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IPPF MEDICAL BULLETIN. 1993 Jun; 27(3):1-2.Sterilization consists of occlusion of the vas deferentia or the Fallopian tubes to prevent the sperm and ovum from joining. Counseling is important since voluntary surgical and contraception is a permanent contraceptive method. Trained counselors should know about and discuss other contraceptive methods, the types of anesthesia available, and the different sterilization procedures and stress the permanent nature of sterilization and the minimal risk of failure. Counseling must maintain voluntary, informed consent and not coerce anyone to undergo sterilization. It is best to counsel both partners. Vasectomy should be encouraged because it is simpler and safer than female sterilization. Most sterilization techniques are simple and safe, allowing physicians to conduct them on an outpatient basis. Local anesthesia and light sedation are the preferable means to reduce pain and anxiety. In cases where general anesthesia is required, the patient should fast for at least 6 hours beforehand and the health facility must have emergency resuscitation equipment and people trained in its use available. Aseptic conditions should b maintained at all times. Vasectomy is not effective until azoospermia has been achieved, usually after at least 15 ejaculations. The no-scalpel technique causes less surgical trauma, which should increase the acceptability of vasectomy. Vasectomy complications may be hematoma, local infection, orchitis, spermatic granuloma, and antisperm antibodies. Spontaneous recanalization of the vasa is extremely rare. Postpartum sterilization is simpler and more cost-effective than interval sterilization. Procedures through which physicians occlude the Fallopian tubes include minilaparotomy, laparoscopy, and vaginal sterilization via colpotomy or culdoscopy. They either ligate the Fallopian tubes or apply silastic rings or clip to them. Vaginal sterilization is the riskiest procedure. Reversal is more likely with clips. So complications from female sterilization are anesthetic accidents, wound infection, pelvic infection, and intraperitoneal hemorrhage. About 1% of all sterilization clients request reversal. Pregnancy rates are low with reversal.
New York, New York, AVSC, 1991. 28 p.The annual report for 1990-1991 of the Association for Voluntary Surgical Contraception (AVSC) enumerates changes that came about in 1990, accomplishments of the last decade, and then summarizes activities by region with a brief feature on 1 country in each. Some of the developments in 1990 included introduction of Norplant, a training workshop in Georgia for physicians from newly independent CIS states, and the Male Involvement Initiative. The Gulf War delayed major activities requiring travel. Overall, in 1990 the AVSC provided 133,328 sterilizations, 72% female and 28% male in 50 countries, trained 325 doctors, led 58 courses in counseling and voluntarism training 568 counselors, and published or collaborated on numerous professional articles and teaching materials. In-country work emphasized no-scalpel vasectomy and minilaparatomy female sterilization under local anesthesia. As an example of country projects in 20 African nations, a client-oriented, provider-efficient system for improving clinic management and quality of care called COPE, was the focus in Kenya. Male responsibility was an emphasis in Latin America. In India, where sterilization is the most popular contraceptive method, training centers were upgraded in 12 states. In the US, AVSC conducted training sessions for physicians in laparoscopy under local anesthesia.