterilization, needs to adjust his lifestyle for a while. During the first 2-3 days it is recommended to avoid physical activity. Sexual life can be resumed no earlier than 7-10 days after sterilization.

Requires special attention postoperative suture. Care after the intervention consists in the regular treatment of the wound and the replacement of dressings. Punctures or incisions should not be wetted, so you should refrain from taking a shower or bath for several days. As a rule, self-absorbable threads are used during male sterilization, so the removal of stitches is not required.

It is worth remembering that the cleansing of the ducts from viable spermatozoa does not occur immediately, but after 20-25 ejaculations. Therefore, at first (the timing depends on the intensity of a man’s sexual life), it is necessary to use additional male or female contraceptives. To verify the effectiveness of sterilization, it is recommended to analyze the seminal fluid for the presence of spermatozoa in it. Only after the successful completion of the operation is established, a man can refuse additional contraceptives.

Complications

Sterilization of men, although not associated with extensive tissue injury, is still an operation with possible undesirable consequences and complications. Within a few days, there may be swelling of the scrotum, pain in the groin area, and discomfort. A slight increase in body temperature is considered normal. Usually, on the 3-4th day after sterilization, the listed symptoms disappear.

Every male undergoing sterilization needs to be aware of the possible complications that may arise. To undesirable consequences include hematomas, infection of the wound, and rupture of sutures.

You should immediately consult a doctor with a sudden increase in body temperature to 38 degrees and above, the appearance of bloody or purulent discharge from the wound, aggravated painful sensations in the scrotum. It is strongly not recommended in these cases to self-medicate, guided by advice from articles and videos on the Internet.

Male sterilization as a method of contraception is almost 100% effective, but the decision to intervene requires a conscious and balanced approach. It should be remembered that a few years after the procedure, it is no longer possible to restore the ability to conceive. That is why experts advise choosing sterilization only for those men who are absolutely sure that they will no longer want to have children. It is necessary to carefully analyze all the arguments for and against, and at the slightest doubt, postpone the intervention by choosing another method of preventing unwanted pregnancy.