Sterilization (also spelled sterilisation) is any of several medical methods of permanent birth control that intentionally leaves a person unable to reproduce. or arm implant, and in the United States, surgical complications are low. It is not very likely, but if it does happen, there is a high risk of ectopic gestation. In some cases, sterilization can be reversed, but this can not be guaranteed. If you might want to become pregnant in the future, do not have this surgery.

In April 2018, the FDA restricted the sale and use of Essure due to several complications certain women experienced. On July 20, 2018, Bayer announced it would end sales in the US by the end of 2018.

  • Quinacrine has also been used for transluminal sterilization, but despite a multitude of clinical studies on the use of quinacrine and female sterilization, no randomized, controlled trials have been reported to date, and there is some controversy over its use. See also mepacrine.

Pharmacological

There are no oral medications for sterilization currently approved for human use.

Effects

The effects of sterilization vary greatly according to gender, age, location, and other factors. When discussing female sterilization, one of the most important factors to consider is the degree of power that women hold in the household and within society.

Physical

Understanding the physical effects of sterilization is important because it is a common method of contraception. Among women who had interval tubal sterilization, studies have shown a null or positive effect on female sexual interest and pleasure. Similar results were discovered for men who had vasectomies. Vasectomies did not negatively influence the satisfaction of men, and there was no significant change in communication and marital satisfaction among couples as a result. According to Johns Hopkins Medicine, tubal sterilizations result in serious problems in less than 1 out of 1000 women. Tubal sterilization is an effective procedure, but pregnancy can still occur in about 1 out of 200 women. Some potential risks of tubal sterilization include "bleeding from a skin incision or inside the abdomen, infection, damage to other organs inside the abdomen, side effects from anesthesia, ectopic pregnancy (an egg that becomes fertilized outside the uterus), [and] incomplete closing of a fallopian tube that results in pregnancy." Potential risks of vasectomies include "pain continuing long after surgery, bleeding and bruising, a (usually mild) inflammatory reaction to sperm that spill during surgery called sperm granuloma, [and] infection." Additionally, the vas deferens, the part of the male anatomy that transports sperm, may grow back together, which could result in unintended pregnancy.

Psychological

It can be difficult to measure the psychological effects of sterilization, as certain psychological phenomena may be more prevalent in those who eventually decide to partake in sterilization. The relationships between psychological problems and sterilization may be due more to correlation rather than causation. That being said, there are several trends surrounding the psychological health of those who have undergone sterilization. A 1996 Chinese study found that "risk for depression was 2.34 times greater after tubal ligation, and 3.97 times greater after vasectomy." If an individual goes into the procedure after being coerced or with a lack of understanding of the procedure and its consequences, they are more likely to develop negative psychological consequences afterward. However, most people in the United States who are sterilized maintain the same level of psychological health as they did before the procedure. Because sterilization is a largely irreversible procedure, post-sterilization regret is a major psychological effect. The most common reason for post-sterilization regret is the desire to have more children. In the United States, where there are no governmental incentives for being sterilized (see below), the decision is often made for personal and familial reasons. A woman, sometimes along with her partner, can decide that she does not want any more children or she does not want children at all. Many women report feeling more sexually liberated after being sterilized, as there is no risk of pregnancy. By eliminating the risk of having more children, a woman can commit to a long-term job without a disruption of maternity leave in the future. A woman will feel more empowered since she can make a decision about her body and her life. Sterilization eliminates the need for potential abortions, which can be a very stressful decision overall. Sterilization can lead to distrust in a marriage if the husband suspects his wife of infidelity. Furthermore, the husband may become angry and aggressive if the decision to be sterilized is made by the wife without consulting him. If a woman marries again after sterilization, her new husband might be displeased with her inability to bear him children, causing tumult in the marriage. There are many negative consequences associated with women who hold very little personal power. However, in more progressive cultures and in stable relationships, there are few changes observed in spousal relationships after sterilization. In these cultures, women hold more agency, and men are less likely to dictate women's personal choices. Sexual activity remains fairly constant, and marital relationships do not suffer, as long as the sterilization decision was made collaboratively between the two partners. Scholars define "voluntarily childless" women as "women of childbearing age who are fertile and state that they do not intend to have children, women of childbearing age who have chosen sterilization, or women past childbearing age who were fertile but chose not to have children".

In industrialized countries such as the United Kingdom, those of Western Europe, and the United States, the fertility rate has declined below or near the population replacement rate of two children per woman. Women are having children at a later age, and most notably, an increasing number of women are choosing not to bear children at all. According to the U.S. Census Bureau's American Community Survey, 46% of women aged 15 to 44 were childless in June 2008 compared to 35% of childless women in 1976. The personal freedoms of a childless lifestyle and the ability to focus on other relationships were common motivations underlying the decision to be voluntarily childless. Such personal freedoms included increased autonomy and improved financial positions.

In relationships, the couple could engage in more spontaneous activities because they did not need a babysitter or to consult with someone else. Women had more time to devote to their careers and hobbies. Regarding other relationships, some women chose to forgo children because they wanted to maintain the "type of intimacy that they found fulfilling" with their partners. The Temporary Assistance for Needy Families was another federal block grant created in 1996 and is the main federal source of financial "welfare" aid. The U.S. Department of Health and Human Services administers Title X as the sole federal program dedicated to family planning. Under Title X, public and nonprofit private agencies receive grants to operate clinics that provide care largely to the uninsured and underinsured. Unlike Title X, Medicaid is an entitlement program that is jointly funded by federal and state governments to "provide medical care to various low-income populations". Medicaid provided the majority of publicly funded sterilizations. In 1979, regulations were implemented on sterilizations funded by the Department of Health and Human Services. The regulations included "a complex procedure to ensure women's informed consent, a 30-day waiting period between consent and the procedure, and a prohibition on sterilization of anyone younger than 21 or who is mentally incompetent." Another reason may include individuals who choose sterilization to concentrate on caring for a child with a disability and to avoid withholding any necessary resources from additional children. For individuals without children, technological advancements have enabled the use of carrier screening and prenatal testing for the detection of genetic disorders in prospective parents or their unborn offspring. If prenatal testing has detected a genetic disorder in the child, parents may opt to be sterilized to forgo having more children who may also be affected.

Barriers to elective sterilization

Individuals who desire to undergo elective sterilization may face barriers to accessing these procedures. In the United States, there has been a growing demand for sterilization procedures, especially among women. This is thought to be at least partially due to the Supreme Court's decision to overturn Roe v. Wade in 2022, leaving the fate of abortion rights uncertain. However, male reproductive procedures, like vasectomies, are not required to be covered. This can be attributed to both cultural attitudes and structural obstacles within the healthcare system. Misinformation continues to surround the procedure, such as the misconception that a vasectomy undermines masculinity, contributing to hesitation and stigma. Minority women were more likely to use female sterilization than their white counterparts. The proportion of women using female sterilization was highest for black women (22%), followed by Hispanic women (20%), and white women (15%).

Several factors can explain the different findings between female and male sterilization trends in the United States. Women are more likely to receive reproductive health services. "Additionally, overall use of contraception is associated with higher socioeconomic status, but for women, use of contraceptive tubal sterilization has been found to be related to lower socioeconomic status and lack of health insurance." Many of the women affected by this were poor, minority women.

In May 2014, the World Health Organization, OHCHR, UN Women, UNAIDS, UNDP, UNFPA, and UNICEF issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement. The report references the involuntary sterilization of several specific population groups. They include:

  • Women, especially in relation to coercive population control policies, particularly including women living with HIV, Indigenous and ethnic minority girls and women. Indigenous and ethnic minority women often face "wrongful stereotyping based on gender, race, and ethnicity".
  • People with disabilities are often perceived as sexually inactive. Women with intellectual disabilities are "often treated as if they have no control, or should have no control, over their sexual and reproductive choices". Other rationales include menstrual management for the benefit of careers.
  • Intersex persons, who "are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved", often as a "sex-normalizing" treatment.
  • Transgender persons, "as a prerequisite to receiving gender-affirmative treatment and gender-marker changes".

The report recommends a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability, and access to remedies.

Incentivizing

Some governments in the world have offered and continue to provide economic incentives to use birth control, including sterilization. In countries with high population growth and insufficient resources to sustain a large population, these incentives become more enticing. Many of these policies are aimed at certain target groups, often disadvantaged and young women (especially in the United States). While these policies are controversial, the ultimate goal is to promote greater social well-being for the whole community. One of the theories supporting incentivizing or subsidy programs in the United States is that it offers contraception to citizens who may not be able to afford it. This can help families prevent unwanted pregnancies and avoid the financial, familial, and personal stresses of having children if they so desire.

Sterilization becomes controversial when considering the degree of a government's involvement in personal decisions. For instance, some have posited that by offering incentives to receive sterilization, the government may change the decision of the families, rather than just supporting a decision they had already made. Some critics argue that incentive programs are inherently coercive, which makes them unethical. Therefore, eugenic policies in America often targeted Latinos, African Americans, Native Americans, people with disabilities, and poor whites. The 1927 Supreme Court decision in Buck v. Bell ruled that a state could perform forcible sterilization procedures on those deemed unfit for reproduction. As a result of this ruling, an estimated 70,000 Americans were forcibly sterilized. In addition, states varied in the extent to which they employed these practices, with California operating one of the largest eugenic sterilization programs in the country. In many cases, sterilization policies were not explicitly compulsory in that they required consent. However, this meant that men and women were often coerced into agreeing to the procedure without being in the right state of mind or receiving all of the necessary information. Under the Japanese leprosy policies, citizens with leprosy were not forced into being sterilized; however, they had been placed involuntarily into segregated and quarantined communities. This program, among other birth control incentives and education programs, greatly reduced Singapore's birth rate, female mortality rate, and infant mortality rate while increasing family income, female participation in the labor force, and a rise in educational attainment, among other social benefits. These are the intended results of most incentivizing programs, although questions of their ethicality remain.

India

Another country with an overpopulation problem is India. Medical advances in the past fifty years have lowered the death rate, resulting in large population density and overcrowding. This overcrowding is also a result of poor families' lack of access to birth control. Despite this lack of access, sterilization incentives have been in place since the mid-1900s. In the 1960s, the governments of three Indian states and one large private company offered free vasectomies to some employees, occasionally accompanied by a bonus. In 1959, the second Five-Year Plan offered medical practitioners who performed vasectomies on low-income men monetary compensation. Additionally, those who motivated men to receive vasectomies, and those men who did, received compensation. Therefore, abortion and sterilization were restricted. With these policies and the social and economic improvements associated with the new regime, rapid population growth ensued. In the past decade, the restrictions on family size and reproduction have lessened. The Chinese government has found that by giving incentives and disincentives that are more far-reaching than a one-time incentive to be sterilized, families are more willing to practice better family planning. These policies seem to be less coercive as well, as families are better able to see the long-term effects of their sterilization rather than being tempted with a one-time sum.

Criminalization

Certain countries have enacted legislation prohibiting or restricting elective sterilization procedures for contraceptive purposes.

Poland

In Poland, reproductive sterilization of men or women has been defined as a criminal act since 1997

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  • Cat's sterilization (video)
  • Vasectomy Information —The website of newsgroup alt.support.vasectomy.
  • All About Vasectomy & Finding a Doctor. Latest advances, videos etc
  • My Vasectomy in Words and Pictures —One man's personal experience.
  • Vasectomy Reversal Resource
  • Female Sterilization Options – /mk.nkl/cvas1.html Is Vasectomy the Right Method For Me?] and * * * Is Female Sterilization the Right Method For Me?
  • No-Scalpel Vasectomy: The NSV Book
  • Video: The NSV Procedure (graphic)