INTRODUCTION

Surgical sterilization is a safe, highly effective, permanent, and convenient form of contraception. Numerous methods for achieving permanent sterilization have been described, and subsequently modified to improve success rates, simplify surgical technique and reduce postoperative pain and length of hospital stay. Laparoscopic techniques are preferred for most patients, as they are effective, and are usually performed on an outpatient basis, and result in rapid patient recovery. In 1995, almost 30 percent of contraceptive users in the United States used tubal sterilization [1].

GENERAL CONSIDERATIONS

Tubal sterilization is an elective and essentially permanent procedure. There are virtually no absolute contraindications, although a patient's gynecologic disease may require sterilization by hysterectomy and bilateral oophorectomy.

• Known extensive intra-abdominal adhesions increase the potential for intraoperative morbidity during laparoscopy. With the development of transcervical (or hysteroscopic) sterilization, laparotomy is now rarely necessary for sterilization. Alternatively, other forms of contraceptive can be offered. (See "Hysteroscopic sterilization" and "Overview of contraception".)
• Pregnancy may pose a significant risk to women with some medical disorders; thus forming a basis for elective sterilization. However, consultation with a maternal-fetal medicine specialist is advisable to determine the current magnitude of risk to mother and offspring, since occasionally women have been told that pregnancy is contraindicated when, in fact, it is not.
• Women with mental disabilities or their families/caregivers may request sterilization. Physicians caring for these women must be aware of the federal, state, and local regulations pertaining to their ability to give informed consent. Court approval of the procedure may be required and input from a hospital ethics committee can be useful.

Informed consent — A woman's decision to undergo sterilization must be voluntary and not coerced by her family, partner, or health care providers. Complete, nonbiased information about the procedure and alternatives to surgery helps to reduce post-sterilization regret. Failure of one method of contraception is not an indication for permanent sterilization. The woman's husband is not required to give consent before performing the procedure (in the United States); however, ideally both partners should have an understanding of the procedure as well as the benefits, alternatives, and potential risks. This discussion includes [2]:

• A review of the risks and benefits of reversible and permanent methods of contraception, as well as information about male sterilization. (See "Overview of contraception", section on 'Vasectomy'.)
• The woman's reasons for choosing sterilization.
• Screening for risk indicators of regret (see 'Regret after sterilization' below).
• An explanation of the details of the procedure, including anesthesia.
• The permanence of the procedure and information on reversal.
• The causes and probability of sterilization failure, including the chance of ectopic pregnancy.
• The need to use condoms for protection against sexually transmitted diseases (eg, HIV) if she has multiple sex partners or a partner with other partners.
• A reduction in the risk of ovarian cancer [1,3] and pelvic inflammatory disease.
• No consistent differences in menstrual cycle characteristics occur as a result of tubal sterilization (see 'Postablation tubal sterilization syndrome' below) [4-8].