What is sterilization 2
Sterilization of the woman (fallopian tube transection)
The description of the interventions was compiled with the greatest care. However, it can only be an overview and does not claim to be complete. The websites of the service providers and the personal consultation with the doctor or the surgical explanation in the respective operating facility provide further information.
The persons responsible for the content of this website do not guarantee the completeness and correctness of the information, as constant changes, further developments and concretizations are made as a result of scientific research or adaptation of the guidelines by the medical societies.
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Once the family has been planned, the sterilization of the woman - i.e. the operative cutting of the fallopian tubes - is one of the safest forms of contraception. However, you should be very confident in your decision not to want any more children, as the procedure is practically irreversible. Around 6% of all women in Germany have chosen this final form of contraception. The fallopian tubes are cut using a laparoscopy and can easily be carried out on an outpatient basis.
What happens during this procedure?
First, access to the inner abdominal cavity must be established. For this purpose, a thick special needle is pierced through the abdominal wall. As a rule, the lower navel pit is chosen as the puncture site, as this is where the distance between the skin and the brook cover is the smallest. This also has cosmetic advantages, as the remaining scar can hardly be seen at this point later.
Before the puncture, it is ensured that no large vessels or organs are in the way and could be injured. Only then will the doctor insert the puncture needle.
Even after the successful puncture, the surgeon still has to be patient with his insight. First of all, the stomach has to be “pumped up” a little so that the tightly packed organs and intestinal loops do not obstruct the doctor's view. For this purpose, an aseptic (sterile) hose is attached to the cannula lying on it and connected to a gas pump (insufflator). Then, with constant pressure measurement, carbon dioxide (CO2) is directed into the abdomen. Since the pressure in the abdomen is controlled all the time, nobody needs to be afraid of "bursting". Depending on the body size, the abdominal cavity is filled with 2.5 to 7 liters of gas until a kind of dome is formed and the surgeon can move safely between the organs with his instruments.
The puncture cannula (hollow needle) with its small diameter is not yet sufficient for the procedure as such. It is replaced by a plastic or metal sleeve (trocar) with a diameter of 5 to 12 mm. This is provided with a pointed end for piercing the abdominal wall, which is then pulled out again so that a kind of sleeve remains as an access. A valve ensures that the gas that has been introduced does not flow out again. Any gas that has disappeared is replaced again and again during the procedure. For the introduction of instruments, a second small incision is usually made directly above the pubic hairline.
After introducing the optical instrument laparoscope, the surgeon first gets an overview of the abdomen and the pelvic and pelvic organs. Then the fallopian tubes are cut on both sides - either by setting a plastic clip, cutting with a scalpel or welding with heat (thermocogulation). The fallopian tube section treated in this way is then no longer continuous, i.e. egg cells and sperm can no longer come together.
At the end of the procedure, the trocar is carefully pulled out while the camera is in view and the abdominal incisions are closed with a few sutures. The remaining gas is easily absorbed by the body and exhaled through the lungs.
When does the doctor advise you to have this procedure?
Sterilization is recommended as a method of contraception whenever family planning has been completed and you are definitely sure that you do not want any more children. Many women want this type of contraception because the regular use of the “pill” is no longer necessary and they no longer have to constantly deal with the subject of contraception.
Which stunning method is usually used?
The fallopian tubes are usually transected under a brief general anesthetic. For you this means: apart from the induction of anesthesia, you will not notice anything, neither how your abdominal wall is pierced nor how your stomach is “pumped up”. You won't wake up until all instruments are removed and the procedure is over.
How long does the procedure take on average?
The procedure takes about 30 minutes.
Who may not be suitable for this procedure?
A laparoscopy (laparoscopy) can be technically difficult or even impossible in very overweight people. Even with many previous operations in the abdominal area, a laparoscopy would be advised against, as adhesions in the abdomen can hinder access.
The operation may not be carried out if there is a suspicion of malignant diseases or in the case of certain previous internal diseases with impaired cardiopulmonary function. These include, for example, diseases of the coronary arteries (coronary artery disease, angina pectoris and chronic obstructive pulmonary disease (COPD)).
Infections in the abdomen such as peritonitis and blood clotting disorders (coagulopathies with an increased tendency to bleed, e.g. Markumar® therapy) can also speak against a laparoscopy. It may also be advised against in the case of umbilical or incisional hernias or gaps in the diaphragm (hiatal hernia), as there is a risk that abdominal organs will be trapped in the gaps due to the increased pressure.
Ultimately, the decision rests with your treating doctor, who will assess your individual risks after the preliminary examinations.
For women under 35 who do not yet have children of their own, the doctor may advise against it, since experience has shown that at some point they will still want to have their own child. Ultimately, however, you alone decide whether sterilization is the right method of contraception for you. Consent from husband or partner is not required.
In Germany, it is forbidden to sterilize minors and persons unable to give their consent.
How is the risk to be assessed?
With today's technology, cutting the fallopian tubes is a very safe procedure. Nevertheless, as with any surgical procedure, complications cannot be completely ruled out. In the vast majority of cases, however, they are manageable, even if a second intervention may be necessary in individual cases.
Your doctor will explain the type and frequency of complications such as bleeding, organ and vascular injuries or wound infections before the procedure. In rare cases, damage to the blood vessels to the fallopian tube can lead to a subsequent reduced blood flow to the ovaries with a premature onset of menopause.
The risk of becoming pregnant unintentionally after sterilization is low. The procedure is 98 to 99% successful. Out of 1000 sterilized women, only one to three become pregnant within a year (so-called Pearl index 0.1 to 0.3).
What do you have to consider before the procedure?
From 10:00 p.m. on the evening before the procedure, you should stay sober, i.e. do not eat or drink, do not smoke or chew gum. If you take medication regularly because of other illnesses, you should inform your doctor or anesthetist in advance, as some medications such as blood-thinning substances should be discontinued a few days before the procedure. Since the abdomen may still be a little bloated after the procedure, you should wear clothes that are as loose as possible for the appointment
What happens after the procedure and what should be considered?
After the fallopian tubes have been transected, you will remain under observation for a few hours - until you feel fit to go home. The anesthesia will subside relatively quickly, so that you will soon be available again. However, it may take a little longer before you are completely clear in your head again. You are therefore not allowed to drive your own car on the day of the operation and you should also not use public transport on your own. Let family or friends pick you up or take a taxi home. You may be exhausted and sleepy for several hours after the procedure. So lie down in bed and rest. However, you should take a few steps on the day of the operation to get your circulation going again.
As a result of the anesthesia, some patients may experience slight nausea after the operation, but this will soon subside.
Greater pain is not to be expected after a fallopian tube transection. Some patients complain of right shoulder pain. The cause is suspected to be nerve irritation, which is caused by the increased pressure in the abdomen as the liver shifts. Some movement or positioning in bed with a pillow under your buttocks can help - if not, a mild pain reliever will help.
Don't be frightened if there are larger plasters on your stomach - the wound underneath is much smaller. As a rule, you can shower after 1-2 days, although the wound should not be soaped and patted dry. You should not take a full bath for about 5 weeks.
The contraceptive effect is available practically immediately after the procedure. The procedure can only be reversed through complicated microsurgical operations with little chance of success.
There are no effects on the hormonal balance, i.e. you will get your days regularly as before. The desire for sex is not changed either. However, you should note that sterilization offers protection against unwanted pregnancy, but not against sexually transmitted diseases.
When does the next doctor's appointment usually take place?
On the day of the procedure, your doctor will tell you when you should come back for the next check-up. In your own interest, you should absolutely keep this appointment.
If you get a fever or severe pain at home, or if you notice reddening or other signs of inflammation on the wound, you should contact your doctor immediately. Even if you are unsure and still have questions about the normal course of healing, in practice no one will be angry with you if you call for advice.
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