PocketGuide: Client Assessment - Guidelines for Voluntary Sterilization

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Client Assessment

Guidelines for Voluntary Sterilization

Female Voluntary Sterilization Guidelines | Male Voluntary Sterilization Guidelines

Voluntary sterilization procedures, including minilaparotomy and laparoscopy, generally can be provided safely in ambulatory health care facilities. The guidelines presented in the following tables are intended for use in selecting healthy clients who can have a VS procedure in an ambulatory health care facility (see Voluntary Sterilization chapter for details). Not acceptable indicates that the procedure probably should be performed in a facility where additional assistance and backup services are available (e.g., more experienced physician). It does not relate to the appropriateness of the client's decision to undergo VS.

Note: A successful VS program in an ambulatory facility depends on clinicians and staff who are trained and confident working with awake or lightly sedated clients.

Table 3. Female Voluntary Sterilization Guidelines

CATEGORY	SELECTION CRITERIA
CATEGORY	Acceptable	Not Acceptable
General health (assessed by history and limited physical examination)	Normal history and no current symptomatic heart, lung or kidney disease	Uncontrolled diabetes or history of bleeding disorder; current symptomatic heart, lung or kidney disease, etc.
Emotional state	Calm	Unresolved fear or anxiety
Blood pressure	< 160/100 mm/Hg	> 160/100 mm/Hg
Weight	Maximum weight: 80 kg (176 lb) Minimum weight: 35 kg (77 lb)	> 80 kg < 35 kg
Previous abdominal/pelvic surgery	Cesarean sections—only if mobile abdominal scar and normal pelvic examination	Other abdominal surgery, fixed scar or abnormal pelvic examination
Previous pelvic disease (PID, ectopic pregnancy) or ruptured appendix	No history and normal abdominal/pelvic examination	Abnormal abdominal/pelvic examination
Anemia^a	Hemoglobin > 7 g/dl	Hemoglobin < 7 g/dl

^a WHO eligibility criteria recommend caution in performing voluntary sterilization if hemoglobin is 7–10. (The procedure is normally conducted in a routine setting, but with extra preparation and precautions.)

Table 4. Male Voluntary Sterilization Guidelines

CATEGORY	SELECTION CRITERIA
CATEGORY	Acceptable	Not Acceptable
General health (assessed by history and limited physical examination)	Normal history and no current symptomatic heart, lung or kidney disease	Uncontrolled diabetes or history of bleeding disorder; current symptomatic heart, lung or kidney disease, etc.
Emotional state	Calm	Unresolved fear and anxiety
Blood pressure	< 160/100 mm/Hg	> 160/100 mm/Hg
Scrotal/inguinal infection or abnormalities (undescended testes, hernia)	Normal examination	Infection of scrotal or inguinal area, infection of foreskin or anatomic abnormalities
Anemia^a	Hemoglobin > 7 g/dl	Hemoglobin < 7 g/dl

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