This document discusses permanent contraception options for men and women, including vasectomies and tubal ligations. It provides details on the procedures, such as vasectomies involving transecting and occluding the vas deferens through non-scalpel or scalpel methods. Tubal ligations can be performed through abdominal, laparoscopic, or vaginal approaches. Both procedures are generally safe and effective but require extensive counseling as they provide permanent sterilization.

1. V A S E C T O M Y F O R M E N
T U B A L L I G A T I O N I N W O M E N
Permanent contraception

2. Introduction to Permanent Family Planning
 Surgical procedure to permanently and intentionally
terminate male and female reproductive function
 Appropriate for men and women who made a fully
informed and well considered decision
 Most are not reversible
• Vasectomy for men
• Tubal ligation in women
Permanent
Family
Planning

3. Vasectomy
 For men who do not want more children
 Transection and occlusion of the vas deferens
 Also called male sterilization, male surgical
contraception
 No interference with sexual performance
 Outpatient procedure by local anesthesia

4. Facts about vasectomy
 It is simple, safe and effective method of permanent
contraception.
 Can be done on OPD basis under local anesthesia.
 No effect on sexual activity, semen volume and general
physical health.
 Sterility doesn't occur immediately. It requires approx 20
ejaculation to completely evacuate vas, which takes
3month. Absence of sperm should be confirmed by
microscopic examination(HSA).
 Reversal is possible but sperm recovery rate after
procedure declines with time particularly after 7 years.

5. Procedure should be delayed if…
Patient has
 scrotal skin infection
 Active STDs
 Epididymitis or orchitis
 Filariasis
 Intrascrotal mass
 Coagulation disorders
 Psychosexual disorder

6. Techniques of Vasectomy
 Scalpel (conventional) and Non-scalpel
 Palpate the vas through the scrotum
 Grasp the vas with fingers or forceps
 Pull loop of vas and remove segment
 Ligate both ends of the vas
 Bury the proximal stump
 Skin stitch and dressing

7. Vasectomy (cont’d)

10. Post surgery care
 Painkiller SOS
 Antibiotics not required.
 Dry dressing only, avoid bath for 24 hours.
 Avoid cycling and moderate exercise for 1 weeks.
 Scrotal support for initial few days.
 Take contraceptive measures for next 3 months or
confirm sperm free ejaculate by 2 separate
microscopic examinations.


11. Benefits of Vasectomy
 Failure is less than 1%
 Reason for failure can be:
 Unprotected intercourse soon
 Failure to occlude the vas
 Recanalization
 Safer and more effective than tubal ligation
 0.5 deaths per 100,000 vasectomies

12. Complications of Vasectomy
 Side effects are uncommon to very rare
 Testicular and scrotal pain lasting for months
 Surgical site infection
 Hematoma
 Sperm granuloma

13. Female sterilization

14.  For women who do not want more children.
 Also called tubal sterilization, tubal ligation or
tubectomy.
 Most widely used procedure globally.

15. counselling
 About permanent procedure.
 Its failure rate.
 Alternative methods of long term contraception.
 complications

16. Different types
 According to time
post partum
Interval
Postabortal
 According to approach
Abdominal
conventional 3-4 cm
Minilaparotomy2.5 to 3cm
laparoscopic
Vaginal
hysteroscopic

17. Procedure
 1. Before operations: confirm patient's last menstrual period, exclude pregnancy and take
 necessary consents
 2. Ensure empty urinary bladder
 3. After proper gowning and scrubbing, the operative area is cleaned and draped.
 4. Determine the incision site and size - 2 fingers from the symphysis pubis superiorly.
 5. Make the skin incision about 3 to 4 cm long.
 6. Open the abdomen in layers until the rectus sheath.
 7. Open the rectus sheath using the scissors and push the muscle laterally.
 8. Proceed to open the peritoneal cavity with two artery forcep and the maximburm
 scissors.
 9. By using 2 fingers - identify the uterine body and move laterally to identify the fallopian
 tube.
 10. Grasps the tube using the babcock. The tube can be determined by identifying the
 fimbriae end of the tube.
 11. Lift the tube gently and clamp the area for incision using the artery forceps.
 12. Make a knot on one side and subsequently on the opposite site. Be sure to relief the
 artery forceps temporally when making the knot.
 13. Any absorbable suture size 2/0 can be used - eg. Vicryl or catgut
 14. The tube can then be excised using the scissors.
 15. The stump is then inspected for any residual bleeding.
 16. The same procedure is employed for the contralateral tube.
 18. Finally close the abdomen and skin

18. Occlusion methods
 Partial salpingectomy
 Tubal clip
 Tubal rings/fallopes rings
 Fimbriectomy
 Electrocoagulation or cautrization

20. Pomeroy Method

22. Minilaparotomy for Tubal Ligation
 Ligation of the fallopian tubes through 3-4cm incision
on the abdomen, can be done:
 As an outpatient procedure
 By local anesthesia and sedation
 Minilaparotomy following vaginal delivery:
 Enlarged uterus, tubes in the mid abdomen, 3-4 cm sub
umbilical incision
 Interval minilaparotomy:
 Short transverse suprapubic incision
 Uterine elevator used through the vagina

24. Laparoscopic sterilization
 Simple and effective procedure.
 Can be done single port or two port technique,
under local anesthesia.
 Position modified lithotomy.
 LA infiltrated.
 Pneumoperitoneum is created.
 Small stab incision given, trocar inserted followed
by loaded laprocater.
 Fallope rings or filshie clips are applied bilaterally

28. Indications to Delaying lap Tubal Ligation
 Current pregnancy
 Less than 6 weeks postpartum
 Severe postpartum or post abortion complications
 Unexplained vaginal bleeding
 Pelvic inflammatory disease and STIs
 Pelvic malignancies

29. Benefits of Female Sterilization
 No known side effect
 Helps to protect against unwanted pregnancy
 Nothing to remember and no worries about
contraceptives again
 Prevents against pelvic inflammatory disease
(PID)
 May protect against ovarian tumor

30. Risks of Female Sterilization
Few complications
 Related with surgery, anesthesia, previous
surgery, PID, Obesity, and DM
 1-2 deaths /100,000 cases
 2 pregnancies per 100 women over 10 years
 Possibility of future regret
 Young age
 Lost a child
 Few or no children
 Not married/ Marital problems

31. Newer methodsESSURE

32. Immunocontraceptions /FRV
Fertility regulating vaccines/FRVs
 Anti HCG vaccine
 Anti zona vaccine
 Anti sperm vaccine

33. Summary
• Permanent methods are irreversible
• Non-scalpel vasectomy in men and
minilaparatomy for women are preferred
• Permanent methods are less popular in Ethiopia
• Detailed counseling is essential
• Rare complications - not related to method