Sterilisation — Not the end of female nature

WHEN the term sterilisation is used, many associate this with the end of “womanhood”. But contrary to popular belief, this is not so. Sterilisation is actually an effective and permanent form of contraception and involves manipulation of the tubes in such a way that the tubes are “blocked” and thus prevent sperm from fertilising an egg.

The Fallopian tubes are tubular structures which are located laterally to the top of the uterus. They can be 10-15 cm in length and are about 0.5 -1 cm thick. They have a finger-like end called the fimbrae which grabs the egg when ovulation occurs and transports it to the uterine cavity. This is aided by cilia epithelium within the tubes which are fine hairlike particles which propel the egg. The tubes are not directly attached to the ovary so manipulation of same does not usually result in damage to the ovaries and thus damage to “female nature”.

Types of sterilisation

For centuries, the only means of sterilisation was surgically. This would involve an incision in the abdomen and accessing the tubes where they are double tied and cut, referred to as a tubal ligation. This procedure is usually conducted under general anaesthesia and usually takes about 15-20 minutes. This procedure can be done at any time once the female is in good health and is not dependent on the female reproductive cycle. It can also be done right after delivery — post-partum sterilisation — when the uterus is still expanded and within the abdomen. Here an incision can be made around the umbilicus and the tubes grasped, tied and cut.

With the advancement in medical technology, classical tubal ligation is becoming something of the past. With laparoscopy, a camera is used to visualise the inside of the abdomen through the umbilicus. The tubes are manipulated through secondary small incisions and they can be physically occluded by placing a small ring over them or by scarring them with electrosurgical energy, both being very effective.

There are fewer complications with laparoscopy when compared to classical tubal ligation and generally, patient satisfaction is improved with laparoscopy.

Non-surgical techniques involve placing a fibre like material which is inserted into the tubes through the cervix and physically blocking the tubes. This can be done in office.

Most sterilisation techniques have efficacies up to 99 per cent. The failure rate of tubal ligation is 1/200 , thus patients must be adequately counselled on same.

What age to do it ?

There is no age limit. This is a decision that should be made by the patient. There is a huge amount of regret that potentially can be associated with sterilisation so the decision should not be rushed and adequate counselling should take place.

Reversal is possible but does not necessarily result in future fertility. Sterilisation should be a permanent procedure. Possibly one solution if reversal fails or is not possible is in vitro fertilisation.

Vasectomy

This is male sterilisation and involves occlusion of the tubes which transport sperm from the testicles to the penis. It’s done under local anaesthesia and has a lower failure rate when compared to female sterilisation. This, too, does not affect the man’s nature and is a good alternative for a couple if a woman is unable to get sterilisation due to other reasons.

Dr Daryl Daley is a consultant OBGYN at Gynae Associates, 23 Tangerine Place, Kingston 10 and Shops 46-50, Portmore Town Centre. He can be reached at 929-5038/9, 939-2859, 799-0588 or drdaryldaley@gmail.com