Culdoscopy and Culpotomy:
Culdoscopy and culpotomy are two types of vaginal sterilization approaches. The vaginal method of tubal ligation was once the preferred technique. However, since it is associated with higher risks than laparoscopic surgery, surgeons have been favoring the abdominal approach to transvaginal procedures.Culdoscopy and culpotomy tend to be reserved for obese patients or for women with a retroverted uterus. Both procedures involve a small incision made into vaginal wall. Research is showing that these methods are safer than originally thought. Both procedures are difficult to perform as they require a woman to be in a knee-to-chest position while under anesthesia.
Culdoscopy: An incision is made into the posterior vaginal fornix (the recess behind the cervix). A culdoscope is inserted through the incision into the peritoneal cavity (the space within the abdomen that contains the intestines, the stomach, and the liver) to locate the tubes and seal them shut.
Culpotomy: An incision is also made into the posterior vaginal fornix. The surgeon then inserts an instrument through the incision into the peritoneal cavity to help bring the tubes out through the incision. The tubes are sealed closed and put back, and the incision is stitched shut.
These procedures each take about 15 to 30 minutes, and women are able to go home the same day.
It may take a few days at home to recover. Sexual intercourse is usually postponed until the incision is completely healed, which usually requires several weeks, and there are no visible scars.
Hysterectomy:
Hysterectomy, a procedure to remove the uterus, is considered major surgery. It is usually not used for sterilization, but it can be. A hysterectomy will end menstruation as well as the potential of pregnancy. However, it does not necessarily affect the fallopian tubes. A hysterectomy can be performed through the vagina or abdomen. A combined approach can also be used.Some medical conditions require the removal of a tube and/or ovary, on one side or both. A total hysterectomy is one which involves removal of the cervix, uterus, and the fallopian tubes -- the ovaries remain intact.
Women need to spend several days in the hospital and several weeks recovering at home. Women should not have sexual intercourse for 4 to 6 weeks after having undergone a hysterectomy.
Medical and Noncontraceptive Advantages of Tubal Ligation:
Women who have chosen a tubal ligation (performed in any of the ways mentioned) as a permanent method of birth control may attain an extra medical benefit. Researchers have shown that a tubal ligation appears to lower a woman's risk for ovarian cancer. In fact, this is a well-established protective effect; tubal ligations seem to reduce the risk of ovarian cancer by about 30%. Although the exact relationship is unknown, the two main theories suggest:- The interference with the blood supply to the ovary or some other mechanism reduces the level of hormones produced, which results in the reduced risk.
- The closing off of the fallopian tubes may, perhaps, protect the ovaries from environmental agents that could cause cancer.
Additionally, tubal ligation may lower a woman’s risk of pelvic inflammatory disease (PID).
