From Big Medical Encyclopedia

STERILIZATION SEXUAL (Latin sterilis sterile) — impact on a human body or an animal for the purpose of deprivation of ability of reproduction of posterity at preservation of endocrine function of gonads. The page of the item should be distinguished from castrations (see), at a cut also endocrine function of gonads is switched off.

For the first time S. the item as the method interfering transfer to posterity inherited patol. signs, it was applied in 1907 in the USA. S. was made by the item of especially dangerous criminals recidivists, the persons having incurable mental diseases, and also sexual perversions. Law on G. the item was accepted in the USA in 1927 and officially approved in many states in 1934. Laws on S. of the item were adopted also in Switzerland (1922), Denmark (1928), Norway (1934), Sweden and Finland (1935). Especially ugly forms adopted the law on violent S. of the item adopted in fascist Germany in July, 1933 and which became effective since January 1, 1934. According to the first paragraph of this law of violent S. of the item persons with inborn weak-mindedness, schizophrenia, maniac-depressive psychosis, hereditary epilepsy, a chorea, a hereditary blindness, hereditary deafness, heavy hereditary corporal uglinesses, heavy alcoholism had to be exposed; also criminals recidivists were subject to forced sterilization. This law which is formally directed to «biological improvement» of the German race in the conditions of fascist terror was used against political opponents.

In the Soviet Union the item is carried out by S. only with the consent of the patient, according to strict medical indications. At men it is applied only for prevention of inflammatory diseases of gonads and epididymes at operational treatment of adenoma prostate (see). The page of the item of women in a crust, time has no practical value in connection with a big arsenal of effective contraceptives (see) it is also applied only at contraindications to their use.

Beam S. of the item (impact on gonads of x-ray or other type of ionizing radiation), in addition to sharp oppression of processes spermatogenesis (see), leads to considerable disorders of endocrine function of gonads therefore beam S. is practically not used by the item. In clinic the operational method C. of the item is applied. The purpose of operations — to create in seminiferous ways an obstacle for advance spermatozoa (see) and to exclude a possibility of their penetration into an ejaculate (see. Sperm ). It turned out that for this purpose it is not enough to tie up and separate the ends of a deferent duct since its passability can be recovered. Due to the danger of damage of blood vessels seed cord (see) and subsequent atrophy small egg (see) also the technique of mechanical transdermal crush of a deferent duct did not gain recognition. The greatest distribution was gained by the sexual sterilization which is carried out by a bilateral resection deferent duct (see). After a section of a scrotum the deferent duct is separated from a seed cord, the part of the canal (2 — 3 cm) is resected, and the ends tie up. Having carried out a careful hemostasis, the wound is taken in tightly. In the postoperative period to the patient within 2 — 3 days appoint a bed rest, preventively antibiotics, apply suspenzoriya (see).

After S. of the item the ejaculate consists of a secret of a prostate (see) and a seed bubble (see); within 10 — 12 days (sometimes up to 2 months) in it the spermatozoa which were before operation in an ampoule of a deferent duct and partially in seed bubbles can be found. Therefore in the first 2 months after operation recommend to use contraceptives and to periodically control structure of an ejaculate. At correctly carried out (without damage of blood vessels) S. the item of jumps in a parenchyma of a small egg does not come. The biopsy of testicles made in 16 — 20 years after a bilateral resection of deferent ducts confirms existence of an active spermatogenesis with all stages and presence of mature forms at gleams of tubules of testicles and appendages. Change of endocrine function of testicles is not observed. Sometimes even its strengthening takes place that is shown by improvement of the general state, strengthening of a libido and potentiality. However in some cases the spermatogenesis is oppressed, in testicles fibrosis develops, and in the subsequent mental disorders in the form of depressions are possible.

At S. women of the item more often is not independent intervention, and it is made during operation, napr, apropos extrauterine pregnancy (see), prolapses of the uterus, vaginas (see), at Cesarean section (see). Operational methods C. of the item in ginekol. practice can divide into 4 groups: operative measures on a vagina, a uterus, ovaries, uterine tubes. The first three groups of operations lost practical value.

For the first time simple bandaging of uterine tubes for the purpose of sexual sterilization was made by Lung-ren in 1880. However this way, as well as Flat's way at — setting of a uterine tube in a node after its preliminary cutting off from a wide ligament of a uterus, were insufficiently reliable and did not gain distribution.

Several ways of crush of a uterine tube with the subsequent its bandaging are offered. So, on Madlener's way the uterine tube was taken tweezers and raised, the formed loop with the small site of a mesentery of a uterine tube (mezosalpinksy) was crushed a clip and tied up. Vazer's modification differed in the bigger extent of the crushed site. This operation also was insufficiently reliable in connection with a possibility of education in a zone of crush of a uterine tube of the fistular courses, through to-rye the ovum could get. Ways with a section or a resection of uterine tubes are more reliable. Treat them the simple section of a uterine tube between ligatures offered in 1885 by Thomas and Kerer (F. A. Thomas, Kehrer); the section of a uterine tube in the field of an isthmus with separation of leaves of a peritoneum and immersion of the tied-up end of a uterine tube turned to a uterus in a pocket between leaves of a wide ligament of uterus offered in 1905 by R. Asch. B.C. Gruzdev in 1922 offered a section of uterine tubes with the subsequent imposing of the ends one on another, their binding and peritonization. In 1897 H. Fritsch for the first time made a resection of the site of a uterine tube between two ligatures. Rabinovich's method consists in imposing on a uterine tube of two ligatures, allocation by means of a linear section of a peritoneum of a segment 3 — 4 cm long and its resection, sewing together of leaves of a wide ligament of uterus and fixing of a stump of a uterine part of a pipe to a wall of a uterus. By Genter's method a uterine tube tie up at distance 1 — 1,5 cm from a corner of a uterus and scissors excise a part of a pipe to a uterine part; the ends of a ligature use for immersion of a stump between leaves of a peritoneum; the corner of a uterus is sewed. Efficiency of this operation depends not so much on the place of a section and size of the resected site of a uterine tube how many from care of peritonization. The way of wedge-shaped excision from corners of a uterus of uterine tubes in the field of their isthmus is good; at the same time the distal piece of a uterine tube is peritonized (Serdyukov's ways, Blagovolina) or leave open (Kiparsky's ways, Sergeyev). Braude's way is most widespread, at Krom in a mesentery of a uterine tube at distance of-2 cm from a corner of a uterus by a clip or tweezers do an opening and carry out a ligature to it. The uterine tube is tied up and crossed. The proximal end of a pipe is taken a clip and separated from a mesentery towards a uterus, cut out the wedge-shaped site from a corner of a uterus so that not to open her cavity. Edges of a uterus take in 2 — 3 catgut seams. The distal end of a uterine tube is peritonized by means of the same ligature, a cut it was tied up, one end of a ligature is spent through a round ligament of a uterus, another — through a leaf of a mesentery of a uterine tube. During the setting of a ligature the stump of a pipe is immersed under a fold of a peritoneum.

Bibliography: Braude I. L. Operational gynecology, M., 1959; Wolves H. N. Skopchestvo pi sterilization, M. — JI., 1937; And r e r Yu. M. Influence of bandaging of deferent ducts on a prostate and on a small egg, Minsk, 1927; Kagan S.A. Sterility at men, L., 1974; M about l of N and p E. The general spermatology, the lane with it., Budapest, 1969; Narubanov P. G. Pregnancy in a stump of a pipe, Akush. and ginek., Jsft 1, page 106, 1 962; Rembez I. N. Operational gynecology, Kiev, 1966; With t and-f e e in and E. N. Vozmozhnost of approach of pregnancy after surgical sterilization, Akush. and ginek., No. 7, page 60, 1976; P i 1 I i p s J. o. Laparoscopic procedures, J. reprod. Med., v. 18, p. 219, 1977; Vasectomy, immunologic and pathophysiologic effects in animals and man, ed. by I. H. Lepow a. R. Croizier, N. Y., 1979.

B. H. Stepanov; H. P. Mikhaylova (gin.).