Short notes on permanent methods for effective birth control

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Sterilization can be done for either males or females. The advantages of sterilization are:

1. It is a one-time method

2. It does not require continued motivation

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3. Complications are less if done properly

4. It is most cost-effective.

Guidelines for sterilization: The guidelines issued by the Gov­ernment for sterilization are:

1. Age of husband should be above 25 years and less than 45 years.

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2. Age of wife should be above 20 years and less than 45 years.

3. They must have 2 living children at the time of operation

4. Lower limit of age of husband or wife can be relaxed, if the couple has 3 or more living children.

5. It is enough a. if the acceptor declares that he/she has obtained the consent of spouse without any force or pressure b. he/she knows that the operation is irreversible c. the spouse has not been sterilized earlier.

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Male sterilization (Vasectomy)

In this method, a piece of vas deferens of about 1 cm length is removed after clamping. The ends are ligated and then folded back on themselves and sutured. Now, the cut ends face away from each other.

Advice after vasectomy

1. The patient should be told that he is not sterile immediately after operation. He is sterile only after 30 ejaculations.

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2. He must use contraceptives till aspersion is established.

3. He must avoid cycling or lifting heavy weights for 15 days.

Complications of vasectomy

1. Operative complications like hematoma and infections.

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2. Sperm granuloma accompanied by pain and swelling.

3. spontaneous recanalization.

4. Psychological disturbances like loss of sexual vigor, impotence, fatigue etc.

Female sterilization

It is done by two procedures : 1. Laparoscopy 2. Minilaprotomy

Laparoscopy

It is done through abdominal approach with a specialized in­strument called ‘laparoscope’. The abdomen is inflated with gas (carbon dioxide, nitrous oxide or air). Then the instrument is intro­duced into the abdominal cavity to visualize the fallopian tubes. The tubes are occluded with fallop rings (or clips).

Advantages of laparoscopy are short operating time, shorter stay in the hospital and a small scar. Rarely puncture of large blood vessels and other complications may occur.

Minilaprotomy

It is a modification of abdominal tubectomy. It is a very simple procedure done under local anesthesia. It requires a very small abdominal incision of 2.5 to 3 cm in length. It is a safe, efficient and easy procedure with less complications.

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