Female sterilization is preferably performed by laparoscopy (laparoscopy of the abdomen). The goal is bilateral blockage of the fallopian tubes and thus permanent inability to conceive.
Indications (areas of application)
- Completed family planning
Female sterilization is a relatively more complex operation than male sterilization.
The surgical procedure
In women, the following procedure is mainly used to obtain sterility:
- Laparoscopic tubal coagulation
Laparoscopic tubal coagulation involves closing the tubes (fallopian tubes) under laparoscopic vision. This can be achieved with different methods:
- Removal of a tubal section (fallopian tube part) on both sides and in each case ligation (Unterbindung) of the tube ends, if necessary, removal of the two entire tubes.
- Electrocoagulation (heat coagulation) of the tubes (fallopian tubes) in the tubal isthmus (constriction in the middle third of the fallopian tube), if necessary with additional cutting of the coagulated area.
- Clamping of the tubes with clips or plastic rings.
The procedure is performed under general anesthesia. The operation can also be performed during a cesarean section or a few days after a spontaneous birth. Infertility exists immediately after the operation. Sterilization of the woman usually cannot be reversed. Sexual dysfunction or other hormonal disturbances generally do not occur. The procedure can be performed on an outpatient or inpatient basis in a hospital.
PEARL index – contraception by surgical sterilization
- Tubal ligation by laparoscopy – PI = 0.3 schw.
- Tuber ligation per laparotomy – e.g. on the occasion of a caesarean section – PI = 0.5 schw.
The PEARL index (PI), describes the reliability of a contraceptive measure by means of the number of pregnancies that occurred per 1,200 cycles of use or per 100 years of use.
Potential complications
- Injury to internal organs (bowel, bladder, ureter) or major blood vessels (aorta (large body artery) or iliac artery (common iliac artery) and major veins) is rare
- Pneumothorax – presence of air in the pleural space (actually airless space between the pleura and the lung).
- Skin emphysema – excessive presence of air in the skin due to injury during laparoscopy.
- Pneumomediastinum (synonym: mediastinal emphysema) – excessive occurrence of air in the mediastinum (space between the lung lobes) due to an injury during laparoscopy.
- Wound healing disorders
- Rupture of the abdominal suture (abdomen burst) (very rare).
- Adhesions (adhesions) in the abdominal cavity. This can lead to ileus (intestinal obstruction) after a long time.
- As after any surgical procedure, thrombosis (formation of a blood clot) may occur, with the possible consequence of embolism (occlusion of a blood vessel) and thus pulmonary embolism (danger to life). Thrombosis prophylaxis leads to a reduction in risk.
- The use of electrical devices (e.g. electrocoagulation) can cause leakage currents, which can lead to skin and tissue damage.
- Positioning on the operating table can cause positional damage (e.g., pressure damage to soft tissues or even nerves, resulting in sensory disturbances; in rare cases, this can also lead to paralysis of the affected limb).
- In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Infections, after which severe life-threatening complications concerning heart, circulation, breathing, etc. occur, are very rare. Similarly, permanent damage (eg paralysis) and life-threatening complications (eg sepsis / blood poisoning) after infections are very rare.
