Obstetrics and Gynecology - A.M. Hromova 2000

Modern family planning methods
Modern contraception methods
Voluntary surgical sterilization (VSS)

This efficient and cost-effective method is a surgical Procedure designed to create permanent artificial tubal occlusion (female sterilization) or vasal occlusion (male sterilization).

Female sterilization is performed either via traditional laparotomy (during Cesarean Section or adnexectomy), mini-laparotomy, or laparoscopy (the least invasive approach).

Mini-laparotomy can be postpartum or interval. In postpartum mini-laparotomy, During the first two days after delivery (when the Uterus and fallopian tubes are located high in the Abdominal cavity), a 1.5–3 cm incision is made below the navel to perform the tubal procedure.

Interval (suprapubic) mini-laparotomy is performed 6 weeks postpartum or on any day of the Menstrual cycle.

Laparoscopic sterilization is performed via transabdominal or transvaginal access.

All Methods of female sterilization are divided into four groups:

1. Methods involving ligation and division of the fallopian tube.

2. Mechanical methods of creating fallopian tube occlusion by applying clips or rings.

3. The Use of thermal energy for the coagulation and blockage of the fallopian tubes.

4. The Introduction of substances into the fallopian tubes that induce chemical Burns followed by scar formation.

The contraceptive efficacy of female sterilization is 0.05–0.4 pregnancies per 100 women-years.

Sterilization can be performed either for medical indications (severe extragenital diseases, malignant neoplasms) or at the woman's request (in the presence of uterine scars from previous cesarean sections and when the family already has two or more children).

Sterilization is not performed in the presence of acute inflammatory pelvic diseases, unexplained uterine bleeding, or in cases where the woman does not give voluntary and informed consent to the surgery.

Voluntary male sterilization (vasectomy) is a surgical procedure involving the transection of the vas deferens, resulting in an ejaculate devoid of spermatozoa.

The procedure is performed under local anesthesia using several techniques:

— through one or two Skin and Muscle incisions, the vas deferens is ligated, transected, and coagulated;

— a similar procedure, but without ligation and electrocoagulation of the abdominal ends (as prophylaxis for epididymitis);

— a scalpel-free technique utilizing a specialized dissecting clamp.

The contraceptive efficacy is 0.1–0.15 pregnancies per 100 women-years.

The procedure does not alter sexual function and can be performed on men of any reproductive age who have already achieved their desired family size, or when the use of other contraceptive methods is undesirable or unfeasible.