Sterilization has become the most widely used method of family planning in both the developed and developing world. This article discusses the importance of presterilization counseling and describes the timing of the procedure, methods of anesthesia, and occlusion techniques (eg, tubal ligation and the use of rings and clips) in female sterilization. Other topics covered in sterilization of women are long-term follow-up and complications, reversal of sterilization, impact of national sterilization policies, and nonsurgical sterilization. The article includes a short section on surgical contraception for men.
PIP: The emergence of surgical sterilization as the most widely used contraceptive method, in developed as well as developing countries, has led to refinement of surgical techniques, attention to the potential for reversibility, and a greater emphasis on preoperative counseling. Much of the increase in sterilization procedures is attributable to newly introduced laparoscopic instruments and fiberoptics, which enabled the procedure to be performed beyond the puerperal period. Such interval sterilizations enable the use of local anesthesia with intravenous sedation on an outpatient basis, thereby reducing the time required for the procedure and its cost. For puerperal sterilization, the Filshie clip has been demonstrated to be at least as effective as the traditional Pomeroy method. Long-term follow up studies of sterilization acceptors have focused on the incidence of pregnancy (70% of which are ectopic after tubal sterilization), menstrual disorders requiring hysterectomy, and regret. Needed are prospective longitudinal studies that evaluate the effects of contraceptive methods used before sterilization, pre-existing pathologic pelvic conditions, and the surgical technique selected on outcome. Women sterilized when under 25 years of age represent the group most likely to request sterilization reversal, largely because of changes in marital status. Since fear of surgery comprises a major barrier to the wider acceptance of sterilization, nonsurgical methods (especially phenol Atabrine paste instillation) are under investigation.