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3 The Use of Chemical Agents in Female Sterilization

Vasectomy is a simple technique that can readily be applied to large populations using an outpatient approach. Although it is a surgical procedure, male sterilization does not require entering the abdominal cavity and the incision and surgical manipulation are not associated with a high degree of risk. Because the procedure and the anatomy of the vas are relatively straightforward, paramedical technicians can be trained to perform vasectomies and significant numbers of male sterilizations have been performed by nonmedical teams in a number of countries. In contrast, conventional female sterilization using any of the standard surgical approaches requires abdominal entry because the fallopian tubes are located within the abdominal cavity. A woman who is in the postpartum period or is thin and cooperative can be sterilized surgically through a relatively small incision, as with laparoscopic tubal sterilization. Even in highly favorable cases using state-of-the-art technology, however, a surgeon’s skills are required in most settings because vital internal structures are close to the area being treated and may inadvertently be injured. The procedure is highly skill dependent and must be performed in a relatively protected environment. Sterilization requires of the patient only a single motivation, following which it is, in demographic terms, the most effective family planning procedure in the cafeteria of contraceptive methods. As a surgical procedure, however, it is essentially unavailable to much of the developing world, owing to an inadequate number of physicians, particularly trained surgeons, in rural areas where most of the population lives; further, the surgically trained physicians who do practice in rural areas are overwhelmed with other problems, which to them are more pressing than elective sterilization. Even in the developed countries and even with the use of new technologies, female sterilization is an expensive procedure and absorbs a significant part of the available health funds. Clearly a female sterilization procedure that is simple, inexpensive, nonmorbid, and nonsurgical would be a useful adjunct to the delivery of family planning services, particularly in the rural areas of developing countries. Investigators have made a number of attempts to develop a nonsurgical female sterilization technique using cryotherapy, electrocoagulation, mechanical plugs, the instillation of hot water, and chemical materials to produce local epithelial necrosis and fibrosis, and obliteration of the lumen through scarring. The physical methods, such as cryotherapy and silicone rubber in-