Female sterilization has become a relatively safe, simple, and inexpensive procedure. Approximately 25% of married women of childbearing age in the United States rely on female sterilization as their method of contraception (Mosher & Jones, 2010). Tubal sterilization can be accomplished by a variety of techniques that use small inci­sions and either local or general anesthesia. A laparoscopy is shown in 1 Figure 10.10. One or two small incisions are made in the abdomen, usually at the navel and slightly below the pubic hairline. A narrow, lighted viewing instrument called a laparoscope is inserted into the abdomen to locate the fallopian tubes. The tubes are then tied off, cut, clipped, or cauterized to block passage of sperm and eggs. The incisions are gener­ally so small that adhesive tape rather than stitches is used to close them after surgery. Sometimes, in a procedure called a culpotomy, the incision is made through the back of the vaginal wall.

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I Figure 10.10 Female sterilization by laparoscopic ligation. Front view shows tubes after ligation.

Newer techniques do not require an operating room, general anesthesia, or much recovery time (Lee-St. John & Gallatin, 2008). The procedure takes half an hour and is performed using local anesthesia. During a transcervical sterilization, a physician inserts a tiny coil, called Essure (shown in I Figure 10.11), made of polyester fibers and nickel – titanium alloy (the same material that is used to make artificial heart valves), or a silicone implant, called Adiana, into the vagina, through the cervix, and into the opening of each fallopian tube in the uterus. Essure and Adiana promote tissue growth that, after 3 months, blocks the fallopian tubes and prevents the ovum and sperm from meeting. Women and/or their partners should use another form of birth control during those 3 months (Hollander, 2008c). The most common side effect is cramping; in rare cases the device is expelled or perforates the fallopian tube.

Sterilization does not affect a womans repro­ductive and sexual systems. Until menopause her ovaries continue to release their eggs. The released eggs simply degenerate, as do millions of other cells daily. The womans hormone levels and the timing of menopause remain unchanged.

Her sexuality is not physiologically changed, but she may find that her interest and arousal increase because she is no longer concerned about pregnancy or birth control methods.