The evolution of methods for female sterilization

Abstract

Methods for the sterilization of women by occlusion of the Fallopian tubes have evolved by changes in the approaches to the tubes and trials of various methods for occluding the tubal lumen. Approaches to the tube have included: the anterior abdominal wall routes by laparotomy, minilaparotomy and laparoscopy; a vaginal approach through the posterior vaginal fornix; and transcervical approaches, either blind, or via the hysteroscope. Methods for obtaining tubal occlusion have included: excision and suture techniques; electrocautery; clips and rings; intratubal occlusive devices and chemicals introduced into the tubal lumen. The development of each of the approaches to the tube and of the methods for obtaining tubal occlusion are discussed.

Tubal sterilization in relation to breast cancer risk

“…1,4,18 Prior to 1970, most tubal sterilizations were performed during the postpartum period and used the Pomeroy ligation technique, in which the fallopian tubes are looped, tied and sometimes also divided. 2,19 In the late 1960s, with the advent of fiber optics, laparoscopic methods of tubal sterilization were developed.…”

“…2,19 In the late 1960s, with the advent of fiber optics, laparoscopic methods of tubal sterilization were developed. 4 Laparoscopy made sterilizations outside the postpartum period more feasible, and the frequency of these interval procedures increased from less than 30% in 1970 to more than 50% by 1973. 19 Unipolar electrocautery was introduced in 1967 19 and was the only laparoscopic tubal sterilization method in the early 1970s.…”

“…Pomeroy ligation, bipolar electrocautery and bands generally destroy 2-3 cm of the fallopian tube, 2 while unipolar electrocautery causes destruction of 3-5 cm of the tube, as well as coagulation extending 2-3 cm beyond the tube, often including the surrounding vessels. 4,20 Whether tubal sterilization causes hormonal dysfunction has not been determined definitively, although many investigators have examined changes in menstrual symptoms and circulating hormone levels as markers of disrupted hormonal functioning. Increased disturbance in menstrual cycles and symptoms in sterilized women, when compared with those of either a control group or the sterilized women before the procedure, have been observed in most, [20][21][22][23][24][25][26] but not all, [27][28][29] studies.…”

“…While it is a successful contraceptive method, tubal sterilization may alter hormonal function by damaging the utero-ovarian artery, which provides blood to the ovaries. [1][2][3][4] Methods of sterilization have evolved over time, and different procedures cause various degrees of tissue destruction. 2,4 If a decline in hormone production results from damage to the utero-ovarian artery, 5,6 women who have undergone tubal sterilization may have a lower lifetime exposure to endogenous hormones.…”

“…[1][2][3][4] Methods of sterilization have evolved over time, and different procedures cause various degrees of tissue destruction. 2,4 If a decline in hormone production results from damage to the utero-ovarian artery, 5,6 women who have undergone tubal sterilization may have a lower lifetime exposure to endogenous hormones. Given the direct relation between hormones and breast cancer, 7,8 tubal sterilization may decrease the risk of breast cancer.…”