Opinions concerning male and female sterilisation in Turkey

Background?Vasectomy is well accepted in some countries, but uncommonly used in others. The failure of family planning programmes may be the result of men failing to play a role in contraception. This study was carried out to determine the attitudes of women and men regarding male and female sterilisation.

Study design?Women of reproductive age (17–35 years old; n?=?1211) and their husbands (n?=?1174) were enrolled in this study. Information was collected from the participants via face-to-face interviews using a questionnaire.

Results?In our study, 61.4% of women would agree to their husbands' undergoing a vasectomy but only 3.7% of husbands agreed to it. Most (92.7%) men said they would agree to their wives' undergoing a sterilisation and 83.1% of women would agree to tubal occlusion. Only 2% knew anyone who had been sterilised. Nearly a fifth of women thought vasectomy could lead to impotence.

Conclusion?The prejudices against vasectomy are probably due to misinformation. Female sterilisation, however, is widely accepted by both participants. Family planning programmes organised equally for women and men, supported also by mass media could improve access to convenient and effective contraception.     

New technologies in contraception

New technologies in both reversible contraception and sterilisation are described. The review includes recent advances in the development of oral contraception, emergency contraception, injectable contraception, vaginal rings, subdermal implants, transdermal contraception, intrauterine devices, spermicides and barrier methods. It also covers methods of transcervical female sterilisation and more easily reversible male sterilisation. The emphasis is on the technology and its safety and effectiveness. Hormonal delivery systems are described in some detail. Mention is also made of research into vaccines and male hormonal methods, where progress has been disappointing.     

Learning curve for hysteroscopic sterilisation: lessons from the first 80 cases

The present report looks at the first 80 patients of Essure sterilisation performed by a surgeon with experience in operative hysteroscopy. The results show that the procedure is well tolerated under local anaesthesia with or without sedation, and that devices can be successfully placed in 90% of cases. Surgical time is reduced with increased experience, and successful placement increased by improving visibility within the endometrial cavity (cycle timing).     

Office ultrasound should be the first-line investigation for confirmation of correct ESSURE placement

BACKGROUND: Hysteroscopic options for permanent birth control (PBC), such as the ESSURE device, are becoming increasingly popular as an alternative to laparoscopic tubal ligation. The success of the technique hinges upon correct device placement within the intramural portion of the fallopian tube. OBJECTIVE: To determine the utility of office ultrasound for confirming correct ESSURE PBC device placement at the 3-month check in a general gynaecology practice. STUDY POPULATION: The first 99 patients in a single centre following ESSURE PBC device placement. TYPE OF STUDY: Prospective cohort study. METHODS: Clinical data was reviewed from patient records, both from the time of the initial procedure and from the follow-up at 3 months. All women underwent an ultrasound at the 3-month check. RESULTS: The ESSURE PBC devices were placed successfully in 84.8% of cases. Of those cases with apparently successful placement, office ultrasound alone confirmed correct device placement at the 3-month check in 94% of cases. Further imaging was needed in only 6% of cases. DISCUSSION: Office ultrasound performed by the general gynaecologist at the 3-month check is more convenient for the patient, and is sufficient to confirm ESSURE PBC device placement in the vast majority of cases. We propose that the protocol for ESSURE PBC device follow-up should be altered to replace X-ray with ultrasound as the first-line investigation.     

A comparison of the modified Pomeroy tubal ligation and Filshie clips for immediate postpartum sterilisation: A systematic review

ABSTRACT

Objectives The modified Pomeroy procedure is currently the most widely used method for postpartum sterilisation. Alternative options are Filshie clips, Hulka-Clemens clips and Falope rings. In this systematic review we pooled the available evidence in order to compare the failure rates, complications, technical difficulties, and reversibility of the Pomeroy method and Filshie clips when resorted to for postpartum sterilisation.

Methods We gathered data from MEDLINE, EMBASE (1970–2010), the Cochrane database, and reference lists of randomised controlled trials (RCTs) and observational studies. We extracted information on study design, sample characteristics, interventions, and outcomes.

Results Our search yielded 294 citations of which 43 were retrieved for detailed evaluation. Fourteen studies were included in the systematic review. One RCT and three observational studies compared failure rates of the Pomeroy method vs. Filshie clips. A random-effects analysis of the pooled studies showed no difference in the failures rates between these two methods (odds ratio 0.76 [95% confidence interval 0.30–1.95]). Complication rates were similar although the Filshie clip technique was reported to be easier.

Conclusions Filshie clip application is easier to perform. The failure and complication rates are comparable to those of the modified Pomeroy method, when performed in the postpartum period.     

Laparoscopic salpingectomy and removal of Essure hysteroscopic sterilisation device: a case series

Objectives: Tubal sterilisation using Essure is a minimally invasive technique for permanent contraception, with high rates of patient satisfaction. However, some women subsequently choose removal of the inserts, due to side effects such as pelvic pain, abnormal bleeding, dyspareunia or allergic dermatitis. This case series presents the management of eight women who underwent laparoscopic removal of Essure inserts in conjunction with salpingectomy. We describe our surgical technique, its underlying principles and immediate surgical outcomes.

Methods: Eight patients were identified as having undergone removal of Essure inserts, via an electronic search of the surgical procedures database. A retrospective review of case records was undertaken. The primary outcome was safety and feasibility of the laparoscopic salpingectomy approach. Secondary outcome measures included implant fracture rate, operative time, blood loss and length of patient stay.

Results: All eight women were able to undergo laparoscopic salpingectomy and removal of the Essure inserts without the need for laparotomy or hysterectomy. There were no incidences of fracture or incomplete removal of the insert. Immediate postoperative recovery was uncomplicated in all eight women; the mean length of stay was 17?h. One patient had a small bowel serosal tear attributed to laparoscopic entry.

Conclusion: This case series suggests that laparoscopic salpingectomy for removal of Essure inserts is safe and feasible. We acknowledge that the numbers were small. However, consistent use of a laparoscopic approach in these eight patients indicates that this procedure is a feasible and suitable alternative to hysterectomy.     

State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation

A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the ‘no-scalpel technique’. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30–60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure.     

Hysteroscopic sterilisation in the outpatient department without anaesthesia

Background: Compared to laparoscopic sterilisation, the hysteroscopic approach obviates admission, general anaesthesia, surgical incisions and a complication rate of 5 per 1,000 procedures. The use of the new hysteroscopic sterilisation device Essure (Conceptus) for the first consecutive 175 patients, without the use of local or intravenous anaesthesia or any sedation, has been evaluated in the outpatient department (OPD). Results: Successful bilateral placement was achieved in 95% of all women. Pain during the procedure was assessed by a visual analogue score and appeared to be 2.5 on average. All women could be discharged within 1 h; only two women encountered a vasovagal collapse; no adverse events occurred. All women were satisfied with this method. After 1,200 woman-months, no pregnancy was found. Conclusion: Hysteroscopic sterilisation with Essure can be done safely in the OPD without anaesthesia.     

Contraception and its ethical considerations

Access to appropriate contraception not only has direct benefits for women's health and wellbeing but also has a broader positive impact on society as a whole. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women's preferences, cultural and religious beliefs as well as any co-existing medical issues.This article outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive.     

Referrals for complications following hysteroscopic sterilisation: characteristics associated with symptomatic patients after the Essure procedure

Objective: This report summarises recent experience with a series of symptomatic Essure® patients with an emphasis on clinical presentation, preoperative imaging, surgical intervention, and outcome. Methods: This case series presents Essure® patients (n?=?7) who sought medical consultation for various complications. This retrospective analysis is based on consultations during a six-month interval beginning in April 2015. Results: In this sample, mean (± SD) patient age was 35.9?±?3.4 yrs. The gravida/parity status was 3.6?±?1.1 and 2.4?±?1.4, respectively. Average duration of exposure to Essure® coils among these patients was 25.6?±?24.5 (range 5–67) months. Except for one woman, these patients had hysteroscopic sterilisation (HS) either with heavy sedation or under general anaesthesia. More than two Essure® devices were implanted in two women. Complications reported after HS included device migration, coil fragmentation, tissue perforation, and vaginal expulsion of Essure® fragment. Three of seven women have required hysterectomy. Conclusion: The current series offers evidence of migration of contraceptive coils as well as Essure® inserts perforating tissue and being spontaneously expelled. Evaluation of symptomatic HS patients should include determining how many devices have been implanted, as some women have more than two.     

Reasons for tubal sterilisation,regret and depressive symptoms

Objective: To examine the associations between sterilisation reasons, regret and depressive symptoms. Method: Black, Hispanic and non-Hispanic White US women ages 25–45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n = 837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors and depressive symptoms. Results: Findings revealed that 28% of US women who have undergone tubal sterilisation report regret. Time since sterilisation and having a reason for sterilisation other than simply not wanting (more) children (e.g. situational factors, health problems, encouragement by others and other reasons) are associated with significantly higher odds of sterilisation regret. Finally, sterilisation regret is significantly associated with depressive symptoms after controlling for sociodemographic characteristics. Conclusion: Sterilisation regret is relatively common among women who have undergone tubal sterilisation, and regret is linked to elevated, but not necessarily clinical, depressive symptoms. The reasons for sterilisation can have important implications for women’s sterilisation regret and associated depressive symptoms.     

Incidence of upper genital tract occlusion following microwave endometrial ablation (MEA)

The aim of the study was to determine the incidence of occlusion of the upper genital tract following microwave endometrial ablation (MEA) in women treated for therapy-resistant menorrhagia. A total of 35 women were recruited between January 1997 and January 2005, Royal United Hospital Bath, to have interval hysterosalpingogram (HSG) post-MEA. After a successful MEA, either with general or local anaesthesia, 35 HSGs were performed 3 or more months later. Complete occlusion of the upper genital tract was found in 30 women (85.7%) and incomplete occlusion with tubal patency persisted in 5 (14.3%).     

Legalised non-consensual sterilisation – eugenics put into practice before 1945, and the aftermath. Part 2: Europe

This article deals with the nine European nations which legalised non-consensual sterilisation during the interwar years, thus completing the review, the first part of which was published in an earlier issue of this Journal. Like we did for North America, Japan and Mexico, countries concerned are addressed in chronological order, as practices in one of these influenced policies in others, involved later. For each, we assess the continuum of events up to the present time. The Swiss canton of Vaud was the first political entity in Europe to introduce a law on compulsory sterilisation of people with intellectual disability, in 1928. Vaud’s sterilisation Act aimed at safeguarding against the abusive performance of these procedures. The purpose of the laws enforced later in eight other European countries (all five Nordic countries; Germany and, after its annexation by the latter, Austria; Estonia) was, on the contrary, to effect the sterilisation of large numbers of people considered a burden to society. Between 1933 and 1939, from 36,000 to 400,000 residents (two-thirds of whom were women) were compulsorily sterilised in Nazi Germany. In Sweden, some 32,000 sterilisations carried out between 1935 and 1975 were involuntary. It might have been expected that after the Second World War ended and Nazi legislation was suspended in Germany and Austria, including that regulating coerced sterilisation, these inhuman practices would have been discontinued in all nations concerned; but this happened only decades later. More time still went by before the authorities in certain countries officially acknowledged the human rights violations committed, issued apologies and developed reparation schemes for the victims’ benefit.     

Male and female sterilisation

Male and female sterilization are important forms of contraception worldwide despite declining popularity in developed countries. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilization, particularly Long Acting Reversible Contraception (LARC) should be discussed in detail as they are at least as effective or more effective and have the advantage of reversibility. Hysteroscopic techniques for female sterilization are no longer available as of 2019. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilization and requests for reversal are more common in patients under 30 years and in men with no children.     

Male and female sterilisation

Male and female sterilisation are important forms of contraception worldwide despite declining popularity in developed countries. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilisation, particularly Long Acting Reversible Contraception (LARC) should be discussed in detail as they are at least as effective or more effective and have the advantage of reversibility. Hysteroscopic rather than laparoscopic techniques for female sterilisation are more cost effective but are limited in their availability. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilisation and requests for reversal are more common in patients under 30 years and in men with no children.     

The Copper-T 380A IUD: A ten-year alternative to female sterilisation in India

High unmet need for limiting contraception persists in most states of India despite wide access to sterilisation. Qualitative evidence from a rural community in which child mortality is high and women's autonomy is low suggests that women may seek reversibility in a contraceptive even if they have finished childbearing. This paper describes the introduction of the Copper-T 380A--a contraceptive with an effective life span of ten years--as an alternative to female sterilisation in a rural area of the state of Rajasthan, in a clinic linked to an outreach programme. The intervention addressed women's apprehensions, ensured service standards and guaranteed women's right to have the Copper-T removed at will. Data on 216 insertions over 34 months revealed a preference for the Copper-T 380A among older women and women who had achieved desired family size, especially among tribal women. More than a quarter of the 30 removals in that period were for non-medical reasons, such as family opposition, child death or remarriage. As a long-term but reversible option, the Copper-T 380A allows women room to change their minds in relation to future childbearing until they have reached menopause. Including this option in family planning services can help to meet a portion of the unmet need for contraception among women not willing to choose sterilisation, while reducing dependence on doctors and expensive equipment.     

Outpatient Vaginal Hysterectomy: A Pilot Project

a pilot project was undertaken at the Woodstock General Hospital to determine the feasibility and cost-effectiveness of completing vaginal hysterectomies as outpatient procedures. Nineteen women voluntarily participated in this project between October 1998 and June 1999. There were no complications reported for seventeen of the women but two women required triage assistance. No hospital admissions were required. Compared to the control group there were no differences in complication rates. The cost to the hospital was significantly lower for the outpatient procedure. Given the early success of this project, outpatient vaginal hysterectomies will continue to be offered at the Woodstock General Hospital.