SESSION-2

PERMANENT METHOD OR TERMINAL METHODS OF FAMILY PLANNING

Sterilization is the most effective and one of the widely practiced contraceptive methods
available worldwide. Currently female sterilizations accounts for about 85% and male
sterilizations for 10-15 % of all sterilizations in India.

ADVANTAGES OF STERILIZATION:

1. It is a one- time method

2. It does not require any sustained motivation of the user for its effectiveness
3. Provides most effective protection against pregnancy
4. Risk of complications is small if it done based on medical standard
5. Cost effective

GUIDELINES FOR STERILIZATION:

1. The age of the husband should not ordinarily be less than 25 years nor should it be over
50 years.
2. The age of the wife should not be less than 20 years or more than 45 years.
3. The motivated couple should have 2 children at time of operation
4. If couple has 3 or more living children, the lower limit of age of the husband or wife may
be relaxed at the discretion of the operating surgeon.
5. Consent for sterilization should not be obtained under coercion or when the client is
under sedation.

MALE STERILIZATION;

Male sterilization or vasectomy is a simple operation can be performed even in primary

health centres by trained doctors under local anaesthesia. There is no risk if it is done under
strict aseptic technique.

Procedure: In vasectomy, it is customary to remove a piece of Vas at least 1 cm after

clamping. The ends are ligated and then folded back on themselves and sutured into
position, so that the cut ends face away from each other. This will reduce the risk of
recanalization at a later date. It is important to stress the acceptor is not immediately
sterile after the operation, usually until approximately 30 ejaculations have taken place.

Vasectomy is simpler, faster and less expensive operation than tubectomy in terms of
instruments, hospitalization & Doctor’s training. Cost wise the ratio is about 5 vasectomies
to one tubectomy.

Complications:

1. Operative: pain, scrotal haematoma and local infection, wound infection rarely.
2. Sperm granules
3. Spontaneous recanalization
4. Auto immune response
5. Psychological: diminution of sexual vigour, impotence, headache, fatigue
 Causes of Failure: The most common cause of failure is due to the mistaken identification
of the vas.
Post-operative advice:
To ensure the normal healing of the wound and to ensure the success of the operation, the
patient should be given the following advice:
1. The patient should be told that he is not sterile immediately after the operation; at
least 30 ejaculations may be necessary before the seminal examination is negative.
2. To use contraceptives until aspermia has been established
3. To avoid taking bath for atleast 24 hours after the operation
4. To wear a T-bandage or scrotal support for 15 days; and to keep the site clean and
dry.
5. To avoid cycling or lifting heavy weights; no need for complete bed rest.
6. To have the stiches removed on the 5th day after the operation.

No Scalpel Vasectomy:
No-scalpel vasectomy is a type of vasectomy procedure in which a specifically designed
ringed clamp and dissecting hemostat is used to puncture the scrotum to access the vas
deferens. This is different from a conventional or incisional vasectomy where the scrotal
opening is made with a scalpel. This new method is now being canvassed for men as a
special project, on a voluntary basis under the family welfare programme. This project is
being funded by UNFPA.

Female Sterilization:

Sterilization (sometimes called female sterilization, tubal ligation, or “getting your tubes
tied”) is a safe and effective surgical procedure that permanently prevents pregnancy.

In addition to being permanent, it is highly effective, safe and relatively free from side
effects. In India female sterilization by tubectomy or tubal occlusion is the most commonly
accepted methods among eligible couples.

It can be done as an interval procedure,postpartum or at the time of abortion. Two

procedures have become most common, namely laparoscopy and minilaparotomy.

A) Laparoscopy:
This is a technique of female sterilization through abdominal approach with a
specialized instrument called laparoscope. The abdomen is inflated with gas( carbon
dioxide, nitrous oxide or air) and the instrument is introduced into the abdominal cavity
to visualize the tubes. Once the tubes are accessible, the falope rings are applied to
occlude the tubes.

Patient Selection:

 Not advisable for postpartum patients for 6 weeks after delivery.

 It can be done as concurrent procedure to MTP
 Heamoglobin percent should not be less than 8
 There should not be any associated medical illness such as heart disease, respiratory
disease etc,.
 Keep the patient in hospital for minimum 48 hours after the operation.
 Followed up once between 7-10 days after surgery & once again between 12-18 months.
 Complication:

 Complications are uncommon

 Puncture of large blood vessels some times.

(b) Minilap Operation:

It is a modification of abdominal tubectomy.it is a much simpler procedure requiring a smaller

abdominal incision of only 2.5 to 3 cm conducted under local anaesthesia. minilap/pomeroy
technique is considered a revolutionary procedure for female sterilization. Minilap operation is
suitable for postpartum tubal sterilization. The