PERMANENT FAMILY

PLANNING
MRS.NILAKSHI BARIK MANDAL
LECTURER
 INTRODUCTION
 Sterilisation is the most effective, and one
of the most widely used contraceptive
methods available worldwide. It is often
the best contraceptive choice when desired
family size has been achieved. Both tubal
ligation in women, and vasectomy in men,
are one-time procedures that are safe,
inexpensive and relatively straightforward
to do for a trained person.
VOLUNTARY SURGICAL CONTRACEPTION

 Voluntary surgical
contraception (VSC) is a
permanent family planning
method, which involves female
sterilisation or male
sterilisation. 
 TUBECTOMY
 Female sterilisation is a surgical
intervention that provides permanent
contraception for women who do not
want any more children. It is a safe
and simple surgical procedure. Female
sterilisation is also known as Tubal
Ligation (TL), or ‘tying the tubes’, as
well as VSC. TL is the procedure most
commonly done in Ethiopia.
 HISTORY OF TUBECTOMY

 Prior to the 1960s, female sterilization in the United States was generally
performed only for medical indications (when additional pregnancies would be
hazardous to the mother).
 The changing cultural climate in the 1960s encouraged women to reduce family
size.
TYPES
 LAPAROSCOPY
 This is a technique through abdominal
approach with specialised instrument
called “laparoscope”.
 The abdomen is inflated with gas
( carbondioxide ,nitrous oxide or air)
 Instrument is inserted into abdominal
cavity to visualize tubes.
 Once the tubes are accessible ,the falope
rings (or clips) are applied to occlude
tubes.
CONT….........

 This OT should be undertaken

where obstetrician and
gynaecologist is available.
 The short operating time
 Shorter stay in hospital.
 Small scar
 PATIENT SELECTION
Not advisable for postpartum patients for
6 weeks from delivery.
Concurrent procedure to MTP.
Hb should be more than 8 .
No associated medical disorder.
CONT. ………..
 Client should be married.
 Couple should have at least 1 child whose
age is above 1 yr.
 Client should be in a sound state of mind.
 Mentally ill client must be certified by
psychiatrist.
 MINILAP
Modification of abdominal tubectomy.
Its simpler procedure.
Smaller abdominal incision of only 2.5 – 3
cm conducted under local anesthesia.
Also know as Pomeroy technique.
Its is suitable for Postpartal tubal ligation.
CONT…….
 POST OP ADVICE
 Rest for 2-3 days.
 Avoid heavy lifting .
 Avoid sex for at least 1
week.
 Follow up
-High fever,
-Pus or bleeding
-Pain ,swelling
-Fainting ,dizzy
CONT. …………
Its recommended Pt to be kept in
hospital minimum 48 hrs.
The cases are followed up by health
workers.
7-10 days after operation.
Once again 12-18 months after
operation.
 SEXUALITY
 Women are fully able to enjoy sex after a tubal
ligation.
 Hormone levels and a woman’s menstrual cycle
are not affected by sterilisation.
 The ovaries continue to release eggs, but they
remain in the fallopian tubes and are re-absorbed
by the body. Some women experience improved
sexual pleasure, because they are less worried
about becoming pregnant.
 ADVANTAGES
 Permanent birth control.
 Immediately effective.
 Requires no daily attention.
 Cost-effective in the long term.
 No long term side effects
 Does not affect sexual pleasure.
 DISADVANTAGES
 Requires surgery and has risks associated with
surgery.
 Internal bleeding or infection at incision
 More complicated than male sterilisation.
 May not be reversible, resulting in possible regret
 Does not protect against sexually-transmitted
infections (STIs), including HIV/AIDS.
 COUNSELLING
 Temporary methods are available.
 Sterilization is a surgical procedure.
 Has risk & benefits.
 Prevent having more children.
 Permanent – decision to be taken
carefully.
 Make sure client understand all point.
 COMPLICATION
 Intraoperative
o Nausea ,vomiting
o Respiratory depression
o Cardiorespiratory arrest
o Uterine perforation
 Postoperative
o Wound sepsis
o Haematoma
o Incisional hernia
 VASECTOMY
 Vasectomy is a surgical procedure for male

sterilization and a method of permanent birth

control , in which the vasa differentia of a man
are tied and separate to prevent sperms to
entering into seminal stream which results to
prevent conception
 HISTORY OF VASECTOMY
 First recorded vasectomy 1823 by Coper from
England
 After a short time a barber R. Harrison by
profession performed first human vasectomy in
1924
 First programme launched 1954 in India.
 TYPES
 Convential vasectomy(scalpel):
 The oldest method.
 Total 3 incision .
 1 on each side and 1 in middle of scrotum (1.5 -3 cm. on each
side).
 Closure by sutures ,High risk for infection.
CONT.….
 Non scalpel vasectomy:
 Two special forceps Vas ring clamp and vas
dissectors.
 Less complication and not required sutures.
 Minimally invasive:
 It is also type of non scalpel
 Minor complications and low risk of infection
INSTRUMENTS
 NON SCALPEL
 A sign consent of person who will be undergone
with procedure.
 Explaining the procedure for a good
cooperation.
 Operation done in an In patient dept. or in clinic.
 Provide supine position to the patient , assure the
local area should be shaved and clean with full
aseptic technique.
CONT…..

Procedure done under local

anaesthetic agent for numb the
area.
Vas is palpated at the level
midway between the top of
testis & the base of penis.
 CONT…..
 the vas is grasp with the help of ringed clamp applying then
the skin is punctured by sharp pointed dissecting forceps.
 vas is elevated by dissecting forceps and hold with ringed
clamp.
 Then division of vas is made by diathermy and ligated apart
from and by tip 1 cm.
 No skin suturing required small pressure bandage will be
applied.
 Same procedure done on other side.
MALE REORODUCTIVE SYSTEM
WHAT TO EXPECT AFTER SURGERY

 The patient can resume sexual intercourse once pain and swelling
subsides.
 But the partner can still get pregnant until the sperm count is zero.
 Till that another birth control methods can be used , until the patient has
follow up sperm count test, 6 weeks after the vasectomy or 10 to 20
ejaculations.
 PRE OPERATIVE EVALUATION
 Complete history collection and physical
examination
 Bleeding disorders & any surgical history
related to Genito urinary tract.
 Avoid aspirin and NSAID drugs 24 to 48 hrs
Prior.
 Anxiolytic drugs administer before the
procedure.
 POST OPERATIVE EVALUATION
 Rest for next 24 hrs.
 Light work 2-3 days.
 Do not put heavy weight upto 7
days.
 Scrotal support and pressure
bandaging should apply.
 No sexual activity till 3 days.
 ADVANTAGES
 An effective and permanent way to
prevent pregnancy for that couple who
did not want children.
 It does not affect sexual activity.
 More easier and less expansive then
female contraception.
 DISADVANTAGES

It does not protect against

STDs.
 Other short term risks are:
swelling , bleeding , blood
presence in the semen and
infection
 COMPLICATIONS

Bleeding and bruising.

 Infection at the site.
 Sperm leaking from a vas
deferens into the tissue around it
& forming a small lump.
 NURSES ROLE
Asses the patient carefully.
 Note if any complication seen.
 Some times the sedation and pain will
be feels after operation so analgesics
can be given.
 Advice them about next 7 days of life
style changes.
CONCLUSION