--EstherO 5 février 2009 à 18:52 (MET)

What is sterilization?

Sterilization is a surgical technique performed to generate infertility to an organism. It can be a method to control birth and has the characteristics to be permanent. It is a good solution for people who are sure they never want children anymore and do not want to take the risk of being or having a partner pregnant. Doctors and gynecologists often encourage their patients to chose another technique of contraception in order to not have patients who change their mind after surgery.

What is fertility?

Fertility is the capacity to reproduce and thus to generate offspring. A man is fertile from puberty until the end of his life in a continuous process. A woman is fertile from puberty even if she already has her ovaries full of oocytes before birth. However she is fertile until menopause process.

When would sterilization be made?

Sterilization would be made as a permanent birth control. It can be a solution in different situation : A couple who is sure that they do not want any children anymore should appeal to sterilization because it can provide them advantages (see below).
It can be another solution in case of rapist or pedophile because by sterilized them, it will “cut“ their sexual pulsion. This solution was often used in order to protect the state against criminality. In addition, there were countries around the world which adopt programs, usually as part of eugenics programs in order to prevent the reproduction and multiplication of members of the population considered to be carriers of defective genetic traits. These programs have sometimes racism movement, such as the Nazis, who have sterilized more than 400’000 people in order to protect the “purity of the race”. Most of the time, these people has been sterilized against their’s will. Moreover, there are some countries which legitimize the sterilization to people attended to mental disorder for “the protection and the health of the state”. Sterilization was also a way to control the demographic situation of a country.

Can sterilization be used for women and men?

Yes, sterilization can be performed on women and men:

Women

Tubal ligation

Tubal ligation is a surgical sterilization technique for women which is quite simple to make. This surgical operation closes the fallopian tubes (=oviducts), and stops the egg from traveling from the ovary to the uterus. It also prevents sperm cells from reaching the egg to fertilize the egg.
In a tubal ligation, both fallopian tubes have to be cut, burned, or blocked with rings, bands or clips, otherwise, the efficiency of sterilization would not be good. Indeed, both ovaries have the possibiliy to ovulate every single month, on day 14 of the ovarian cycle.
There exist another type of sterilization process, Essure, in which are placed tiny metal coils in the women's fallopians tubes. After the surgery, scar tissue grows in and around these coils, which block the tubes so that sperm cannot reach a woman’s eggs.

See Annex Sterilization 1
See Annex Sterilization 2

Men

Vasectomy

Vasectomy is the men's sterilization. During surgery the vas deferens from each testes is either squeezed, cut or sealed. This technique of sterilization prevents sperm cells from mixing with the semen that is ejaculated from the penis. When there are no sperm cells in the semen an egg cannot be fertilized. This technique blocks the sperm cells in the testes and the sperm cells are naturally reabsorbed and eliminated by the body. The fact that the sperm cells are blocked does not mean that the man does not ejaculate fluid.

See Annex Sterilization 3
See Annex Sterilization 4

How effective is sterilization ?

For women, tubal ligation is 99 percent effective and Essure is 99.7 to 99.8 percent effective. The effectiveness rate of a vasectomy is greater than 99 percent. There is a small failure rate with a one in two hundred chance of becoming pregnant at some point following sterilization. But vasectomy is only efficient after three months and during this laps of time, people may appeal to other birth control such as pill or condoms. Do not forget that tubal ligation and vasectomy offers no protection against sexually transmitted infection, because in the vasectomy case whether or not it contains sperm cells, sexually transmitted infections can be carried in ejaculation.

Is there any comparaison between tubal ligation and vasectomy?

The comparaison between the ratio of tubal ligations and the ratio of vasectomies is very variable among the countries and most of the statistics are based on questionnaire studies. For example, in the US, tubal ligation is more used than veasectomy, but in Britain, it is the contrary. However,in worldwild, married women rely more on female sterilization than male sterilization.

Reasons of why couples opt for tubal ligation

-Convenience of coupling the procedure with giving birth at hospital
-Fear of side effects in the man
-Fear of surgery in the man

Reasons of why couples opt for vasectomy

-The lower cost of vasectomy
-The simplicity of the surgical procedure
-The lower mortality of vasectomy
-Fear of side effects in the woman
-Fear of surgery in the woman

Is sterilization irreversible ?

It would be wrong to say that sterilization of both sex are irreversible, except for Essure.
In the case of tubal ligation, it may be reversible by requiring microsurgery to reconnect fallopian tubes, which is a difficult operation. If a woman would like to be pregnant after sterilization, it is possible without reversal sugery. Indeed women will be offered in vtro fertilization.
For vasectomy, it is reversible by having a surgery which is a complicated procedure requiring general anesthesia and a lengthy operation. Many men who had this surgery are again able to have children.

What are the advantages of sterilization?

For women

There are different advantages of having a tubal ligation :
First, the fact that it is immediately effective.
Secondly, it does not require a daily attention such as pill.
Then, it is a cost-effective over the time, but again, tubal ligation does not protect against STD.

For men

The advantages of vasectomy are simple.
First, men won't have to worry about your partner becoming pregnant anymore because the semen does not contains sperm anymore, but do not forget that vasectomy, as tubal ligation does not protect against STD.
Secondly, vasectomy is a safe and cheap procedure compare to the cost of other methods known as pills or condom over the time.

What are the disadvantages of sterilization?

For women

Sterilization as it has been said is almost 100 percent effective and permanent. The fact that this birth control is permanent can be an advantage, but before choosing this method the women should think about any possible life changes that may bring her to change her mind. Also as for any surgery there is some risks, but it's very rare, because it's an easy operation. Finally the most important thing to remember is that this birth control do not protect against sexually transmitted diseases (STDs), including infection with HIV. To help protect yourself and your partner from possible STD infection, use a condom every time you have sex.

For men

The disadvantages for vasectomy is almost the same as for tubal ligation. The man must be sure of his decision before appeal to this kind of birth control which is irreversible. Again there are risks with any medical procedure, including vasectomy. It's important to understand the risks before having a vasectomy. And finally as said before it does not protect against sexually transmitted diseases.

See Annex Sterilization 5

What are the side effects of sterilization?

For women

It can creates some pain and discomfort during and after the operation. The surgery can cause some damages to intestines, bladder, from the instruments including perforation of the uterus. There can also be some anesthesia infections but this is very rare. Death is extremely rare too, but it still remains a risk as in every operation. If the woman get pregnant even after the surgery for any reason, there is a big risk (about 32%) of an ectopic pregnancy.

For men

As for women it can creates some pain and discomfort. Bruising and infections of the skin around the incision can occur. There may have some testicular discomfort related to ejaculation, but it's usually resolved after three months. There is also a risk of about 2% of an epididymitis incidence which is an inflammation of the epididymis, the tubular structure that connects the testicle with the vas deferens.

What are the ethical problems?

Sterilization can in fact raise several questions; for example, in the case of the people who are handicaped; who has the ability to decide who and in which case would sterilization be made without the person consentment ? Indeed, they could have some difficulties to educate their children for example and disrupted the society if they have children. However, isn't it a reason to forbid them to have children? Is there any movement of discrimination in it?
By the past, forced sterilization conducts to abuses, such as the huge forced sterilization in Sweden in 1935, 62 888 person (women in many case) were sterilized by force because of their origin.
Nowadays, ethic groups say that the forced sterilization on handicaped person is a negation of their dignity and of their physical integration ; but, is it better to keep their physical integrity and to let them have children which will have to live and to grow with these people ? Furthermore in the case of rapist or pedophile, isn't it consider as torture if sterilization is made without their consentment ?
Who can say that he/she knows who should be sterilized by force? Who can know that by sterilizing they wouldn't continue their acts? In addition, as we know sterilization is a way in order to not have children. Indeed some religion are against sterilization, because sterilization can be considered as a control on a possibility of a childbirth. Thus, is sterilization be a solution for just having sexual relation without a risk to have any child? If yes, for some religion groups, it is considered as it is a deny of one of the most best gift from God. However, life isn't yet created here, but doesn't it reduce the next generation of our earth?