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The effect of laparoscopic sterilisation by diathermy or silastic bands on post-operative pain, menstrual symptoms and sexuality.

A total of 530 patients was reviewed six months after laparoscopic sterilisation by diathermy (235 patients) or silastic bands (295 patients). In the immediate postoperative period severe lower abdominal pain was more common in the patients who had silastic bands. There was no differences in the nature or incidence of menstrual problems when the two methods were compared. In all, 40 per cent of patients reported an increase in menstrual blood loss ad 26 per cent of patients an increase in menstrual pain, and this could not be attributed entirely to stopping oral contraception; 42 per cent of patients reported improvement in their sex lives after sterilisation, while 6.6 per cent reported deterioration mainly due to lack of libido. There was some regret about the operation in 5.1 per cent of patients.

Diathermy↗

Why 103 women asked for reversal of sterilisation.

Between 1975 and 1976 103 women requesting sterilisation reversal were interviewed at Hammersmith Hospital. Their average age at sterilisation was 26-7 years; 65 (63-1%) had been sterilised immediately after pregnancy, and many patients had previously used contraception inadequately when they were sterilised. When they had been sterilised 78 (75-7%) patients were unhappily married and remarriage was the chief reason for the request for reversal. Sexual dissatisfaction after sterilisation was common, but there was no obvious increase in menstrual disturbance. Thirty-nine (37-8%) patients had been sterilised by irreversible methods, and in only half the cases sterilised by tubal ligation were conditions technically suitable for reversal surgery. It therefore seems unwise to sterilise women under 30 particularly immediately after pregnancy or if their marriage is in jeopardy.

Adult↗

Combination of 19-nortestosterone-hexyloxyphenylpropionate (Anadur) and depot-medroxyprogesterone-acetate (Clinovir) for male contraception.

Because monotherapy with 19-nortestosterone hexyloxyphenylpropionate (Anadur, Pharmacia Arzneimittel, Ratingen, Federal Republic of Germany) suggested improved results for male contraception compared with available testosterone esters, it was tested for induction of complete azoospermia when combined with depot-medroxyprogesterone acetate (DMPA, Clinovir, Upjohn GmbH, Heppenheim, Federal Republic of Germany). Twelve men were treated for 7 weeks with weekly intramuscular (IM) injections of 200 mg Anadur followed by 3-weekly IM injections of Anadur up to week 15. Clinovir (250 mg) IM was administered at the start of treatment and during weeks 6 and 12. Anadur and Clinovir suppressed serum gonadotropins. Although serum testosterone declined steeply, in general, libido and potency were not impaired. Sperm concentrations were reduced significantly after 3 weeks of treatment. Lowest sperm counts were seen during week 8 of follow-up, when only 2 volunteers showed measurable sperm counts of 2.1 and 3.0 X 10(6)/ml, with a declining tendency. After 43 weeks, sperm concentrations were still below pretreatment range in 2 men, but later returned to pretreatment values. Computerized sperm motion analysis revealed that motility parameters in the residual sperm were reduced. In vitro analysis excluded a direct effect of medroxyprogesterone acetate in seminal plasma on sperm motion. The data indicate that the combination of Anadur with Clinovir increases the rate of azoospermia in normal volunteers seen under Anadur monotherapy, although the goal of azoospermia in all participants was not quite achieved.

Anabolic Agents↗

Complications of laparoscopic sterilization. Comparison of 2 methods.

A retrospective study of 5346 cases of laparoscopic sterilization with special reference to early and late complications was undertaken. In the 6-year period from 1972 to 1978, 846 patients were sterilized by the elasticized silicone-ring technique and 4500 patients were sterilized by the electrocautery method. The electrocautery method was complicated by electrical burns in 13 cases (0.29%); 3 of these patients required bowel resections. Mechanical complications occurred in 1.6% of the Silastic-ring cases, but none of the patients required additional surgery. The Silastic-ring patients had greater postoperative abdominal pain than the electrocautery patients, but it usually abated within 48 hours. There were 15 cases of postoperative pelvic infection in the electrocautery group, and none in the Silastic-ring group. Bleeding from the mesosalpinx occurred in both groups and occurred more often with coincident suction D&C. Technical failure to perform the sterilization procedure was principally related to previous abdominal surgery. A substantial number of patients complained of menstrual irregularity and/or dysmenorrhea following these sterilization procedures. The majority of women reported unchanged or improved sexual relations. Improvement in sexual relations was reported by significantly more patients in the Silastic-ring group than in the electrocautery group.

Burns, Electric↗

Emotional reaction to sterilization.

Ninety-four patients sterilized by tubal occlusion were interviewed at the time of hospitalization for surgery and followed at scheduled intervals for a 2-year period. There were no serious problems, medical or psychologic, and all but 3 patients were pleased and satisfied at the end of 2 years. There were no technical failures. Psychosomatic symptoms do develop. They are more prominent and persist longer in the younger age group. Patients having these symptoms are those who had difficulty with contraceptive technics, have a limited understanding of the sterilization procedure, and continue to question its permanency. The need for preoperative evaluation and counseling is emphasized.

Adolescent↗

[The value of irreversible contraception].

8 years after sterilization was in force in GDR it is stated, that this way of female healthy protection was different performed in the varions countries of GDR. The portion of the country Rostock amount to 56,6%. --85,3% of the women were elder than 30 years. 60% of the applicants have had legal abortions. 66,8% of the propositions were based by medical indication. --The rate of complications and failures amount to 0,3%. --By reason of the results it is recommended to regard the sterilization as the adequate method of contraception, if reproduction is finished.

Adolescent↗