LAPAROSCOPIC STERILIZATION

Laparoscopy is the commonly employed method of endoscopic sterilization. It is gradually becoming more popular—especially, in the camps. The procedure is mostly done under local anesthesia. The operation is done in the interval period, concurrent with vaginal termination of pregnancy or 6 weeks following delivery. It should not be done within 6 weeks following delivery.

The procedure can be done either with single puncture or double puncture technique. The tubes are occluded either by a silastic ring (silicone rubber with 5 percent barium sulfate) devised by Fallope or by Filshie clip is made of titanium lined with silicone rubber. Only 4 mm of the tube is destroyed. Failure rate is 0.1 percent. Hulka-Clemens Spring Clip is also used. Electrosurgical methods—Dessicates the tissue by heating. Unipolar or bipolar method of tubal coagulation is used. Bipolar cautery is safer than unipolar one but it has higher failure rates (2.1 percent). Laser photocoagulation is not popular because of high recanalization rate.

Principal steps (Single puncture technique)

Premedication — Pethidine hydrochloride 75–100 mg with phenergan 25 mg and atropine sulfate 0.65 mg are given intramuscularly about half an hour prior to operation.

Local anesthesia—Taking usual aseptic precautions about 10 mL of 1 percent lignocaine hydrochloride is to be infiltrated at the puncture site (just below the umbilicus) down up to the peritoneum.

Position of the patient—The patient is placed in lithotomy position. The operating table is tilted to approximately 15 degrees of Trendelenburg position. Usual aseptic precaution is taken as in abdominal and vaginal operations. The bladder should be fully emptied by a metal catheter. Pelvic examination is done methodically. An uterine manipulator is introduced through the cervical canal for manipulation for visualization of tubes and uterus at a later step.

Producing pneumoperitoneum—A small skin incision (1.25 cm) is made just below the umbilicus. The Verres needle is introduced through the incision with 45° angulation into the peritoneal cavity. The abdomen is inflated with about 2 liters of gas (carbon dioxide or nitrous oxide or room air or oxygen). Choice of gas depends upon the method of sterilization.

Introduction of the trocar and laparoscope with ring

loaded applicator—Two silastic rings are loaded one after the other on the applicator with the help of a loader and pusher. The trocar with cannula is introduced through the incision previously made with a twisting movement. The trocar is removed and the laparoscope together with ring applicator is inserted through the cannula

The ring loaded applicator approaches one side of the tube and grasps at the junction of the proximal and middle third of the tube. A loop of the tube (2.5 cm) is lifted up, drawn into the cylinder of the applicator and the ring is slipped into the base of the loop under direct vision. The procedure is to be repeated on the other side.

Removal of the laparoscope: After viewing that the rings are properly placed in position, the tubal loops looking white and there is no intraperitoneal bleeding, the laparoscope is removed. The gas or air is deflated from the abdominal cavity. The abdominal wound is sutured by a single chromic catgut suture.

Understanding Sexual Health Disorders

So you’re not in the mood. Or you’re just not enjoying it anymore. Or sometimes, well, it hurts. And the thing is, these problems are bothering you or your partner or both of you. It’s important to remember that sexual health issues often referred to as sexual dysfunction by health care professionals can affect women of all ages and at any stage of life.

Female Sexual Dysfunction Defined

Sexual dysfunction in women is not just one condition. Instead, sexual health experts have identified several types of female sexual dysfunction (FSD). These include:

• Sexual desire disorders

• Sexual arousal disorders

• Orgasmic disorders

• Sexual pain disorders

Just as there are different types of pneumonia, depression and cancer, there also are different types of sexual disorders. Your diagnosis and how you, your partner and your health care professional approach treatment depends on your symptoms. The following list presents the different types of female sexual disorders and the definitions health care professionals use to diagnose them. Keep in mind that even if you think your sex life fits the description, if your condition doesn’t bother you and you’re just fine with your current sex life, then you do not have a disorder. 2 Unless your sexual health issue causes distress, you don’t necessarily need to “fix” it.

• Hypoactive Sexual Desire Disorder (HSDD):

The technical definition of HSDD is the persistent or recurrent lack (or absence) of sexual thoughts and desire for sexual activity. HSDD causes distress for the patient, may put a strain on relationships with partners and is not due to the effects of a substance, including medications, or another medical condition. If you have HSDD, you simply aren’t interested—or aren’t as interested—in having sex as you once were. HSDD is undiagnosed for many women.

• Subjective Arousal Disorder.

You don’t feel sexually aroused or excited, and you don’t get pleasure from sex, but you are still able to become lubricated.

• Genital Sexual Arousal Disorder. You don’t get physically aroused when your partner touches your genitals, but you can still become aroused from other sexual stimulation (for example, kissing, having your breasts stroked, touching your partner).  

• Combined Genital and Subjective Arousal Disorder.

As its name implies, this condition is a mix of both arousal disorders. Basically, nothing turns you on.

• Persistent Genital Arousal Disorder.

This is the opposite of the other three arousal disorders. You become physically aroused when nothing sexual is going on. Even having an orgasm doesn’t make this feeling go away. The key here is that this constant arousal bothers you; you want it to go away

• Orgasmic Disorder.

Put simply, despite being highly aroused and enjoying sex, you can’t experience intense orgasm. This applies to women who have never experienced orgasm or to women who previously had orgasms but now no longer have them because of changes in their health, their medications, life circumstances or relationships.  

• Dyspareunia.

This condition means pain with sex. Whether the pain occurs before, during or after intercourse, if it interferes with your enjoyment of sex and your quality of life, it’s a sexual disorder. Dyspareunia is more common than you might think. One study suggests that as many as six out of 10 women experience pain with intercourse.  

• Vaginismus.

This condition refers to a persistent or recurrent involuntary contraction of the muscles surrounding the vagina when penetration is attempted, making intercourse or even inserting a tampon into your vagina painful, if not impossible.

Impotent Drugs May Affect the Motility Sperm

Impotent drugs used to treat erectile dysfunction may have improved sex lives of men around the world, but a new study conducted in the laboratory suggests that such drugs can have a negative effect in sperm motility, or the ability of the sperm to move freely through the female reproductive tract. Due to the need that the sperm must “swim” to reach and fertilize the egg in the female reproductive tract, the findings raise new questions now about the effect of these drugs on male fertility.

Results of the study shows that sildenafil (better known as Viagra) or other drugs are injected directly into the penis, such as Phentolamine can reduce the motility of sperm, according to the American Journal of Obstetrics and Gynecology Dr. J Roberto Andrade, an obstetrician and gynecologist at the Union Memorial Hospital in Baltimore, Maryland. Dr. Andrade was straight to the point by saying that the study was on small sperm samples in the laboratory and therefore this cannot happen in the similar way inside our body, given the conditions of the human body. The study was done using samples from 10 men aged 18-44 years.

While both drugs in high concentrations end up affecting sperm motility, research in turn was not performed under ideal conditions, reports Dr. Andrade to Reuters Health. “We try to isolate the molecule Viagra but could not do so in pH that would likely be found in natural conditions, instead the researchers ended up mixing Viagra and sperm at low pH.” A dose of 200 micrograms has no effect on motility of spermatozoa, but the dose 2000 microgram reduces the motility by 50% according to the results presented. These are well below the doses that men take, though the drug found in sperm is quite diluted, noted Dr. Andrade. Still, this was not the expected result, since he anticipated that Viagra could even accelerate motility sperm. I thought just the opposite," commented Dr. Andrade while talking to Reuters Health.

The effect of Phentolamine was expected because more is known that the drug inhibits androgen receptors. A dose of 20 micrograms has no effect; however, with 200 micrograms mixed with sperm “results in a significant reduction in sperm motility.” With 2000 micrograms almost all the sperm stopped along the way. In fact, people are very curious about this study. No one until the research thought the sperm quality and its motility will be affected while using drugs to treat erectile dysfunction.  While most men who take these drugs are older and perhaps therefore less concerned with the issue of fertility, there are also young men who are doing fertility treatment. Men only think of order Viagra and take it, never realised that it will affect their fertility.

The study was unable to determine the exact concentration of the drugs found in sperm. “Clinical studies must be undertaken to assess the concentration of these drugs in the sperm necessary for the restoration of erectile function, but also to determine how these drugs affect the quality and quantity of sperm and fertility ultimately”, concluded Dr. Andrade and his team. They plan to study the effect of these drugs on sperm motility directly in human models. “While these results are still preliminary, if a couple has experienced fertility problems while man is using drugs for the treatment of impotent, his doctor should be consulted”, advises the researcher.