Sterilization (surgical procedure)

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For the process of removing or killing all microorganisms from an object, see Sterilization (microbiology).

Sterilization is a surgical technique leaving a male or female unable to procreate. It is a method of birth control.

Common sterilization methods include:

Vasectomy in males. The vasa deferentia, the tubes which connect the testicles to the prostate, are cut and closed. This prevents sperm produced in the testicles to enter the ejaculated semen (which is mostly produced in the seminal vesicles and prostate). Although the term 'vasectomy' is established in the general community, the correct medical terminology is deferentectomy, since the structure known as the 'vas deferens' has been renamed the ductus deferens.
Tubal ligation in females. The Fallopian tubes, which allow the sperm to fertilize the ovum and would carry the fertilized ovum to the uterus, are closed.
Hysterectomy in females. The uterus is surgically removed, permanently preventing pregnancy and some diseases, such as uterine cancer.
Castration in males. This is frequently used for the sterilization of animals, with added effects such as docility, greatly reduced sexual behaviour, and faster weight gain being desirable in some cases.

1 Vasectomy
- 1.1 Safety and effectiveness
- 1.2 Reversal
2 Tubal ligation
- 2.1 Reversal
3 Sterilization of animals
4 See also
5 References
6 External links

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Vasectomy

Vasectomy should not be confused with castration: vasectomy does not involve removal of the testicles and it affects neither the production of male sex hormones (mainly testosterone) nor their secretion into the bloodstream. Therefore sexual desire (libido) and the ability to have an erection and an orgasm with an ejaculation are not affected. Because the sperm itself makes up a very small proportion of the ejaculate, vasectomy does not affect the volume, appearance, texture or flavor of the ejaculate. Similarly, in females, hormone production, libido, and the menstrual cycle are not affected by a tubal ligation.

When the vasectomy is complete, sperm can no longer exit the body through the penis. They are broken down and absorbed by the body. Fluid content is absorbed by membranes in the epididymis, and solid content is broken down by macrophages and re-absorbed via the blood stream. Sperm is matured in the epididymis for about a month once it leaves the testicles, and approximately 50% of the sperm produced never make it to ejaculation in a non-vasectomized man. After vasectomy, the membranes increase in size to absorb more fluid, and more macrophages are recruited to break down and re-absorb the solid content.

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Safety and effectiveness

Early failure rates of vasectomy are below 1%, but the effectiveness of the operation and rates of complications vary with the level of experience of the surgeon performing the operation and the surgical technique used. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%–6% of men undergoing vasectomy. The incidence of chronic epididymal pain Template:Ref is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.Template:Ref

Although late failure (caused by recanalization of the vasa deferentia) is very rare, it has been documented.Template:Ref

Vasectomy is the most effective long-term contraceptive method, and is among the safest options for family planning. How popular sterilization is as a birth control method varies by age, with men in their mid 30's to mid 40's being most likely to have a vasectomy. The rate of vasectomies to tubal ligations worldwide is extremely variable, and the statistics are mostly based on questionaire studies rather than actual counts of procedures performed. In 2005, the CDC published state by state details of birth control usage by method and age group. Overall, tubal ligation is ahead of vasectomy but not by a large factor. In Britain vasectomy is more popular than tubal ligation, though this statistic may be as a result of the statistical data gathering methodology. Couples who opt for tubal ligation do so for a number of reasons, including:

Convenience of coupling the procedure with delivery at a hospital.
Refusal of the man to undergo vasectomy due to fear of possible side effects.

Couples who choose vasectomy are motivated by, among other factors:

Fear of surgery in the woman
Knowing men who have had the procedure and are satisfied with the results
A stronger motivation for sterilization in the man
The lower cost and simplicity of vasectomy
The lower mortality of vasectomy

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Reversal

In order to allow for reproduction (via artificial insemination) after vasectomy, some men opt for cryostorage of sperm before sterilization. However, the long term viability of spermatozoa in cryostorage is questionable.

Although men considering vasectomies should not think of them as reversible, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). It is, however, not effective in all cases, with the success rate depending on the method used for the vasectomy.

Various temporary male contraceptives are being researched but not yet available, such as male oral contraceptives and the intra vas device. There has been at least one documented case of a vasectomy being reversed on a dog, which then fathered puppies after the reversal.

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Tubal ligation

In women, a tubal ligation can be done in many forms, through a vaginal approach, through laparoscopy, a minilaparotomy ("minilap"), or through a regular laparotomy. Also a distiction is made between postpartum tubal ligation and interval tubal ligation, the latter being done not after a recent delivery. There are a variety of tubal ligation techniques, noteworthy the Pomeroy type that was described by Ralph Pomeroy in 1930, the Falope ring that can easily be applied via laparoscopy, and tubal cauterization done usually via laparoscopy. Also a bilateral salpingectomy is, of course, effective as a tubal ligation procedure. A tubal ligation can be performed as a secondary procedure when a laparatomy is done, ie a cesarean section. Any of these procedures may be sometimes referred to as having one's "tubes tied."

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Reversal

Generally tubal ligation procedures are done with the intention to be permanent. However, some types of procedure can be reversed with surgery, notably those that leave a sizable amount of tubal tissue in place, i.e the Pomeroy type of tubal ligation or the Falope ring application. In contrast, tubal ligation with the use of cautery, or a salpingectomy are generally poor or no candidates for reversal. However, in vitro fertilization can overcome fertility problems in patients with tubal occlusion due to any type of tubal ligation.

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Sterilization of animals

In animals, castration (removal of the testes) and salpingo-oophorectomy (removal of the ovaries and fallopian tubes), called "neutering" or "spaying" when applied to pets, are used to reduce or eliminate sexual behaviour, and to prevent conception, heat and possible uterine diseases in females, potentially prolonging an animal's lifespan. Due to the hormonal changes involved with both genders, this will definitely cause minor personality changes in the animal. When these changes are undesired, a different method of sterilization can be used, such as vasectomy in males or tubal ligation in females. A typical example of this practise is when male cats are subjected to vasectomy so that they are able to mate with females, thereby "bringing them off heat" (terminating estrus). This keeps the condition of the female from deteriorating due to the extra energy that is expended during estrus. A vasectomized male cat is called a "teaser tom" by cat breeders.

Animal control organizations urge owners who do not keep animals for the specific purpose of breeding from them to have their pets spayed or neutered in order to prevent an increase in the population of stray animals. These stray animals are often malnourished, and are frequently euthanized by animal welfare societies.

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References

Template:Note {{cite journal

| author=Pamela J. Schwingl, Ph.D., and Harry A. Guess, M.D. | title=Safety and effectiveness of vasectomy | journal=Fertility and Sterility | year=2000 | volume=73 | issue = 5 | pages=923–936}}

Template:Note {{cite journal

| author=Denise J. Jamieson et al | title=A Comparison of Women’s Regret After Vasectomy Versus Tubal Sterilization | journal=Obstetrics & Gynecology | year=2002 | volume=99 | issue = 6 | pages=1073–1079}}

Template:Note {{cite journal

| author=Philp, T; Guillebaud et al | title=Late failure of vasectomy after two documented analyses showing azoospermic semen | journal=British Medical Journal (Clinical Research Ed.) | year=1984 | volume=289 | issue =6437 | pages=77–79}}

Template:Note {{cite journal

| author=Christiansen and Sandlow | title=Testicular Pain Following Vasectomy: A Review of Postvasectomy Pain Syndrome | journal=Journal of Andrology | year=2003 | volume=24 | pages=293–298}}

Template:Note Attracting men to vasectomy, Network: Spring 1998, Vol. 18, No. 3
Template:Note {{cite journal

| author=Evelyn Landry and Victoria Ward | title=Perspectives from Couples on the Vasectomy Decision: A Six-Country Study | journal=Reproductive Health Matters | year=1997 | volume=(special issue) | pages=58–67}}

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