STERILIZATION

This is obviously an effective, once-and-for-all method of contraception, and for some women it is suitable. But it is drastic-the woman must be prepared to rule out any possibility of ever having another child.

The term sterilization is now used rather more loosely that it was when the procedure was first put into practice. This is because occasionally an operation is performed to attempt to reverse a sterilization operation.

Nevertheless, any woman choosing this method of contraception must be confident that she sill want no more children even is her personal circumstances change, since it is potentially irreversible.

METHODS OF STERILIZATION

For a woman to be fertile she mist be able to release eggs from her ovaries; she must have in fact Fallopian tubes along which the eggs can pass to the womb; and she must have a normal womb in which the fertilized egg can embed itself and develop into a foetus and eventually a baby. All methods of sterilization work by permanently blocking one or more of these stages.

Most sterilization operations consist in blocking the Fallopian tubes in one of a number of ways. This method is particularly popular as it involves a relatively minor operation, although it is still a slightly more risky procedure than sterilizing a man by vasectomy. Women sterilized in this way do not have sudden menopausal symptoms-as happens when the ovaries are involved-and their periods continue, although these may be slightly heavier.

The function of the Fallopian tubes may be permanently interrupted in a variety of ways. First, they may be completely removed, a method of sterilization which is very unlikely to fail. Alternatively, a portion-about 1 cm (1/3 in )- may be cut away from the middle of each, or they may be cut through or burnt by the meted of diathermy. The burn is made in only two places but the effect will travel along the tubes, thus damaging them. In some cases, clips are placed on both tubes, or a loop of each is pulled into a tight plastic ring. All these procedures, except for total removal of the Fallopian tubes, are potentially reversible, but any woman undergoing one of these operations should assume that it will make her permanently sterile. They are probably the methods most often used and there are seldom any complications with this type of operation.

Unfortunately, between one and four women in every thousand who have this type of operation subsequently become pregnant. This is probably because the tubes get unblocked. Another rare problem is that a fertilized egg can be trapped in one of the Fallopian tubes, where it grows until it ruptures the tube and passes into the abdominal cavity. This is called an entopic pregnancy and is treated by surgically removing the affected tube. These problems are nevertheless uncommon and many women are very happy with this type of sterilization

There are other methods which are not often used as they are less satisfactory. For example, it is possible to sterilize a woman by removing or damaging her ovaries, but she will then rapidly develop menopausal symptoms such as hot flushes. This method is usually contemplated only if the ovaries are already damaged or diseased.

Women and doctors seldom consider hysterectomy-the removal of the uterus - an ideal form of contraception because it involves a major operation. However, it may be a sensible choice if the woman has gynecological problems such as large fibroids or very heavy periods, both of which may be effectively cured by hysterectomy.

FIGURE: STERILIZATION BY CUTTING THE FALLOPIAN TUBES

ADVANTAGES AND DISADVANTAGES

When a woman decides to be sterilized she is making a major irreversible decision about her life which can yield many benefits. She will not have to make regular visits to the family planning clinic, and she will not have to worry in future about the side-effects which she might otherwise have suffered with another form of contraction. She may even find that she enjoys her sex life more when she is free from the fear of an unwanted pregnancy.

On the other hand, some women find that they enjoy sex more when they are running the risk of becoming pregnant. Moreover, there is always the possibility that a woman may at a later date want more children-for example if she were to form a new relationship or if any of her children should unfortunately die.

Doctors are also very worried about sterilizing women who are unmarried, have no children or are very young, especially as there are successful reversible forms of contraception on the market which may suit them better. Of course, in every case the decision to sterilize a woman will depend ultimately on the individual herself and her doctor.

For this reason it is extremely important for any woman contemplating sterilization to weigh up the pros and cons as rationally as possible. If she has any worries or questions, her doctor may set her mind at rest. Further, although the decision rests ultimately with her, she should also discuss her thoughts and feelings with her husband, whose agreement may be required.

WHY CHOOSE STERILIZATION ?

There seem to be three important times in a woman’s life when she may consider sterilization as a form of contraception. The first may be when she is having an abortion. Although her decision is often completely rational, many doctors prefer not to sterilize a woman at the same time as performing an abortion. There are two main reasons for this. Firstly, she runs a greater risk of developing blood clots in her leg and pelvic veins during the operation, since she still has in her blood the altered levels of clotting factors which are associated with pregnancy. Secondly, many women may make the wrong decision at a time when they are undergoing much emotional turmoil.

Similar arguments apply against sterilizing a woman immediately after having a baby, as well as the further argument that it is sensible to be certain that the new baby will thrive. Often, however, women and doctors feel that the convenience of the mother being sterilized while still in hospital with the baby outweighs the disadvantages.

Women also choose sterilization as they approach middle age rather than continuing to take the Pill.

AFTER OPERATION

An instrument called a laparoscope's is often used in sterilization. This is a fine rod which allows a clear view of the Fallopian tubes, and also which the necessary instruments can be passed to perform the operation.

Laparoscipic sterilization is occasionally done while the woman is awake, but of course the area where the laparoscope's is to be inserted is first made completely numb so that the operation is relatively painless. The majority of sterilizations are, however, performed under general anesthetic and the woman is allowed home the next day. The scare will be tender for several days and most women prefer to rest as much as possible during this time, although this is difficult if a woman has a large family.

Unlike male sterilization, female sterilization is effective immediately so that a couple need not use any other form of contraception. Most women wait a week or so after being sterilized before having sexual intercourse so that their scars will have time to heal. If the woman has been sterilized by hysterectomy her scars will take even longer to heal, and she would be well advised to wait at least a month or even six weeks before attempting to have sexual intercourse.

OUTLOOK

Stories abound about the disastrous consequences for a woman who has her Fallopian tubes blocked off. Most of these are completely untrue. The woman will not look different, become less feminine or lose interest in sex. Indeed, she will probably enjoy it more as she no longer has to worry about the possibility of an unwanted pregnancy. The operation will certainly not make her put on weight, she will still have periods and go through the menopause in exactly the same way as if she had not been sterilized.

Most surgeons performing the operation are well aware that a woman does not want an unsightly scar-and in most cases it will eventually be hidden at the umbilicus or by her pubic hair as it regrows.

It is very important for every woman to continue having routine smear tests after she has been sterilized, as she will still need to be screened against the possibility of developing cancer of the cervix.