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Recommendations for Contraceptive Use

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Female Sterilization


Classification of Selected Procedures for Female Sterilization

Procedure Class Class Rationale
  General Anesthesia Local Anesthesia  
Pelvic examination (speculum and bimanual) A A A pelvic exam is required to assess the size, position and mobility of the uterus prior to surgery.
Blood pressure A B Hypertension increases the anesthesia risks associated with female sterilization procedures. Postural hypotension increases the risk of the procedure1.
Breast examination C C A breast exam is not necessary to ensure a safe female sterilization procedure.
Sexually transmitted disease (STD) screening by lab tests (for asymptomatic persons) C C STD screening by lab tests is not necessary for a female sterilization.
Cervical cancer screening C C Cervical cancer screening is unrelated to the female sterilization procedure.
Routine, mandatory lab tests (e.g., cholesterol, glucose, liver function tests) C C Cholesterol levels, glucose levels and liver function do not affect the female sterilization procedure.
Hemoglobin level testing B B
  • A hemoglobin level is recommended before female sterilization. If a woman has symptomatic anemia, delay the procedure and treat the anemia1.
  • If hemoglobin testing cannot be done, clinical assessment of anemia is satisfactory, particularly when using local anesthesia with light sedation.
Urine sugar testing B B Undetected diabetes may delay wound healing or increase risk of post-operative infection1.
Proper infection prevention procedures A A Proper infection prevention procedures are important to minimize the risk of infection to clients and providers.
Specific counseling points for female sterilization:
  • irreversibility of method
  • efficacy
  • common side effects
  • signs and symptoms for which to see a health provider
  • STD protection (when/as appropriate)
  • pre-operation instructions
  • recovery/post-operation instructions
A A
  • Proper counseling is important to ensure informed consent prior to having a sterilization operation.
  • Proper counseling may also minimize future regret.
  • Female sterilization should be considered a permanent contraceptive method.

KEY:

Class A = essential and mandatory or otherwise important in all circumstances, for safe and effective use of the contraceptive method

Class B = medically/epidemiologically rational in some circumstances to optimize the safe and effective use of the contraceptive method, but may not be appropriate for all clients in all settings

Class C = may be appropriate for good preventive health care, but not materially related to safe and effective use of the contraceptive method

Class D = not materially related to either good routine preventive health care or to the safe and effective use of the contraceptive method

Citations for Procedures Table:

  1. World Health Organization. Improving access to quality care in family planning: medical eligibility criteria for contraceptive use. Geneva: WHO, 1996.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.


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