Contraceptive Update: Contraceptive Needs after Age
40
As they pass the age of 40, women and men continue to be fertile and sexually active,
and up to half of women are able to become pregnant well into their fifth decade.
Pregnancy-related health risks, however, increase substantially for this age group,
compared with younger women. The advantages and disadvantages of various contraceptive
methods, including sterilization, are discussed.
Female Sterilization Safe, Very Effective
Female sterilization is free from side effects associated with most temporary methods,
does not interfere with sexual intercourse, and does not require routine follow-up care or
prescription refills. However, because this method is permanent and requires surgery, it
is not appropriate for every women who needs contraception.
Female Sterilization Occlusion Techniques
Female sterilization prevents pregnancy by occluding or mechanically blocking the
fallopian tubes, using one of several occlusion techniques.
Vasectomy Offers Many Advantages
Despite its many advantages, vasectomy (male sterilization) is widely available in only
a few countries. While vasectomy is safe and very effective, incorrect information and
unfounded fears often limit its use, even in countries where the procedure is readily
available.
Time to Azoospermia May Be Longer than Often Assumed
Vasectomy takes weeks to become effective, since sperm remain in a man's reproductive
tract longer after the procedure. Recent small studies suggest that it may take longer
than previously thought for sperm to disappear completely.
Search for Nonsurgical Sterilization Continues
For years, scientists have worked to develop nonsurgical female and male sterilization
methods that would be inexpensive and easy to administer. While some experimental methods
are under study, none are likely to be widely available in the near future.
Counseling Encourages Voluntary Choice
Because male and female sterilizations are permanent, it is especially important to
counsel clients interested in these methods. Counseling serves many purposes, including
careful consideration by clients at risk of regretting the procedure later in life.
Opinion: Voluntary Sterilization -- Six Lessons
Learned
A review of sterilization services in more than 50 countries during the past 25 years
highlights important ways to assure quality voluntary sterilization services. Lynn
Bakamjian and Pamela Beyer Harper of AVSC International list six important lessons: focus
on the client, assure informed choice, support providers with training and other needs,
build ownership in the community, use technology that is appropriate for the setting, and
offer services within an integrated reproductive health program.
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