Asociación entre la esterilización quirúrgica y la disfunción sexual femenina: revisión narrativa / Association between tubal sterilization and female sexual dysfunction: narrative review

Resumen OBJETIVO: Revisar el estado actual del conocimiento acerca de la asociación entre la esterilización quirúrgica femenina y la disfunción sexual en la mujer. METODOLOGIA: Estudio retrospectivo efectuado con base en la búsqueda bibliográfica de artículos publicados en inglés y español en las bases de datos de PubMed, LILACS, MEDLINE y EBSCO entre los años 1990 y 2022. Se seleccionaron artículos con estudios de cohorte, observacionales, casos y controles, revisiones bibliográficas sistemáticas, ensayos clínicos y metanálisis. RESULTADOS: Se obtuvieron 50 artículos de los que se excluyeron 38 por duplicidad, idioma diferente al inglés o español, sin relación con el tema específico o no estaban completos. Al final se incluyeron 12 artículos que cumplieron con los criterios para la revisión. CONCLUSIONES: La asociación entre esterilización quirúrgica y disfunción sexual femenina ha sido ampliamente discutida, pero poco estudiada. Los ensayos disponibles son observacionales efectuados en contextos socioculturales diversos, con desenlaces contradictorios y con limitaciones metodológicas. Los resultados obtenidos varían según el contexto sociocultural y el papel de la mujer en la sociedad donde se estudia, las creencias religiosas y el grado de escolaridad. Es necesario emprender más estudios con mejor calidad metodológica para establecer recomendaciones más precisas y, así, repercutir en la salud sexual de las mujeres.

Abstract OBJECTIVE: Review current status of knowledge about the association between female surgical sterilization and sexual dysfunction in women. METHODOLOGY: Retrospective study based on a literature search of articles published in English and Spanish in PubMed, LILACS, MEDLINE and EBSCO databases between 1990 and 2022. Articles with cohort, observational, case-control, systematic literature reviews, clinical trials and meta-analyses were selected. RESULTS: We obtained 50 articles of which 38 were excluded due to duplicity, language other than English or Spanish, unrelated to the specific topic or not complete. In the end, 12 articles that met the criteria for review were included. CONCLUSIONS: The association between surgical sterilization and female sexual dysfunction has been widely discussed, but little studied. The available trials are observational conducted in diverse sociocultural contexts, with contradictory outcomes and methodological limitations. The results obtained vary according to the sociocultural context and the role of women in the society being studied, the religious beliefs and level of schooling. More studies with better methodological quality are needed to establish more precise recommendations and thus have an impact on women's sexual health.

Results of the insertion of hysteroscopic sterilization devices in a brazilian public hospital / Resultados da inserção de dispositivos de esterilização histeroscópica em um hospital público brasileiro

Abstract Objective To evaluate the insertion of the hysteroscopic intratubal sterilization device for female sterilization concerning the technique and the feasibility. Methods Retrospective study with data collection of medical records of 904 patients who underwent device insertion between January and September 2016 in a public hospital in Rio de Janeiro (Brazil) with data analysis and descriptive statistics. Results In 85.8% of the cases, the uterine cavity was normal, and themost commonlydescribed findings upon hysteroscopy were synechiae (9.5%). The procedure lasted an average of 3.56minutes (range: 1 to 10minutes), and the pain was considered inexistent or mild in 58,6% of the cases, mild or moderate in 32,8%, and severe or agonizing in less than 1% (0.8%) of the cases, based on a verbal scale ranging from 0 to 10. The rate of successful insertions was of 85.0%, and successful tubal placement was achieved in 99.5% of the cases. There were no severe complications related to the procedure, but transient vasovagal reactions occurred in 5 women (0.6%). Conclusion Female sterilization performed by hysteroscopy is a safe, feasible, fast, and well-tolerated procedure. The rates of successful insertions and tubal placements were high. There were few and mild adverse effects during the procedure, and there were no severe complications on the short term.

Resumo Objetivo Avaliar a inserção de dispositivo intratubário de esterilização histeroscópica com relação à viabilidade e à técnica. Métodos Estudo retrospectivo com coleta de dados de prontuários das pacientes submetidas à inserção do dispositivo entre janeiro e setembro de 2016 emumhospital público do Rio de Janeiro, comanálise dos dados e realização de estatísticas descritivas. Resultados Foram incluídos 904 casos no estudo. Em 85,8% dos casos, a cavidade uterina estava normal, e os achados mais comumente descritos à histeroscopia foram as sinequias (9,5%). O tempomédio do procedimento foi de 3,56minutos (gama: de 1 a 10 minutos); a dor foi considerada de ausente a leve em 58,6% dos casos, de leve a moderada em32,8% dos casos, e de forte à pior dor possível emmenos de 1% dos casos (0,8%). A taxa de inserções bem-sucedidas foi de 85,0%, e a colocação tubária foi bemsucedida em 99,5% dos casos. Não foram identificadas complicações graves, mas reações vasovagais transitórias ocorreram em 5 mulheres (0,6%). Conclusão A esterilização feminina por histeroscopia é um procedimento seguro, viável, rápido, e bem tolerado. As taxas de inserção bem-sucedida e de colocação tubária foram altas. Houve poucos e leves efeitos colaterais durante o procedimento, e não foram observadas complicações graves no curto prazo.

Essure no Brasil: desvendando sentidos e usos sociais de um dispositivo biomédico que prometia esterilizar mulheres / Essure in Brazil: unveiling senses and social uses of a biomedical device that promised to sterilize women

Resumo Denúncias graves de efeitos colaterais sofridos por mulheres em vários países (Estados Unidos, nações da Europa e Brasil) desvelaram controvérsias na difusão de um dispositivo permanente para controle reprodutivo, designado Essure, pelo laboratório farmacêutico Bayer. Este trabalho busca compreender a circulação internacional e a introdução desse artefato biomédico no Brasil, a partir de pesquisa documental em sites de agências regulatórias, do laboratório farmacêutico e da divulgação pública feita por hospitais no país, associados ao Sistema Único de Saúde, para convocarem mulheres para o procedimento. Trata-se de primeira aproximação ao tema para se inquirir sobre as condições sociais da implantação do dispositivo em usuárias desses serviços de saúde no período em que ele esteve disponível no país, de 2009 a 2017. Apresentado como um dispositivo seguro, inócuo e de fácil manejo clínico, a promessa de um objeto permanente que impediria a gravidez sem necessidade de recorrer ao método cirúrgico foi vendida pela Bayer ao staff médico como solução simples, prática e moderna de controle reprodutivo. O percurso do dispositivo no Brasil evidencia certo entusiasmo médico com a nova técnica, não acompanhado de monitoramento clínico de longo prazo, principalmente quando as mulheres passaram a demandar a sua retirada em razão de muitas sequelas e efeitos colaterais dele decorrentes.

Abstract Recently, there have been serious reports of side effects suffered by women in various countries (United States, European countries and Brazil), revealing controversies surrounding Bayer's widespread use of a permanent reproductive control device over the last decade: Essure. This article analyzes the international circulation and the introduction of this biomedical artifact in Brazil. This documentary research investigated websites of regulatory agencies, the aforementioned pharmaceutical laboratory, public disclosure made by hospitals in the country, associated with the Brazilian National Health System. This is the first approach to the subject that questions the social conditions of the implementation of Essure in users of these health services when it was available in the country, from 2009 until 2017. This permanent contraceptive method was presented as a safe and easy-to-use clinical management device. The promise of a permanent object that would prevent pregnancy without surgery was sold by Bayer to medical staff as a simple, practical and modern reproductive control solution. Its circulation in Brazil shows medical enthusiasm for the new technique, which was not accompanied by long-term clinical monitoring, even as women began to demand its withdrawal due to the many sequelae and resulting side effects.

Clinical study of factors affecting outcome of tubal recanalization using microsurgical techniques: a retrospective study

Background: In India, many couples complete their families by the age of 25 to 30 years and opt for tubal sterilization as a method of family planning in spite of availability of other spacing methods. Due to unforeseen circumstances, 10 % of them regret their decision and about 1% want to restore their fertility due to various reasons like loss of only child, loss of male child, desire to have more children, loss of children in natural calamities, remarriage and other socioeconomic factors. The objective of the present study was to analyze various factors which are involved in pregnancy rate in tubal recanalization.Methods: 31 women undergoing microsurgical tubal recanalization by mini laparotomy in RRMCH, Bengaluru during a study period of 2 year from 2014 -2016 were followed up for a period of 2 years by telephonic conversation.Results: An overall 67.7 % pregnancy rate was achieved with microsurgery technique.Conclusions: The important factors determining the success of operation were age of the patient, method of previous ligation and the remaining length of tube after recanalization. The microsurgical technique should be available at specialized centres to improve the success of family planning services and also this could be the hope for hopeless.

Clinical indications for recanalization following tubal sterilization / 中国实用妇科与产科杂志

For women planning pregnancy after tubalsterilization,they have to choose tubal recanalization or vitro fertilization(IVF).The important factors fordetermining the successful pregnancy after recanali-zation are the age of patient,the remaining length oftube,the type of sterilization initially performed and thetechnique of tubal recanalization.For women 40 years whoare with electrocoagulation as the method of steriliza-tion,they are suitable for IVF.Nevertheless,for the restones,there is no evidence showing which strategy islikely to be more effective.

Esterilização tubária histeroscópica: uma atualização sobre o dispositivo Essure® / Hysteroscopic tubal sterilization: update on the Essure® device

No intuito de oferecer para a laqueadura tubária uma alternativa menos invasiva e com menos complicações, foi desenvolvido o dispositivo Essure®, aplicado ao método da esterilização histeroscópica, além de ter utilidade nos quadros de hidrossalpinge com indicação de fertilização in vitro (FIV). Este artigo, por meio de uma revisão de literatura, teve como objetivo reunir dados acerca do uso do Essure®, incluindo resultados obtidos com o dispositivo, bem como comparações em diversos aspectos com outras metodologias de esterilização. Foram utilizados os bancos de dados PubMed, Lilacs e Scielo, no período entre 1970 e 2016. Foram pesquisados os termos "hysteroscopic contraception"; "Essure"; "definitive tubal sterilization; "sterilization"; "contraception". A literatura demonstrou se tratar de um dispositivo de fácil e rápida inserção, e com bons resultados para anticoncepção. Porém, devido a complicações como perfuração tubária, implante peritoneal e aborto, bem como para avaliar seu custo financeiro ao sistema de Saúde, mais estudos prospectivos são necessários.(AU)

In order to provide a less invasive and harmful technique compared to the tubal ligation, the Essure® device was developed, applied to the hysteroscopic sterilization method. It is also used in cases of hydrosalpinus and indication of in vitro fertilization (IVF). This article, through a literature review, aimed to gather data about the use of Essure®, including results obtained with the device, comparing different aspects with other methods of sterilization. For this purpose, PubMed, Lilacs and Scielo databases were used, with results from 1970 to 2016. The keywords searched were "hysteroscopic contraception", "Essure", "definitive tubal sterilization". The literature has shown that it is a quickly and easily inserted device with good results for contraception. However, due to complications such as tubal perforation, peritoneal implantation and abortion, as well as to evaluate its financial cost to the health system, more prospective studies are needed.(AU)

O fio cirúrgico da laqueadura é tão pesado!: laqueadura e novas tecnologias reprodutivas / The surgical thread used in tubal sterilization is so heavy!: tubal sterilization and new reproductive technologies

A laqueadura é um método de esterilização cirúrgica feminina, que consiste em cortar cirurgicamente as trompas, que unem os ovários ao útero. É um método considerado seguro, irreversível, cujas taxas dobraram desde 2003, no contexto brasileiro. O presente estudo é pesquisa qualitativa com o objetivo de descrever e analisar os pensamentos e as avaliações acerca da laqueadura entre as mulheres que buscavam auxílio das novas tecnologias reprodutivas para conceber novamente. As entrevistas foram realizadas em um hospital da rede pública de saúde, na região Sudeste do Brasil, São Paulo, com 16 mulheres esterilizadas. Como resultados, as seguintes temáticas emergiram do estudo: o não cuidado com a vida reprodutiva; laqueadura e habitus; e o arrependimento traduzido pela frase proferida por Rosa: “O fio cirúrgico da laqueadura é tão pesado!”. O estudo desvelou a necessidade de que as mulheres sejam mais bem informadas sobre os procedimentos cirúrgicos que desejam aceder: seja à laqueadura, seja a tratamentos na área das novas tecnologias reprodutivas. O acesso às informações pode promover melhor familiaridade com os termos e mais segurança ante as escolhas.

Tubal sterilization is a method of female sterilization, consisting of the surgical severance of the fallopian tubes which connect the ovaries to the uterus. This method, the rates for which have doubled in Brazil since 2003, is considered safe and irreversible. This study is a qualitative research project which seeks to describe and analyze the thought process and assessment of sterilization by women who have subsequently sought the help of new reproductive technologies to enable them to conceive. Sixteen sterilized women were interviewed at a hospital within the public health system in São Paulo, southeastern Brazil. As a result, the following themes emerged from the study: women’s lack of care regarding their reproductive life; sterilization and (constitution) habitus, and the remorse expressed in the phrase proffered by Rosa: “The surgical thread used in tubal sterilization is so heavy!” The study highlighted the need for women to be better informed about the surgical procedures available to them: whether about tubal ligation or about treatments in the field of new reproductive technology. Access to this information can promote greater understanding of the terms and greater confidence in dealing with the choices involved.

Oclusión tubárica bilateral relacionada a dispareunia / Fallopian tube occlusion and dispareunia

La dispareunia (dolor durante o después de la relación sexual) tiene una etiología multifactorial y multisistémica; se presenta hasta en un 45% de las mujeres que han dado a luz. La oclusión tubárica bilateral (OTB) es uno de los métodos más utilizados en planificación familiar en México y en el mundo; debido a que toda cirugía implica la formación de una cicatriz -y por tanto dolor-, es lógico pensar en problemas ginecológicos en general como efectos colaterales de este procedimiento, aunado al hecho de que la OTB puede afectar las ramas terminales de las arterias uterina y ovárica, además de la sección de fibras nerviosas. El objetivo de esta investigación es evaluar la existencia de dispareunia en mujeres como posible consecuencia de la OTB. Se analizaron los resultados obtenidos del interrogatorio a todas las pacientes que acudieron al Laboratorio de Biología Celular del programa de Detección Oportuna de Cáncer (DOC) del 2001 al 2008. De un total de 921 pacientes, 287 fueron sometidas a OTB; de ellas, 45 mujeres (15.7%) refirieron presentar dispareunia. La dispareunia de acuerdo con nuestro estudio tiene una incidencia muy baja en pacientes con OTB, por lo que es posible que no represente un efecto colateral de este procedimiento.

Dyspareunia (pain during or after sexual intercourse) has a multifactorial and multisystemic etiology, occurring in up to 45% of the women who have given birth. Bilateral tubal occlusion is one of the top methods in family planning in Mexico and in the world; because all surgery involves the formation of a scar and therefore pain and so the fact that Bilateral tubal occlusion can affect the terminal branches of the uterine and ovarian arteries in addition to the section of nerve fibers, it's possible to think of general gynecological problems as side effects of this procedure. The objective of this research is to evaluate the existence of dyspareunia in women as a possible consequence of the Bilateral tubal occlusion. We analyzed the results of the questioning of all patients who attended the Laboratorio de Biología Celular to the program Early Detection of Cancer from 2001 to 2008. From a total of 921 patients, 287 were submitted to bilateral tubal occlusion, of whom 45 women (15.7%) reported dyspareunia. According to our study dyspareunia has a very low incidence in patients with bilateral tubal occlusion and therefore may not represent a side effect of this procedure.

Esterilización tubaria transvaginal: serie de casos / Transvaginal tubal sterilization

Antecedentes: La esterilización tubaria transvaginal, es una forma de abordar la esterilización quirúrgica, en la actualidad poco popularizada. Objetivo: Evaluar la colpotomía posterior como vía para la esterilización tubaria. Método: Análisis de 100 fichas clínicas de mujeres multíparas en estado no puerperal, a solicitud voluntaria de esterilización. Resultados: Hubo un 3 por ciento de complicaciones. Conversiones en el 4 por ciento y un tiempo operatorio promedio de 25,2 minutos. Conclusión: La colpotomía posterior es una buena alternativa quirúrgica para efectuar la esterilización tubaria, con baja morbilidad.

Background: Transvaginal tubal sterilization is a way for surgical sterilization, that currently is not widely used. Objective: To evaluate the posterior colpotomy as a pathway for tubal sterilization. Method: Analysis of 100 medical records of multiparous women non puerperal state, who request voluntary sterilization. Results: There were 3 percent of complications, 4 percent of conversions and a mean operative time of 25.2 minutes. Conclusion: The posterior colpotomy is a good surgical alternative to perform tubal sterilization with low morbidity and cost.

Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil / Fatores de risco para o arrependimento da laqueadura tubária: resultados de um estudo de caso-controle em Pernambuco, Brasil

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Um estudo do tipo caso controle foi conduzido em um hospital público de ensino no Recife, Pernambuco, Brasil, em 1997, para investigar os fatores de risco para o arrependimento da realização da laqueadura tubária, comparando mulheres laqueadas que solicitaram ou realizaram a reversão da laqueadura tubária com mulheres também laqueadas que não solicitaram e não se submeteram a esta cirurgia. As mulheres que mostraram uma maior probabilidade de arrependimento foram as esterilizadas quando jovens, as que não foram responsáveis pela decisão da cirurgia, as que realizaram a esterilização até o 45º dia pós-parto e as que adquiriram informações sobre métodos contraceptivos depois da laqueadura tubária. Morte de filhos, parceiros sem filhos anteriores à união atual e a mudança de parceiro após a laqueadura tubária também estiveram associados com a solicitação ou realização de reversão da laqueadura. Deve-se avaliar o perfil psicológico e sócio-demográfico das mulheres e seus motivos para solicitar a laqueadura tubária e aconselhá-las para o planejamento familiar a fim de reduzir os riscos de arrependimento futuro.

Atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas, São Paulo, Brasil: percepção de gestores e profissionais dos serviços públicos de saúde / Provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil: perceptions of public health services managers and professionals

A presente pesquisa descreve a percepção de gestores e profissionais de serviços públicos de saúde de municípios da Região Metropolitana de Campinas, São Paulo, Brasil, acerca do atendimento à demanda pela esterilização cirúrgica voluntária. Trata-se de estudo qualitativo, em quatro municípios, onde se realizaram entrevistas semi-estruturadas com 26 gestores e profissionais de saúde envolvidos no atendimento às solicitações de esterilização cirúrgica. Apontaram-se dificuldades para agendamento de consultas nos ambulatórios de planejamento familiar ou centros de referência e número insuficiente de cirurgias que podiam ser agendadas semanalmente nos hospitais credenciados. Enfatizou-se a falta de estrutura física e recursos humanos tanto nas unidades básicas de saúde, quanto nos ambulatórios de planejamento familiar ou centros de referência. Houve críticas aos critérios legais para autorizar a esterilização, bem como se mencionaram adaptações para torná-los mais adequados à situação de cada município. Gestores e profissionais de saúde entendiam que, apesar dos esforços empenhados, o atendimento à demanda pela esterilização cirúrgica na Região Metropolitana de Campinas estava prejudicado pela centralização em ambulatórios de planejamento familiar ou centros de referência, que, na prática, tinham que suprir as deficiências da oferta de ações de planejamento familiar em geral na rede básica de cada município.

This study describes the perceptions of public health services managers and professionals concerning provision of voluntary surgical sterilization in the Campinas Metropolitan Area, São Paulo State, Brazil. The study adopted a qualitative approach in four municipalities (counties), where semi-structured interviews were conducted with 26 health professionals and health services managers involved in the provision of surgical sterilization. The interviewees identified difficulties in scheduling visits at Outpatient Family Clinics or Reference Centers (APF/CR), and the number of available surgeries in the accredited hospitals was insufficient. They emphasized the lack of physical infrastructure and human resources for conducting family planning activities in the primary health units as well as in the APF/CR.They also criticized the legal criteria for authorizing surgical sterilization, and mentioned adaptations to make them more appropriate to the each municipality's situation. According to the health services managers and professionals, despite the efforts, meeting the demand for surgical sterilization in the Campinas Metropolitan Area was jeopardized by its centralization in the APF/CR, which in practice had to cover the gap in family planning activities in each municipality's primary care units.

Esterilización tubaria por culdotomía: serie de casos / Tubal sterilization by colpotomy: case series

ANTECEDENTES: La culdotomía como vía de acceso para realizar esterilización tubaria aparece como una alternativa simple y segura. OBJETIVO: Evaluar esta técnica en mujeres que solicitan esterilización tubaria. MÉTODO: Esterilización tubaria por culdotomía en 75 multíparas. RESULTADOS: El tiempo quirúrgico promedio fue 27,2 minutos. No hubo complicaciones durante la cirugía. En 5 casos (6,6%) la culdotomía se convirtió a laparotomía porque no se identificó una o ambas trompas. CONCLUSIÓN: Técnica segura, de bajo costo y con buena satisfacción de usuaria.

BACKGROUND: Culdotomy as access way for tubal sterilization appear like a simple and safe alternative. OBJECTIVE: To evaluate this technique in women who demand for tubal sterilization. METHOD: Tubal sterilization by culdotomy in 75 multiparous women. RESULTS: The average surgical time was 27.2 minutes. There were no complications during the surgery. In 5 cases (6.6%) the culdotomy was converted to laparotomy because one or both tubes were not identified. CONCLUSION: Culdotomy is a safe technique, of low cost and with good user satisfaction.

Significado da laqueadura tubária para moradoras de vilas populares de Porto Alegre / The significance of tubal ligation for people living in low-end neighborhoods in Porto Alegre / Significado de la ligadura para mujeres que viven en los barrios populares de Porto Alegre

O acesso aos serviços de saúde nos diversos segmentos sociais faz aumentar a procura por métodos que assegurem uma contracepção sem falhas. Nesse sentido, aumentou a procura pela laqueadura tubária (LT) por mulheres maiores de 25 anos e de nível educacional menor. Trata-se de um estudo exploratório descritivo com abordagem qualitativa que tem por objetivos: conhecer o significado da laqueadura tubária entre mulheres esterilizadas da Vila Pinto/Porto Alegre; compreender os motivos da escolha deste método e descobrir se ocorrem mudanças no relacionamento sexual após o procedimento cirúrgico. As participantes do estudo são doze mulheres que se submeteram a LT no período de julho de 2002 a junho de 2003. A coleta das informações foi por entrevista semi-estruturada. Os relatos foram submetidos a análise de conteúdo de onde emergiram três temas: Decisão pela laqueadura tubária; Realização da laqueadura tubária e Vivências após a laqueadura tubária.

Health care access in the several social strata increases the demand for methods that ensure unflawed contraception. In this sense, the demand for tubal ligation by women older than 25 and with little schooling has increased. It is an exploratory and descriptive study with a qualitative approach aiming at: getting to know the significance of tubal ligation among sterilized women in the Vila Pinto, Porto Alegre; understanding the reasons for choosing this method and; finding out whether this surgical procedure entails any changes in sexual relationship. The participants in the study are 12 women who undertook tubal ligation within the period from July 2002 to June 2003. Data collection occurred by means of a semi-structured interview. The contents of the reports were analysed, wherefrom three topics emerged: decision to have tubal ligation; occurrence of tubal ligation and; experiences after tubal ligation.

El acceso a los servicios de salud en los diversos estamentos sociales hace aumentar la búsqueda de métodos que aseguren una contraconcepción sin fallas. En este sentido, aumentó la opción por la ligadura de las Trompas (LT) en las mujeres mayores de 25 años y con nivel educativo más bajo. Este estudio de tipo exploratorio descriptivo y enfoque cualitativo tiene como objetivos: conocer el significado de la ligadura entre mujeres esterilizadas del barrio Vila Pinto en Porto Alegre; comprender los motivos de haber optado por este método y descubrir si ocurren cambios en la relación sexual, después del procedimiento quirúrgico. Las participantes del estudio fueron doce mujeres que se habían hecho la LT, a partir de julio de 2002 hasta junio de 2003. Se recogieron las informaciones mediante entrevista semiestructurada. Los relatos se sometieron al análisis de contenido y se obtuvieron tres temas: Decisión por la ligadura; Realización de la ligadura de las trompas y Vivencias tras la ligadura.

O processo de tomada de decisão na laqueadura tubária / The decision making process in tubal sterilization / El proceso de toma de decisión en la ligadurade trompas

Nesta investigação qualitativa, o objetivo foi o de verificar como a equipe de saúde operacionaliza a tomada de decisão acerca da laqueadura tubária. Utilizamos a dialética marxista e as representações sociais como referenciais. A pesquisa constou de entrevistas e observações de algumas atividades dos agentes da equipe de saúde. Os dados foram submetidos à análise de discurso. Verificamos que no processo de tomada de decisão ocorre uma tendência à horizontalidade da equipe, dada a importância da dimensão ética da esterilização feminina, que tende a deslocar o conhecimento do campo científico biomédico para o campo das ciências sociais humanas.

The objective of this qualitative investigation was to verify how the team makes decisions about tubal sterilization. We used Marxist dialectics and social representation as our references.We held interviews and observed some activities of agents from the health team. The information was submitted to discourse analysis. We found that in the decision making process there is atendency for the team to operate more horizontally, because of the importance of the ethical dimension of sterilization of women, which tends to dislocate knowledge from the field of biomedical and scientific to the field of social and human sciences.

El objeto de la presente investigación cualitativa fue verificar cómo se comporta el equipo durante el proceso de tomade decisión de una ligadura de trompas. Como referenciales utilizamos la dialéctica marxista y las representaciones sociales. Se realizaron entrevistas y observaciones de algunas actividades de los agentes del equipo de salud. Los datos fueron sometidos al análisis del discurso. Observamos que durante el proceso de toma de decisión el equipo tiende hacia una postura horizontal. Esto se debe a la importancia del problema ético de la esterilización femenina, que tiende adesplazar el conocimiento del campo científico biomédico para el campo de las ciencias sociales y humanas.

Comparison of pain during postpartum tubal sterilization between patient premedicated with intramuscular morphine and sublingual buprenorphine.

A randomized double blind clinical trial was carried out at Siriraj Hospital in order to compare pain level during postpartum tubal sterilization between patient premedicated with intramuscular morphine and sublingual buprenorphine. Eighty postpartum women were randomly assigned to one of the two studied groups. The first group was premedicated with intramuscular morphine and oral placebo, the other received sublingual buprenorphine and intramuscular tetanus toxoid. Recorded pain level in abdominal cavity at 5 minutes before drug administration, 30 minutes after drug administration and immediately after surgery. AII side effects were observed, recorded and compared between two groups. There were no significant differences between two groups in the pain relief in postpartum tubal sterilization. Major side effects are nuasea, vomiting and dizziness. Sublingual buprenorphine can be used as a premedication in a normal postpartum women who plan to receive postpartum tubal sterilization instead of intramuscular morphine.

Microsurgical Reversal of Tubal Sterilization :A Report on 1,118 Cases / 대한산부인과학회잡지

This study was performed to review and evaluate a series of 1,118 patients who und-erwent microsurgical reanastomosis of previously sterilized fallopian tubes in the 134-month span encompassing January, 1980 to Febrary, 1991 at Seoul National University Hospital. Clinical characteristics of patients, pregnancy rates, and factors influencing the outcome of microsurgical tubal reversal were analyzed. Of 1,118 patients, 633(56.6%) had been sterilized by laparoscopic cautery. Loss of ch- ildren was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. The postoperative tubal length was 6 cm or more in 76.0%. Nine hundred and twenty-two(82.5%) patients were followed up for more than 5 years. Overall pregnancy rate after microsurgical tubal reanastomosis was 54.8%(505 /922) with delivery rate of 71.5%(418/585), and the estimated anatomical success rate was 88.2%(814/922). In 505 pregnant cases, mean age of patients was younger and postoperati- ve tubal length was longer with statistical significance compared with 417 nonpregnant cases. Pregnancy rate was significantly correlated with postoperative tubal length, but not with method and duration of sterilization or operative procedure. These data suggest that only the postoperative tubal length is a factor influencing si- gnificantly pregnancy rate after microsurgical reversal of tubal sterilization.

Clinical Study for the Pregnancy Rate following Microsurgical Tubal Reversal / 대한산부인과학회잡지

From Jan. 1991 to Apr. 1996, 99 cases of microsurgical tubal reversal were performed in the Department of Obstetrics and Gynecology, Chunchon Sacred Heart Hospital of Hallym University. 80 cases among them were followed up over 1 year postoperatively. The results were as follows : 1. The mean age of total 99 women was 32.5 years(24~42 years), and the average interval between tubal sterilization and tubal reversal was 7.2 years(1~17 years). 2. The methods of sterilization were laparoscopic fallope ring in 59 cases(59.6 %), laparoscopic electrocautery in 30 cases(30.3 %), tubal ligation during cesarean section in 9 cases(9.1 %) and minilap in 1 case. 3. The most common reason for tubal reversal was remarriage(61 case, 61.6 %) and the next was desire for son(16 cases, 16.2 %). 4. 80 cases(81 %) among the total 99 women were followed up over 1 year postoperatively. Intrauterine pregnancy was documented in 59 cases(73.7 %), 53 viable fetuses and 6 spontaneous abortions. Ectopic pregnancy was noted in 3 cases(3.8 %). 5. Pregnancy rates according to maternal age were as follows ; 88.9 % in less than 30 years, 70.3 % in 30~34 years, 71.4 % in 35~39 years. Two normal pregnancies were resulted from 4 women over 39 years. 6. Pregnancy rates according to the method of sterilization were as follows ; 78 % in fallope ring, 89 % in tubal ligation during cesarean section, 55 % in electrocautery. The statistical differences between each groups were not significant(p = 0.053). 7. Pregnancy rates according to the site of anastomosis were as follows ; 81.4 % in isthmicisthmic, 67.1 % in isthmic-ampulla. There was significant statistical difference between them(p = 0.011). 8. Pregnancy rates according to the postoperative tubal length were as follows ; 60 % in less than 4cm, 66 % in 4~6 cm, 95.4 % in more than 6cm(p = 0.024). 9. Among the 59 pregnant women, 38 pregnancies(65.4 %) were resulted within six months after surgery, 48(82.3 %) within one year, and 55(94.2 %) within 2 years. 10. Pregnancy rates according to the interval from tubal sterilization to tubal reversal were as follows ; 89.6 % in less than 5years of interval, 74.5 % in 5~10 years, 44.4 % in 11~15 years(p = 0.230).