Sterilization (medicine)
Sterilization is any of several medical methods of permanent birth control that intentionally leaves a person unable to reproduce. Sterilization methods are available for both males and females. Although a non-surgical option for females was available until 2019, it is no longer an option. Sterilization procedures are intended to be permanent; reversal is generally difficult.
There are multiple ways of having sterilization done, but the two that are used most frequently are salpingectomy or tubal ligation for women and vasectomy for men. There are many different ways tubal sterilization can be accomplished. It is highly effective, like use of an IUD or arm implant, and in the United States, surgical complications are low. With that being said, tubal sterilization is still a method that involves surgery, so there is still a danger. Women who choose tubal sterilization have a higher risk of serious side effects than men who have a vasectomy do. Pregnancies after tubal sterilization can still occur, even many years after the procedure. Some recent studies have estimated that 3% of women become pregnant after tubal sterilization.It is not very likely, but if it does happen, there is a high risk of ectopic gestation. Tubal sterilization surgeries can be performed during a Cesarean section or shortly after a vaginal delivery mostly by mini-laparotomy. In some cases, sterilization can be reversed, but this can not be guaranteed. If you might want to become pregnant in the future, do not have this surgery.
Sterilization procedures can be undertaken voluntarily or promoted by governments. The legal framework surrounding sterilizations varies significantly between countries. In some cases, governments have historically or presently implemented compulsory or incentivized sterilization programs. On the other hand, certain nations have enacted laws that restrict or prohibit the practice.
Methods
Surgical
Surgical sterilization methods include:- Tubal ligation in females, known popularly as "having one's tubes tied". The fallopian tubes, which allow the sperm to fertilize the ovum and carry the fertilized ovum to the uterus, are closed. This typically involves a general anesthetic and a laparotomy or laparoscopic approach to cut, clip, or cauterize the fallopian tubes.
- Bilateral salpingectomy in females, also known as tubal removal. Both fallopian tubes are surgically removed. When done for contraceptive purposes, the ovaries are left in place. This method is considered more effective than tubal ligation as there is no chance of tubal reconnection or clip failure. It also prevents cancer of the fallopian tubes and can reduce the risk of ovarian cancer.
- Vasoligation in males. The vasa deferentia, the tubes that connect the testicles to the prostate, are cut and closed. This prevents sperm produced in the testicles from entering the ejaculated semen. Although the term vasectomy is established in the general community, the correct medical terminology is vasoligation.
- Hysterectomy in females, is not offered for contraception, but is done to manage heavy menstrual bleeding or cancer. The uterus is surgically removed, permanently preventing future pregnancy and some diseases, such as uterine cancer.
- Castration in males, is NOT offered as a form of human contraception, but is sometimes done if there are concerns of cancer that mean the testicles should be surgically removed. This is frequently used for the sterilization of animals but rarely for humans. It was also formerly used on some human male children for other reasons; see castrato and eunuch.
Transluminal
- The Essure procedure was one such transluminal sterilization technique. In this procedure, polyethylene terephthalate fiber inserts were placed into the fallopian tubes, eventually inducing scarring and occlusion of the tubes.
- Quinacrine has also been used for transluminal sterilization, but despite a multitude of clinical studies on the use of quinacrine and female sterilization, no randomized, controlled trials have been reported to date, and there is some controversy over its use. See also mepacrine.
Pharmacological
Effects
The effects of sterilization vary greatly according to gender, age, location, and other factors. When discussing female sterilization, one of the most important factors to consider is the degree of power that women hold in the household and within society.Physical
Understanding the physical effects of sterilization is important because it is a common method of contraception. Among women who had interval tubal sterilization, studies have shown a null or positive effect on female sexual interest and pleasure. Similar results were discovered for men who had vasectomies. Vasectomies did not negatively influence the satisfaction of men, and there was no significant change in communication and marital satisfaction among couples as a result. According to Johns Hopkins Medicine, tubal sterilizations result in serious problems in less than 1 out of 1000 women. Tubal sterilization is an effective procedure, but pregnancy can still occur in about 1 out of 200 women. Some potential risks of tubal sterilization include "bleeding from a skin incision or inside the abdomen, infection, damage to other organs inside the abdomen, side effects from anesthesia, ectopic pregnancy, incomplete closing of a fallopian tube that results in pregnancy." Potential risks of vasectomies include "pain continuing long after surgery, bleeding and bruising, a inflammatory reaction to sperm that spill during surgery called sperm granuloma, infection." Additionally, the vas deferens, the part of the male anatomy that transports sperm, may grow back together, which could result in unintended pregnancy.Psychological
It can be difficult to measure the psychological effects of sterilization, as certain psychological phenomena may be more prevalent in those who eventually decide to partake in sterilization. The relationships between psychological problems and sterilization may be due more to correlation rather than causation. That being said, there are several trends surrounding the psychological health of those who have received sterilizations. A 1996 Chinese study found that "risk for depression was 2.34 times greater after tubal ligation, and 3.97 times greater after vasectomy." If an individual goes into the procedure after being coerced or with a lack of understanding of the procedure and its consequences, they are more likely to develop negative psychological consequences afterward. However, most people in the United States who are sterilized maintain the same level of psychological health as they did prior to the procedure. Because sterilization is a largely irreversible procedure, post-sterilization regret is a major psychological effect. The most common reason for post-sterilization regret is the desire to have more children.Familial
Women in the household
Some people believe that sterilization gives women, in particular, more control over their sexuality and their reproduction. This can lead to empowering women, giving them more of a sense of ownership over their bodies, and an improved relationship with the household. In the United States, where there are no governmental incentives for being sterilized, the decision is often made for personal and familial reasons. A woman, sometimes along with her partner, can decide that she does not want any more children or she does not want children at all. Many women report feeling more sexually liberated after being sterilized, as there is no concern of a pregnancy risk. By eliminating the risk of having more children, a woman can commit to a long-term job without a disruption of maternity leave in the future. A woman will feel more empowered since she can make a decision about her body and her life. Sterilization eliminates the need for potential abortions, which can be a very stressful decision overall.Relationship with spouse
In countries that are more entrenched in the traditional patriarchal system, female sterilizations can inspire abusive behavior from husbands for various reasons. Sterilization can lead to distrust in a marriage if the husband suspects his wife of infidelity. Furthermore, the husband may become angry and aggressive if the decision to be sterilized is made by the wife without consulting him. If a woman marries again after sterilization, her new husband might be displeased with her inability to bear him children, causing tumult in the marriage. There are many negative consequences associated with women who hold very little personal power. However, in more progressive cultures and in stable relationships, there are few changes observed in spousal relationships after sterilization. In these cultures, women hold more agency, and men are less likely to dictate women's personal choices. Sexual activity remains fairly constant, and marital relationships do not suffer, as long as the sterilization decision was made collaboratively between the two partners.Children
As the Chinese government tried to communicate to their people after the population boom between 1953 and 1971, having fewer children allows more of a family's total resources to be dedicated to each child. Especially in countries that give parents incentives for family planning and for having fewer children, it is advantageous to existing children to be in smaller families.In more rural areas where families depend on the labor of their children to survive, sterilization could have more of a negative effect. If a child dies, a family loses a worker. During China's controversial one-child policy reign, policymakers allowed families to have another child if an existing child in the same family died or became disabled. However, if either parent is sterilized, this is impossible. The loss of a child could impact the survival of an entire family.