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More than one hundred different types of operations can be used to achieve female sterilization. Almost all block the Fallopian tubes to prevent the union of sperm and egg. Tubal ligation (tying the tubes) is rarely done by itself today, since it is not as effective as other methods that also cut, clip, or otherwise block the tubes. Many of these operations are still called "tubal ligation" even though more is done.

Tubal ligation is frequently achieved by using a laparoscope, a tubelike instrument with lights and a viewer that is inserted through the abdominal wall. The tubes are cut and cauterized (burned) through this instrument. If laparoscopy can be done through the naval, no scar is visible; as only a one-inch incision is required for this operation, it is often called "band aid sterilization." A similar instrument can be inserted through the back end of the vagina or through the vagina and uterus to perform a tubal ligation.

Laparotomy, an operation involving a four-or five-inch incision through the abdomen, can also be used to perform a tubal ligation. It is rarely used for sterilization unless there is another reason for abdominal surgery, a technical difficulty, or a danger to the woman because of a medical problem, female sterilization also results from hysterectomy (removal of the uterus) or ovariectomy (removal of the ovaries), but these operations are generally done for other reasons with sterility occurring as a by-product.

Female sterilization by most techniques offers almost foolproof protection against pregnancy. In rare instances, the cut ends of the tubes may rejoin, leading to a pregnancy, but the most common cause for "method failure" is when the woman is already pregnant (but no one knows it) when the operation is done. Side effects are infrequent (less than 5 percent) and are usually limited to the first few days after surgery, when infection or bleeding may be a problem.

Most women have no sexual difficulties after sterilization, which affects neither their hormones (since their ovaries are intact) nor their sexual anatomy. A few women may run into problems. If a woman undergoes sterilization involuntarily (e.g., if it was a decision she was pushed into by her husband or by health or economic circumstances), she may develop a reduced interest in sex for psychological reasons. Some women find that after sterilization they no longer feel the same way about sex (or have lowered sexual responsiveness) because they feel

"incomplete" or "less than a woman." This reaction is particularly possible in a woman whose religious background considers sex unnatural or sinful if it is separated from its reproductive potential. On the other hand, some women show increased sexual interest after sterilization due to no longer fearing pregnancy.


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