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 What
are contraceptives? |
| What
is surgical contraception? |
|
Tubal ligation |
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Tubal implants |
| How
is it done? |
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Before surgery |
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The surgery |
| --Tubal
ligation method |
| --Tubal
implant method |
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After Surgery |
| Care
at home |
| Benefits
and drawbacks |
| Risks
and Complications |
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|
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| What
are contraceptives? |
| |
| Contraceptives are also called birth
control methods which are used to deliberately prevent
or reduce the likelihood of a woman becoming pregnant.
They are devices or methods or procedures which reduces
the likelihood of the fertilization of an ovum by a sperm.
Nowadays, there is a vast number of different contraceptive
methods. There are many different contraceptive methods
available and different methods suit people at different
times of their lives. It is very important for the woman
and her partner to decide on the method of contraception
most suited to them. There are barrier methods like
condoms, cervical diaphragm. Then there are hormonal
methods like pills which are very commonly used. Besides,
devices like IUCD are placed in the uterus. But all
these are temporary methods. That means they are reversible.
But for few people, permanent birth control is a more
reasonable option. This option is considered when the
couple:
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- Does not want to have children in the future, no
matter how the life may change.
- Have a partner who also does not want children in
the future but does not want to have a vasectomy
- Have also considered other methods of birth control
and do not want the side effects, risks, or costs
of those methods.
- Have health problems that would be made worse by
pregnancy.
- Have a hereditary condition that one does not want
to pass on.
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| What
is surgical contraception? |
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| Permanent birth control methods are
practically irreversible processes actually require surgical
intervention. So they are also called surgical contraceptives.
Sterilization is when a man or woman has an operation
to prevent pregnancy. It safeguards individual health
and rights, preserves our planet's resources, and improves
the quality of life for individual women, their partners,
and their children. For females there are two methods:
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Tubal ligation
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| It is often referred to as "having
the tubes tied," is a surgical procedure. The fallopian
tubes, which carry the eggs from the ovaries to the uterus,
are blocked or cut and sealed off so that the eggs can't
reach the uterus and be fertilized by sperm. Instead,
the eggs are reabsorbed by the body. |
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Tubal implants
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| They are small metal springs that
are placed in each fallopian tube in a non-surgical procedure
(no cutting is involved). Over time, scar tissue grows
around each implant and permanently blocks the tubes. |
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| Both these methods are considered
to be permanent methods of birth control for women. Both
procedure stops eggs from travelling from the ovaries
into the fallopian tubes, where the egg is normally fertilized
by a sperm. Reversing a tubal ligation is possible, but
it is not highly successful. |
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| How is
it done? |
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| Tubal ligation and tubal implants
are considered to be permanent procedures. They come under
surgical procedures. The female must make sure to talk
to her gynaecologist openly to understand what is best
for her. The choice of birth control depends on factors
such as a person's health, frequency of sexual activity,
number of sexual partners, and desire to have children
in the future. |
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| Before
surgery |
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| A pregnancy test is administered beforehand,
because a pregnant woman can't undergo sterilization.
After a detailed case history taking, the physician may
advice for certain tests, depending upon the clinical
indications. The patient will be advised to fast before
the surgery. The doctor may choose to give either general
anaesthesia or epidural. |
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| The surgery |
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| 1.
Tubal ligation method |
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| There are several different ways of
closing the fallopian tubes, including clipping or banding
them, shut or cutting and stitching or burning them closed.
The surgeon will probably prefer one of the following
methods: |
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| Laparoscopic tubal ligation |
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| Laparoscopy involves inserting a viewing
instrument and surgical tools through small incisions
made in the abdomen. Laparoscopy can be done using local
anaesthesia just at the site of the incision. However,
they are usually done with a regional (epidural) or general
anaesthetic. |
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| The doctor injects a harmless gas
(carbon dioxide) into the abdomen, which inflates the
abdominal cavity, making it easier to see the internal
organs. The doctor then makes a tiny incision near the
navel and inserts a long, thin instrument (called a laparoscope)
that contains a small lens and lighting system to magnify
and illuminate the structures inside the lower abdomen.
The physician may make a second incision just above the
pubic hair to insert an instrument for grasping the fallopian
tubes. The tubes are closed by one of the following means:
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- Tying and cutting (ligation)
- Sealing by creating scar tissue
- Removing a small piece of the tube
- Applying plastic bands or spring-loaded clips
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| The tools are then removed and the
openings closed with stitches. The procedure can be performed
in outpatient surgical clinics. It takes 20 to 30 minutes.
Very little scarring occurs. Women often go home the same
day. They may have sexual intercourse as soon as they
feel comfortable about it. Injury to the bowel or bleeding
inside the abdomen occurs in five out of 1,000 cases.
Major surgery may be required to resolve such complications. |
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The Fallopian tubes being tied
using laparoscopic instrument
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| Mini-laparotomy ("mini-lap") |
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This is done through an incision that
is less than 2 inches (5 cm) long. Postpartum tubal ligation
is usually done by this method, following childbirth.
The fallopian tubes are higher in the abdomen right after
pregnancy, so the incision is made below the belly button
(navel). The procedure is often done within 24 to 36 hours
after the baby is delivered. Mini-laparotomy can be done
using local anaesthetic just at the site of the incision.
However, they are usually done with a regional (epidural)
or general anaesthetic Laparoscopy can be done using local
anaesthesia just at the site of the incision.
For this procedure, there is no gas or laparoscope. It
is typically performed soon after childbirth. The doctor
makes a small incision just above the pubic hair, or if
done within 48 hours of childbirth, below the navel. The
tubes are located, and the doctor uses a small tool to
tie, clip, or seal off the tubes. Women usually recover
in a few days. Doctors will advise as to when sexual intercourse
can be resumed. |
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The mini-lap may be a good choice
for women who cannot undergo laparoscopy due to prior
abdominal surgery or disease, and those for whom full
laparotomy is too risky because of heart or respiratory
conditions. It may not be appropriate for women who are
obese or those with damaged fallopian tubes. |
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| Laparotomy |
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This procedure is major surgery. It
is less commonly used than mini-laparotomy and laparoscopy.
The surgeon makes a two-to-five-inch incision in the abdomen.
Laparotomy is usually done under general anaesthesia.
This uses the same methods for closing or cutting the
fallopian tubes, but the abdomen is opened with a larger
incision to give the surgeon a clear view of all of the
organs.
The surgeon locates and closes off the tubes. The operation
requires general or spinal anaesthesia. A woman may need
to be hospitalized for two to four days. It may take several
weeks at home to completely recover. If the procedure
is done after delivery, the woman's hospital stay may
be extended by one or two days. When to resume sexual
intercourse depends on the rate of recovery.
It may be preferable for women who need other abdominal
procedures at the same time (such as caesarean delivery),
and those who have had pelvic inflammatory disease, endometriosis,
or prior abdominal surgery. |
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| 2.
Tubal implant method |
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| Implants are inserted in the fallopian
tubes without surgery or general anaesthesia. The procedure
is done in an outpatient surgery centre or hospital and
does not require an overnight stay. The implant procedure
usually takes about 30 minutes. A tubal implant can be
difficult to insert. In about 15% of women, a second procedure
is needed to completely block both tubes.
Before the procedure, the cervix is first opened (dilated)
to reduce the risk of injury to the cervix. The health
professional may place a slowly expanding tube or sponge
(laminaria or synthetic dilator) in the cervix several
hours beforehand. If not, a speculum and a dilating
instrument is used to gradually open the cervix just
before the procedure. The physician then passes a thin
tube (catheter) through the vagina and cervix, into
the uterus, and then into a fallopian tube. The catheter
is used to place an implant into a fallopian tube. An
implant is then placed in the other fallopian tube the
same way. One may have some menstrual-like cramping
afterwards. After the procedure, an X-ray is taken to
make sure the implants are in place.
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| For the first 3 months after insertion,
the patient is adviced to use another method of birth
control. At 3 months, dye is injected into the uterus
and an X-ray is taken (hysterosalpingography) to make
sure that the implants are in place and the tubes are
fully blocked by scar tissue. If they are, there is no
longer use of another method of birth control. |
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| After
Surgery |
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| After the surgery, the patient will
be taken to the recovery room, where she will remain until
she wake up or gets the feeling back in the numbed area.
Depending upon the case, the physician may discharge the
patient on the same day. After laparoscopy, the stomach
may be swollen (distended) from the gas that was used
to lift the skin and muscles away from the abdominal organs
so the surgeon could see them better. This should go away
within a day or so. One may also have some back or shoulder
pain from the gas in abdomen. This will go away as the
body absorbs the gas. A follow-up exam in 2 weeks is usually
scheduled. |
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| Care at
home |
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| She will be advised to take rest for
a few days (or at least 24 hours) before beginning to
resume normal activities. The patient has to take care
as to avoid constipation because straining has to be avoided.
The physician will also explain the patient as to when
she can resume with her sexual life. |
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| Benefits
and drawbacks |
| |
| Tubal ligation and tubal implants
are permanent methods of birth control and allows the
female to be sexually active without worrying about becoming
pregnant. Although these methods are expensive but it
is a one-time cost. These procedures are usually covered
by medical insurance, and there are no costs after the
surgery is done. The cost of other birth control methods,
such as pills or condoms and spermicide, may be greater
over time.
Above all, both these methods do not change the biological
rhythm of the body. There is no change in monthly menstrual
cycle. One will still release an egg each month (ovulate)
and have menstrual periods. The female will go through
menopause at the same time that she would have if she
had not had the surgery. On the sexual front also there
is no change. Infact women claim of feeling more relaxed
about having sex because she doesn't have to worry about
becoming pregnant.
The major disadvantage is that Tubal ligation and tubal
implants do not protect against sexually transmitted
diseases (STDs), including infection with the human
immunodeficiency virus (HIV).
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| Risks
and Complications |
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| Major complications of tubal ligation
are uncommon. Minor complications include infection and
wound separation. They affect about 11% of women after
mini-laparotomy, and 6% of women after laparoscopy. Major
complications include heavy blood loss, general anesthesia
problems, organ injury during surgery, and need for a
larger laparotomy incision during surgery. They affect
1.5% of women after mini-laparotomy, and 0.9% of women
after laparoscopy.
Although fewer complications occur with laparoscopy
than with other kinds of tubal ligation surgery, these
complications can be more serious. For example, on rare
occasions, the bowel or bladder is injured when the
laparoscope is inserted. But by choosing a skilled laparoscopic
surgeon, these risks can be avoided.
The risk of pelvic infection is greater with tubal
implants. There is a slight risk of becoming pregnant
after tubal ligation. This happens to about 5 per 1,000
women after 1 year. After a total of 10 years following
tubal ligation, about 18 per 1,000 women will have become
pregnant. Pregnancy may occur if:
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- The tubes grow back together or a new passage forms
(recanalization) that allows an egg to be fertilized
by sperm. The health professional can discuss which
method of ligation is more effective for preventing
tubes from growing back together.
- The surgery was not done correctly.
- One was pregnant at the time of surgery.
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| If a tubal ligation or implant fails
and the female becomes pregnant, she may run into the
risk of having ectopic pregnancy. This means that the
egg after getting fertilized implants itself into the
fallopian tubes instead of uterus. |
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