Female sterilization. Female and male sterilization

Voluntary surgical sterilization (VS) or female surgical contraception is an irreversible and one of the most effective methods of preventing pregnancy. Female DCS is a widespread method of contraception, the demand for which is actively growing in developed countries of the world. Currently, more than 166 million women use this method.Sterilization at the request of the patient has been allowed in Russia since 1993. Previously, DHS was carried out exclusively for medical reasons.

In Russia, operations are carried out in accordance with Art. “Medical sterilization” of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens; On December 28, 1993, the Ministry of Health of the Russian Federation issued Order No. 303 “On the use of medical sterilization of citizens.”

In accordance with Art. 37 of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, DHS is carried out in institutions of the state or municipal health care system that have received a license for the specified type of activity. It must be emphasized that refusal to bear children affects the rights not only of the person who consented to surgical intervention, but also of the spouse and close relatives. However, Russian legislation stipulates that to perform DHS, only the consent of the person undergoing the operation is required. Thus, a doctor who discloses information about DHS is responsible for non-compliance with medical confidentiality.

GENERAL PRINCIPLES OF SURGICAL STERILIZATION

Female sterilization is most often irreversible, so the issue of sterilization must be approached thoughtfully and the possible consequences taken into account. Despite isolated cases of restoration of fertility after expensive conservative plastic microsurgical operations, the frequency of negative results significantly exceeds the frequency of successful outcomes.

Basic requirements for methods of surgical sterilization of fallopian tubes:

• efficiency;
• safety;
• simplicity.

INDICATIONS FOR STERILIZATION

The indication for DHS is the desire to completely prevent fertilization. Medical indications include the presence of severe malformations and disorders of the cardiovascular, respiratory, urinary and nervous systems, malignant neoplasms, blood diseases (contraindications to pregnancy and childbirth for health reasons).

CONTRAINDICATIONS FOR STERILIZATION

Absolute:

• acute PID.

Relative:

• generalized or focal infection;
• cardiovascular diseases (arrhythmia, arterial hypertension);
• respiratory diseases;
• tumors (localized in the pelvis);
• diabetes;
• bleeding;
• severe cachexia;
• adhesive disease of the abdominal cavity and/or pelvic organs;
• obesity;
• umbilical hernia (for laparoscopy and urgent postpartum interventions).

The issue of sterilization of mentally retarded patients remains controversial.

METHODS OF PAIN RELIEF

In Russia and in developed countries, DHS is usually performed under general anesthesia. The use of spinal and epidural anesthesia is possible.

OPERATIONAL TECHNIQUE

DHS is based on the creation of artificial obstruction of the fallopian tubes surgically during laparoscopy, minilaparotomy or traditional transsection (for example, during a cesarean section).

LAPAROSCOPIC TUBAL LIGATION

Currently, the laparoscopic DHS method is widespread in many countries around the world.

Advantages of the method:

• minimally invasive;
• leaves virtually no scars on the skin;
• it is possible to perform the operation on an outpatient basis using local anesthesia;
• the procedure is well tolerated by patients;
• short rehabilitation period.

MINILAPAROTOMY

In the last decade, abdominal surgery specialists have increased interest in the development of minimally invasive interventions on the abdominal organs using the so-called minilaparotomy - a small incision of the anterior abdominal wall 3–6 cm long.

Its effectiveness, the number of intraoperative and postoperative complications, and the rate of rehabilitation are similar to those when using laparoscopic technology. Simplicity of execution, lack of need for complex equipment and instruments have made tubal DHS for minilaparotomy an alternative to laparoscopic surgery.

SURGICAL STERILIZATION USING COLPOTOMY ACCESS

When using colpotomy access, the rectal uterine space is opened with scissors, one of the fallopian tubes is brought into the wound until the fimbriae of the tube are visible, after which a suture is placed almost in the middle of the tube, a little closer to the fimbriae. The tube is tied with a thread made of non-absorbent material and pulled out. After this, the tube is crushed and tied using the Madlener method. The same is done with the second pipe.

The ends of all sutures are cut off only after the surgeon has tied both tubes and inspected their ampullary sections. The incision of the peritoneum and vagina is sutured with a continuous mattress suture.

Thus, DHS via colpotomy access has certain advantages:

• absence of cosmetic defects on the anterior abdominal wall;
• economic benefit (no need to use expensive equipment);
• universal accessibility (can be performed in any gynecological department);
• sterility is achieved immediately after surgery (as opposed to male sterilization).

Currently, the most common methods of creating occlusion of the fallopian tubes can be divided into 4 groups:

• Methods of ligation and separation (according to Pomeroy, according to Parkland). The fallopian tubes are ligated with suture material (ligation) followed by cutting (division) or excision (resection) of a fragment of the tube. Pomeroy method: the fallopian tube is folded to form a loop, tied with absorbable suture material and excised near the site of ligation. Parkland method: The fallopian tube is ligated in two places and a small internal section is removed.
• Mechanical methods based on blocking the fallopian tube using special devices: silicone rings, clamps (Filshi clamp, made of titanium coated with silicone; Hulk-Wulf spring clamp). Clamps or rings are placed on the isthmus of the fallopian tube at a distance of 1–2 cm from the uterus. The advantage of clamps is less trauma to the tube tissue, which facilitates reconstructive operations to restore fertility.
• Methods using thermal energy effects based on coagulation and blocking of the fallopian tubes at a distance of 3 cm from the uterus.
• Other methods: introducing a removable plug into the fallopian tubes, liquid chemicals that cause the formation of a scarring stricture of the tubes.

The sterilization operation can be carried out in the following periods:

• “delayed sterilization” in the second phase of the menstrual cycle;
• 6 weeks after birth, during gynecological surgery;
• “sterilization after abortion”, immediately after an uncomplicated induced abortion;
• “postpartum sterilization” during cesarean section: within 48 hours or with extreme caution 3–7 days after vaginal delivery. DHS does not have a negative impact on the course of the postpartum period, lactation, menstrual function, sexual behavior and physical health; however, even despite changes in legislation, DHS has not become widespread in the postpartum period.

This situation is obviously due to the following factors:

• traditional attitude towards surgery as a complex procedure;
• lack of reasonable criteria for selecting patients for contraception using this method;
• the lack of a developed methodology for informing and counseling various groups of the population on this method of contraception.

Absolute contraindications to DHS in the postpartum period:

• the duration of the water-free interval is 24 hours or more;
• acute infection during and after childbirth.

Relative contraindications to DHS in the postpartum period:

• arterial hypertension (blood pressure more than 160/100 mmHg);
• bleeding during childbirth and the postpartum period, accompanied by anemia (Hb less than 80 g/l);
• obesity degree III–IV.

DHS, like any other method of contraception, has its advantages and disadvantages. A very important aspect of DHS is the reduction in the risk of ovarian cancer by 39%. The risk reduction is independent of sterilization method and remains low for 25 years after surgery.

Disadvantages of the sterilization method:

• irreversibility of the process (the success of the restoration procedure cannot be guaranteed);
• an existing, albeit small, risk of complications (bleeding, injury to neighboring organs, infection, risk of tubal pregnancy, etc.);
• short-term discomfort and pain after the procedure;
• the need for a highly qualified doctor;
• The method does not protect against STIs.

COMPLICATIONS OF STERILIZATION

Complications arise as a result of creating access to the abdominal cavity or as a result of the DCS itself. The incidence of severe complications after all types of sterilization is less than 2%. It is necessary to distinguish between early and late complications.

Early complications of sterilization:

• bleeding;
• intestinal damage and the development of postoperative infection.

Complications occur in 1 case out of 2000 sterilizations. Overall mortality after tubal DHS is 3–19 per 100,000 procedures.

Late complications of sterilization:

• changes in the menstrual cycle;
• heavy bleeding;
• mental disorders.

The pregnancy rate (as sterilization failure) is approximately the same for all methods.

POSTOPERATIVE MANAGEMENT

In the postoperative period it is necessary:

• physical and sexual rest for 1 week;
• exclusion of water procedures (showers) for 2–3 days.

PATIENT INFORMATION

Before surgery, the patient should be informed that:

• like any surgical operation, DHS is associated with a number of possible complications (caused by anesthesia, inflammation, bleeding);
• despite the irreversibility of the process, in the first 10 years after DHS, a woman becomes pregnant in approximately 2% of cases;
• the operation does not affect health and sexual function;
• The operation does not protect against STIs and HIV.

A soft, fluffy, affectionate, purring little ball is a great happiness in the house. However, as this sweet pet grows up and develops from a kitten into an adult cat, natural instincts begin to appear, and with them sleepless nights, loud meows, and sudden mood swings. The cat ceases to be obedient, becomes uncontrollable, may refuse to eat and constantly tries to escape.

And if she has the opportunity to leave the house, then after a few months she brings kittens, which usually have nowhere to go. A humane way for the animal and its owners to get rid of all this and restore calm in the human-cat relationship is to sterilize the cat.

Why are cats sterilized? Pros and cons of sterilization

Sterilization of a cat is necessary in order to reduce the release of hormones - the so-called. estrogens that cause sexual activity. After sterilization, the animal calms down and stops suffering from hormonal surges. As a result, the risk of malignant tumors of the uterus, neoplasms of the mammary glands, polycystic ovary syndrome, and other diseases associated with “downtime” of the reproductive system and/or long-term use of hormonal drugs is reduced. Thus, after the operation, the cat’s life will be healthier and, most importantly, longer (based on the results of many years of observations by veterinarians).

Undoubted advantages of sterilizing cats:

- Sterilization helps prevent unwanted offspring. What will a man do if his pet “brought a bunch of kittens in his lap”? It’s good if he can find a place in good hands. What if he can’t? Throw it out onto the street? Each mature cat is capable of kitting up to 4 times a year.

Count how many stray cats there will be in a year? And in two? And in 10 years? What is better - to sterilize one single cat once or to end up with a huge horde of homeless animals in the future?

- Breeding purebred animals is not always the goal of the owner of a cat of a fashionable breed. Many people purchase an animal in accordance with their preferences, wanting to have a friend and, if you like, an interlocutor, but do not have the slightest desire to engage in breeding. A definite advantage for such people will be the opportunity to sterilize the cat.

In city apartments, where a cat lives without the possibility of going outside and looking for a cat, she begins to worry and suffer. During the period of heat, the cat almost stops eating, her hair may fall out, she begins to mark her territory and meow loudly invitingly. Both the animal itself and the whole family suffer from all this. After sterilization, the cat stops hunting, the calling vocalization that irritates owners so much disappears, it stops looking outside and trying to run away. The owners will finally be able to breathe easy.

We will also add one more point to the advantages of sterilization. Cats that have access to the outdoors and interact with their stray relatives have a high risk of contracting dangerous and incurable infectious diseases. First of all, these are viral immunodeficiency and feline viral leukemia. In addition, there is a high risk of developing feline infectious peritonitis (FIP). These diseases cannot be prevented, there are no preventive methods of protection against them, they are difficult to diagnose and impossible to treat. In addition, diagnosis and treatment are very expensive. By sterilizing an animal, the owner may be saving its life!

Disadvantages of sterilizing cats:

- The main disadvantage is the need for anesthesia. Sterilization is associated with damage to the integrity of the skin, abdominal muscles and reproductive organs (uterus). This requires adequate pain relief. Young cats tolerate anesthesia well, without any consequences for the body. The anesthetic risk for older animals increases many times over. In addition, there are so-called risk breed groups, the use of anesthesia in which can lead to dire consequences. For example, Maine Coons, Sphynxes, British and Scottish Fold cats, as well as some other breeds, are prone to hypertrophic cardiomyopathy (HCM), in which anesthesia can cause thromboembolism and death of the animal. Additional examination before surgery and consultation with a cardiologist will help reduce the risk.

As a result of decreased activity and increased appetite as a result of sterilization, Your cat's risk of obesity increases, and with it come heart problems. Prevention of obesity in sterilized cats is quite simple - you need to streamline your diet, stop feeding your pet food from the table and switch to special food for sterilized cats (for example, Royal Canin Neutered Young Female). They contain less fat and energy, which helps maintain optimal weight.

Methods for sterilizing cats

Sterilization and castration

What is the difference between sterilization and castration of a cat?
Modern Russian veterinary medicine usually means sterilizing a cat oophorectomy (OE)- surgical removal of the ovaries. As a result, sex hormones cease to be produced, hormonal levels change, estrus and related phenomena stop. The risk of tumors and cysts is reduced. Typically this method is used on young and nulliparous females with a healthy uterus.

It is important to know : after oophorectomy there is a high risk of developing purulent processes in the uterus, endometritis and pyometra. If these diseases manifest themselves in old cats (and, as a rule, they manifest themselves in old age), the operation becomes dangerous for physiological reasons related to the risk of anesthesia. Therefore, most veterinarians prefer castration of cats.

Castration is the removal of not only the ovaries, but also the uterus (ovariohysterectomy, OHE). It is performed in cats of all ages, as a planned procedure or according to indications (uterine pathologies, unsuccessful births, extirpation of the uterus with fetuses, etc.). As a result of castration, the risk of uterine diseases and many other health problems is negated.

Tubal occlusion

Otherwise - fallopian tube ligation- a method in which sexual behavior is completely preserved, but the possibility of pregnancy is eliminated. It is rarely used in veterinary medicine, mainly for those cats whose owners insist on preserving sexual behavior in the pet, wanting to provide her with conditions that are stereotypical for humans.

The method involves surgical intervention, the degree of impact on the body is the same as OE or OGE, but without removing the reproductive organs or their parts.

Since the method is not effective in terms of unwanted manifestations of the reproductive instinct (estrus, characteristic behavior, the desire to run away in search of a partner will remain), it is practically not used.

Chemical temporary castration of cats

For cat owners who do not plan to mate their pet in the near future, but want to do so in the future, we can recommend temporary chemical sterilization of the cat by inserting an implant under the skin. For example, the drug Suprelorin has proven itself to be a reliable means for chemical castration of cats.

When it comes to sterilization of cats, in modern veterinary medicine we usually mean oophorectomy or ovariohysterectomy. They can be carried out in various ways.

Surgical methods of sterilization

Cats are sterilized, as a rule, in one of three main ways, differing, in fact, only in access to the abdominal cavity:
access along the white line of the abdomen (the most common method)
access through a lateral incision
one or more punctures of the abdominal wall to remove reproductive organs using laparoscopic equipment.

1. Sterilization of cats with surgical access along the white line of the abdomen- the most common and familiar method. The animal's fur is shaved from the navel to the last pair of nipples, a skin incision is made, then the aponeurosis of the abdominal wall is cut (in the center, between the muscles, without bleeding).

After this, the surgeon removes the uterine horns and, depending on the sterilization method, ligates the vessels and removes only the ovaries or the ovaries and the uterus.

Sutures are then placed on the abdominal wall and skin.

The peritoneum is sutured with absorbable suture material, the skin suture is performed in various ways, depending on the specific animal, the wishes of the owner, conditions of detention, etc. A little later we will dwell in more detail on the sutures placed on cats during sterilization.

To prevent the cat from licking the seam and introducing dirt and infection, a postoperative blanket is worn. The blanket is removed on the day the stitches are removed, not earlier.

The length of the incision for ovario- and ovariohysterectomy with access along the white line of the abdomen is from 1.5 to 5 cm, depending on the size of the animal, the presence of pathologies and the qualifications of the surgeon.

2. Surgical access through a lateral incision developed and used mainly in the implementation of a program for sterilization of homeless animals, without overexposure. Cats that wake up after anesthesia are immediately released into the external environment. Therefore, the method provides for low tissue trauma, a relatively small incision and no need for suture care. Ovariectomy is most often performed this way.

The good thing about this method is that the length of the suture is much shorter than with traditional ovariohysterectomy. A cat recovers quickly after such an operation and requires less care than after an operation with an incision along the white line.

In this case, tissue trauma is more pronounced due to damage to the muscle layer. When sterilizing along the white line, it is not the muscles that are damaged, but the aponeurosis (connective tissue).

Veterinarians do not like the lateral approach due to the inability to objectively assess the condition of the animal’s organs and take appropriate measures or give recommendations to the owner for further diagnosis or treatment of the animal (for example, an enlarged spleen or coprostasis in the intestines). In addition, muscle repair can be even more painful than aponeurosis repair.

3. Modern, low-traumatic and safe method -. Allows you to combine the possibility of complete visualization of the abdominal organs and ultra-low tissue damage.

Laparoscopic sterilization of cats is carried out with a special instrument - a laparoscope, which is a tube with a video camera unit and a lens. The resulting image is displayed on the monitor and allows the doctor to carry out the procedure under full visual control.

The operation is performed through small incisions (up to a centimeter in length), into which a manipulator and laparoscope are inserted.

To create an operative space, a carboxyperitoneum is created - the abdominal cavity is filled with carbon dioxide, the abdominal wall rises, and the internal organs are in excellent visual access for the surgeon. All manipulations are performed directly in the abdominal cavity, bleeding is stopped by coagulating blood vessels and tissues, and the removed organs are removed through a puncture in the abdominal wall. Both spaying and neutering of cats can be performed laparoscopically.

Advantages of the laparoscopic method of sterilization of cats:

• Minimal tissue trauma
• The highest degree of sterility during surgery (contact of the surgeon’s organs and hands is completely excluded, only sterile instruments)
• Good visualization. The opportunity for the surgeon to conduct an inspection of internal organs, both during and after surgery, to assess postoperative risks. Modern laparoscope video cameras provide excellent magnification. Even hamsters, mice and chinchillas can be operated on comfortably and with high quality.
• No need for postoperative treatment. Seam processing is minimal. If the puncture is made with a 0.3 or 0.5 cm trocar, no stitches are applied at all, the wound is simply sealed.

The main disadvantage due to which laparoscopy is available in a very limited number of veterinary clinics is the high cost of equipment and the need for additional training of employees.

The cost of laparoscopic sterilization of cats is always higher than the cost of traditional methods of sterilization.

For any of these three methods, general anesthesia is required.

Sutures in cats after sterilization

With any method of sterilizing cats, stitches are placed on the wound. The abdominal wall is sutured with catgut (rarely used) or synthetic absorbable threads (PHA, vicryl, etc.).

The skin suture is performed in two ways:
1. Classic skin suture. Non-absorbable threads are used (silk, nylon, etc.). Depending on the situation, an interrupted or continuous suture is applied.
2. Interrupted or continuous intradermal suture that does not require removal.

In what situations are certain sutures applied?
For example, photo 9 shows a classic interrupted suture that we applied when sterilizing a yard cat.

Such sutures provide high reliability of tissue fixation, eliminating divergence of the wound edges. In our case, the owner will not be able to watch the stray cat constantly, there is no guarantee that the animal will not damage the seam with its tongue or when jumping, so the most reliable, but not very attractive, method of application was chosen.

Photo 10 shows a cutaneous interrupted continuous suture. We apply this suture in 95% of cases of cat sterilization. It is the least labor-intensive, holds the edges of the wound well and is easily removed. In addition, such a suture has an excellent cosmetic effect - six months after the operation, the skin defect is almost invisible.

Photo 11 shows a continuous intradermal suture. We apply such stitches at the request of the owner. For example, if he cannot find time to visit a veterinary clinic to remove stitches or if the animal is aggressive. A special thread is used that dissolves 50-70 days after surgery.

Sutures are usually removed 7-10 days after sterilization or not removed at all if the suture is intradermal.

Caring for any skin suture comes down to maintaining cleanliness and preventing infection from entering the wound. Good wound protection is achieved by using an aluminum spray. Small particles of the spray reliably close the wound from bacteria and dirt.

Optimal age of a cat for sterilization

Reproductive organs in cats reach full development by the age of 5 months. From this age, hypothetically, one can begin to plan the operation. However, we would not advise rushing. Five-month-old kittens tolerate anesthesia quite hard, and, according to some observations, are even delayed in growth and development compared to cats whose sterilization was carried out a little later, at 7, 8 or 9 months.

However, there is no point in postponing the decision about surgery until later. If estrus passes without mating for several years, the cat may develop diseases of the reproductive organs (very often polycystic ovary syndrome), so you should not delay the operation too much.

We consider the age of a cat to be between 7 months and 10 years optimal for sterilization. The operation is also permissible later; according to indications, it is performed at any age, if the animal does not have serious health problems. It should be remembered that the older the cat, the higher the anesthetic risk. Anesthesia can lead to exacerbation of chronic diseases and death of the animal. Therefore, we prescribe additional examinations for older animals before surgery.

Preparing a cat for surgery

Sterilization is a fairly serious surgical intervention on an animal’s body, so this matter must be approached with great responsibility, and the procedure requires general anesthesia. Therefore, animal owners should listen carefully to the doctor and follow all recommendations. Before the operation, the doctor may prescribe tests and ultrasound, as well as examination by a cardiologist and therapist. These are reasonable precautions because the doctor must be confident that the cat will tolerate the surgery well and that no complications will arise during the procedure. This is especially important for older cats (over 10 years old), since they may have pathologies of internal organs (tumors, polycystic disease, inflammation, etc.), as well as heart problems.

Before the operation, the cat is not fed for 8-12 hours, and water should not be given to it for 2-3 hours. If there is anything in the intestines (even water), vomiting will occur during the induction of anesthesia. Vomit can enter the respiratory tract, introducing harmful bacteria into the bronchi and causing aspiration pneumonia. The body, weakened by anesthesia, does not cope well with the infection and the cat may even die. This is why following a fasting diet is so important for successful surgery.

Caring for a cat after sterilization

After sterilization, your cat requires special care. While she is under anesthesia, her body temperature drops, so she needs to be kept warm, maybe covered with a blanket. In this case, the bed must be on the floor and away from objects from which you can fall (tables, sofas, etc.) or which you can hit (radiators, bedside tables, etc.). Even under the influence of anesthesia, cats can begin to walk and jump on furniture, but during this period the animal’s coordination of movements is impaired, so it is necessary to carefully monitor so that no injuries occur.

You also need to make sure that the cat does not lick the seam - some cats manage to wipe the fabric of the blanket with their rough tongue in a week. Therefore, monitoring the condition of the blanket and the seams under it is very desirable.

It is better to put an absorbent diaper on the bedding on which the cat will lie, because... Under the influence of anesthesia, the animal does not control urination. In addition, vomiting may occur.

It is necessary to regularly inspect the seam; it should not bleed or fester.

You must follow your doctor's recommendations for wound care. Usually no complex interventions are required. When sterilizing a cat in our clinic, for example, the owner does not need to treat the stitches at all, only monitoring the condition of the protective layer and limiting the animal’s mobility.

Other specialists may prescribe daily suture hygiene with antiseptic solutions (chlorhexidine, dioxidine) or lubricating the suture with ointment.

Antibiotic therapy in the postoperative period is necessary in most cases. As a rule, long-acting broad-spectrum antibiotics are used (for example, sinulox, amoxoil, amoxicillin). Most often, two injections are prescribed, 48 hours apart. The owner can do the second antibiotic injection himself or come to see a doctor.

The recovery period after sterilization can last up to ten days and, as a rule, does not cause difficulties for cat owners. If you do not want to care for the animal yourself, many veterinary clinics offer inpatient services.

Changes in cat behavior after sterilization

Sterilization does not entail changes in the cat's character. After the operation, manifestations of the reproductive instinct completely disappear. The cat will not have heat, sudden attacks of obsessive affection or aggressiveness. Typically, after sterilization, cats become more gentle and obedient. The hunting instinct, playfulness, and desire to communicate with people and animals are fully preserved.

Changes in hormonal levels as a result of sterilization can lead to an increase in appetite, so you need to ensure that the animal does not gain excess weight, because obesity is also a disease. Therefore, you should provide rationed nutrition, do not overfeed the cat, and also play with it more often.

Today, there is a very large selection of contraceptives that, to varying degrees, can prevent unwanted pregnancy. The highest level of protection is provided by condoms and sterilization for both women and men. Once women are sterilized, there is virtually no turning back. In order to make a decision about sterilization, you need to carefully weigh the pros and cons. If in any case a woman wants to become pregnant again after sterilization, then it will be very difficult to solve this problem and, most likely, through artificial insemination (in vitro conception).

In some situations, sterilization of women is recommended by the attending physician. This happens when the woman’s health condition requires it. In medicine, sterilization is called voluntary surgical sterilization - this is one of the methods of surgical contraception, abbreviated as DCS.

This procedure is quite widely performed in the West and the consequences are minimal. The number of its supporters is also growing every year in Russia. After sterilization of women, only about 3% regret having such an operation.

According to the definition, female sterilization is a method of irreversible surgical contraception, which involves creating an obstruction of the fallopian (uterine) tubes. It is performed surgically. After a woman is sterilized, male reproductive cells (sperm) do not have the opportunity to meet female reproductive cells (ovum) and perform fertilization. It is noteworthy that the woman’s menstrual function is not affected. Menstruation goes on as usual, sexual desire remains and the opportunity to obtain sexual satisfaction remains.

Historical data

There is historical evidence in the literature that indicates that even at the beginning of the 20th century, forced sterilization of women was carried out in countries such as Denmark, Sweden, the USA and Canada. This happened in accordance with adopted laws indicating the need for sterilization for persons leading an antisocial lifestyle, as well as those with mental disorders. In Germany, about 40,000 women were sterilized between 1933 and 1945. Among them, the bulk were Slavs, dark-skinned people and Jews. According to some literary sources, the USSR also used forced sterilization of certain groups of women (psychiatric patients), but after the collapse of the republic, this measure was canceled, as it contradicts the norms of a humane society.

The legislative framework

In the Russian Federation, both women and men are allowed to undergo sterilization only after reaching 35 years of age and if they have at least two children. The only exceptions are those situations when sterilization is performed for medical reasons, that is, due to the patient’s health condition. There has even been a specific list of these medical indications.

In the event that sterilization is performed forcibly, or the written consent of the patient is not obtained, the doctor who performed this procedure will be held criminally liable.

In almost half of all cases, female sterilization is performed after childbirth by caesarean section. To do this, before giving birth, a woman writes a voluntary consent and signs all the necessary documents. Only after this do medical workers perform surgical sterilization. Before signing such a statement, a preliminary conversation is held with the woman, which describes the entire sterilization procedure, its pros and cons, as well as the consequences for the woman, which may differ in each specific case. After all, after a woman is sterilized, nothing can be changed.

Medical indications

Voluntary surgical sterilization of women is a radical method that requires careful consideration and examination, and in no case should a hasty decision be made.

In medicine, there are conditions of the body or diseases that cannot be combined with bearing a fetus, since this puts the life of the mother at risk. Also, for some of these diseases, using other methods of contraception is risky. A unanimous decision on surgical sterilization of women cannot be made. To do this, they gather a council of doctors and jointly resolve this issue.

Indications for sterilization of women:

• leukemia
• uterine rupture
• severe diabetes mellitus
• malignant neoplasms
• severe congenital heart defects
• severe cardiovascular diseases
• repeated cesarean sections in the presence of healthy children
• schizophrenia and other severe mental illnesses
• other serious diseases of various vital organs and systems

This is not a complete list of all medical indications for sterilization of women. You can study it in more detail in a special law of the Russian Federation.

Contraindications

Surgical sterilization of women should not be performed if they have:

• adhesions in the fallopian tubes
• acute inflammatory diseases of the genital organs
• diseases that affect the blood coagulation system
• severe obesity
• umbilical hernia
• other diseases, the presence of which should consult a specialist

How to do it

As mentioned above, in most cases, a woman is sterilized after a caesarean section. In this situation, there is already access to the fallopian tubes, which greatly simplifies the procedure.

If voluntary surgical sterilization is performed routinely for a woman, then it can be done in several ways. This:

• Culdoscopy (an operation performed through the vagina)
• laparoscopy (by performing punctures in the anterior abdominal wall)
• through standard surgery, which is performed through an incision in the suprapubic region

It should be noted that today laparoscopic surgery is most often used. It is the least traumatic and painful, leaves virtually no visible marks (scars) and minimizes the recovery period. Conventional surgery is practically not used today. Each patient herself chooses how the operation will be performed. The price will differ significantly for all three types of operations.

Consequences

Depending on how the woman is sterilized, one can more clearly judge the likely consequences and complications.

Suprapubic minilaparotomy: consequences

After performing this procedure, the risk of any complications is quite low and is less than 1%. This may be perforation (perforation) of the uterus by the surgical instruments used, trauma to the bladder or intestines, complications due to anesthesia, or infection of the surgical wound.

Laparoscopic sterilization of a woman: consequences

This technique has even fewer risks and likely consequences than the previous one. These include conditions that are associated with anesthesia (pain relief), perforation of the uterus, or damage to nearby organs or blood vessels.

Restoring fertility after female sterilization

The possibility of restoring fertility after sterilization of women, although minimal, still exists. Life is unpredictable and no one can know how it will turn out in the future. This is why situations arise when a woman decides to change her previously made decision. There are a huge number of reasons for this. You can restore the ability to become pregnant after sterilization of a woman by performing reconstructive surgery. It is aimed at restoring the patency of the fallopian tubes. To be fair, it must be said that the percentage of successful operations is not very high; the operation itself is very complex and expensive. Sometimes, in order to become pregnant after surgical sterilization, a woman is offered to undergo an IVF (in vitro fertilization) procedure, which is also known to the general public as “in vitro conception.”

Sterilization of women: price

It is impossible to say unequivocally how much it costs to sterilize women. The price depends on the chosen clinic and methods of performing the manipulation. In Moscow, these prices range from 9,000 to 54,000 rubles.

Comparison of prices for female sterilization in the world:

• price in the USA – from 4,800 Euro
• price in Turkey from 2,479 Euro
• price in the UAE from 1,796 Euro
• price in Thailand from 1,819 Euro
• price in Germany from 1,742 Euro

In conclusion, it is worth noting that sterilization of women, namely its consequences, are very serious. This means that you should think carefully before making this decision.

Start your path to happiness - right now!

Female sterilization is a permanent method of contraception that forever eliminates the possibility of becoming pregnant and giving birth to a child. Usually it is used by women who have already given birth and no longer want to have children. The operation involves actions aimed at preventing the fertilization of an egg by a sperm. Artificial obstruction is created through surgery. The effectiveness of this operation is 99 percent.

Indications for sterilization

Any woman over 35 years of age who has at least one child can undergo sterilization. Nevertheless, the issue of carrying out the operation should be approached responsibly. If there is no certainty that a woman will not want to have children again in the future, 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 presence of a risk of transmitting hereditary defects, diseases or developmental abnormalities that are incompatible with life.

Operating principle of sterilization

During ovulation, the egg is released from the ovary and moves along the fallopian tube towards the sperm for further fertilization. Sterilization creates an artificial obstruction of the tubes, which makes conception and pregnancy impossible.

Types

There are two types of sterilization for women:

• Blocking the patency of the fallopian tubes using clamping, ligation, and excision methods.
• Installation of a special implant (hysteroscopic sterilization)

Methods

Sterilization in women is carried out in three ways.

• Laparotomy. It is performed through an incision in the abdominal cavity. Usually performed in conjunction with other abdominal surgeries, such as cesarean section.
• Laparoscopy. Less invasive and most common method. It is performed through several small incisions around the navel.
• Mini-laparotomy. It is performed through a small incision just above the pubic hairline. Most often it is performed in women who have a history of pelvic organ surgery, inflammatory processes or are obese.

Carrying out the operation

During surgery to create an artificial obstruction using clamps, rings, or tubal ligation, the surgeon makes several small incisions in the abdomen. Using a laparoscope, he places plastic or titanium clips or silicone rings on the fallopian tubes, ties them, excises or cauterizes them. This sterilization method is usually performed under general anesthesia. Sterilization of women takes about half an hour. After a few hours, the patient can be sent home.

If the fallopian tubes are unsuccessfully blocked using the previous method, a salpingectomy is performed - complete removal.

The implants are installed 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. The obstruction is created by the formation of scar tissue.

After sterilization

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

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

In theory, female sterilization has an immediate contraceptive effect. But it is still recommended to use combined hormonal contraceptives, such as oral pills, for a week after sterilization.

The effect of hysteroscopic sterilization occurs after 3 months. Because of this, an additional method of contraception should be used throughout the entire period after surgery. You can refuse protection only after an ultrasound or x-ray to confirm the correct installation of the implants.

Side effects

After sterilization surgery, 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.

Pros 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 when performing 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

After surgery in women, depending on the methods used, there is a risk of the following complications.

• infections;
• bladder injuries;
• bleeding of large blood vessels;
• intestinal perforation;
• abdominal infections;
• anesthesia;
• damage to nearby organs such as the intestines or ureter;
• inflammation and pain;
• infection of the wound or one of the fallopian tubes;
• an ectopic pregnancy that develops in the fallopian tubes rather than in the uterus;
• irregular and prolonged menstrual cycles;
• menstrual pain;
• increased menstrual flow;
• cervical erosion;
• increased premenstrual symptoms;
• risk of cervical cancer;
• ovarian tumors.

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

Contraindications to 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 of the pelvic organs.
• unknown origin.
• Gynecological malignant processes.

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

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

Alternative methods of contraception

In addition to sterilization of women, there are less radical methods of long-term contraception, for example, the use of subcutaneous implants, installation of an intrauterine hormonal or non-hormonal device. 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. It involves ligation or removal of the seminal ducts. This operation carries much fewer risks and complications than surgical sterilization of women.

In addition to long-term contraception, combined oral contraceptives, various vaginal creams or suppositories, rings or patches can be used to protect against unwanted pregnancy. The simplest and most accessible is the barrier method - male and female condoms.

Sterilization of women. Reviews

Not everyone will be able to decide on such a radical method of contraception as sterilization. Typically, women come to make such decisions after the occurrence of unplanned pregnancies, for example, due to 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 all available methods of preventing unwanted pregnancy, a woman has no choice but to resort to sterilization.

According to statistics, after surgery, many women experience pain and nausea, which can be relieved with medications. After a few days everything returns to normal.

Some women who undergo sterilization later regret their decision.

Main aspects

Sterilization in women is an almost 100% method of contraception. However, it does not protect against sexually transmitted infections. Therefore, if a woman does not have confidence in her sexual partner, she should use a barrier method of contraception - condoms.

Sterilization in women does not cause menopause or affect women's sexual desire or enjoyment of sex. After the operation, the ovaries will continue to work as usual, and menstruation will occur as before.

Sterilization in women is entirely voluntary.

Finally

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

Surgical sterilization of women is a method of irreversible contraception, as a result of which the patient loses the ability to become pregnant on her own. Today this is one of the most effective methods of protection; its reliability reaches 99.9%.

The purpose of the procedure is to prevent the egg from penetrating into the uterine cavity; to do this, the patency of the fallopian tubes is eliminated in some way. The woman's ovaries will still function, but the egg released during ovulation will remain in the abdominal cavity and will soon be absorbed. Thus, the process of fertilization itself is prevented - sperm simply cannot overtake the female cell.

After tubal ligation, no additional methods of protection are required. The exception is 3 months after surgery - during this period it is recommended to use barrier or hormonal contraceptives.

Many people are concerned about the question: is it possible to get pregnant after sterilization? Pregnancy is practically impossible, but isolated cases of ectopic pregnancy after sterilization have been identified. The frequency of these situations is less than 0.5% (depending on the method) in the first year after surgery, and in subsequent years it is reduced to zero.

There are several types of female sterilization operations.

1. Electrocoagulation . Using electrocoagulation forceps, an artificial obstruction of the tubes is created. For greater reliability, the pipes can be cut at the site of coagulation.

2. Partial or complete tubal resection . Part of the fallopian tube or the entire tube is removed. There are various techniques for suturing residual tubes, and all of them are quite reliable.

3. Clipping pipes, installing rings and clamps . The pipe is clamped with special clips or rings made of non-absorbable hypoallergenic materials, thereby creating a mechanical occlusion.

4. Non-operative introduction of special substances and materials into the lumen of the tubes . This is the youngest method, which has not yet been sufficiently studied. During hysteroscopy, a substance that “clogs” the lumen (quinacrine, methyl cyanoacrylate) is injected into the fallopian tubes.

Interventions can be performed by laparotomy (opening the abdominal cavity) or endoscopy (laparoscopic sterilization). During laparotomy (as well as mini-laparatomy), tubal resection and clamping are most often performed. Electrocoagulation, installation of clips, clamps and rings are performed endoscopically.

Sterilization can be performed as a separate operation or after a caesarean section and other obstetric and gynecological interventions. If we talk about sterilization as a method of contraception, then this is a voluntary procedure, but sometimes there are medical indications (including urgent ones) for tubal ligation.

Are there any contraindications?

In Russia, women who have reached 35 years of age or have 2 children can undergo voluntary sterilization. If there are medical indications, there are no such restrictions.

As with any medical procedure, there are a number of absolute contraindications:

• pregnancy;
• inflammatory diseases of the pelvic organs;
• sexually transmitted infections.

Relative contraindications include:

• adhesions;
• overweight;
• chronic heart disease;
• pelvic tumors;
• active diabetes mellitus.

In addition to physical health, a woman’s psychological state is of high importance. You should not undergo the procedure during periods of depression, neuroses and other borderline conditions. The decision must be balanced and deliberate, because sterilization in women is almost irreversible.

Consequences of sterilization

Complications after sterilization are extremely rare, but they do happen. Possible:

• complications due to general or local anesthesia;
• recanalization of fallopian tubes (sterilization fails);
• adhesions of the pelvic organs;
• ectopic pregnancy.

There are usually no long-term complications, because the woman’s hormonal background remains the same, which means there are no changes in weight, psycho-sexual sphere, and the frequency of tumor diseases of the breast and ovaries does not increase.

Many people are concerned about the reversibility of female sterilization. The procedure is offered as a method of irreversible contraception and should be considered by patients only in this aspect. Restoring tubal patency in some types of occlusion is possible, but this is an extremely expensive plastic surgery that does not always lead to the desired result.