Permanent Contraception Research Articles

Association Between Preterm Birth and Fulfillment of Desired Permanent Contraception.

In cases of preterm delivery, the Medicaid sterilization policy mandates a signed consent form at least 72h before surgery for permanent contraception, which is less than the 30day minimum waiting period for term births. This study evaluated the association between preterm birth and fulfillment of planned permanent contraception. This was a secondary analysis of a multi-center retrospective cohort study of 3013 patients with a postpartum contraceptive plan of permanent contraception. Primary outcomes were permanent contraception fulfillment, compared between preterm and term deliveries. Secondary analyses examined moderation by delivery mode and insurance type. At hospital discharge, patients who had a preterm delivery were less likely to undergo desired permanent contraception than those with a term delivery (adjusted odds ratio (aOR): 0.67, 95% CI: 0.53-0.84), and this finding persisted up to one year postpartum (aOR: 0.65, 95% CI: 0.53-0.8). For patients with cesarean deliveries, the odds of permanent contraception fulfillment were significantly lower among those with preterm compared to term deliveries (aOR: 0.54, 95% CI: 0.39-0.76). Among patients with Medicaid insurance, those who delivered preterm were less likely than those who delivered term to undergo desired permanent contraception (aOR: 0.66, 95% CI: 0.59-0.88). Patients delivering preterm face barriers to fulfillment of desired permanent contraception postpartum. Prioritization of contraceptive goals is important for patient autonomy and increasing equitable access to contraception for all.

Patient Preferences or Provider Pressure? The Relationship Between Coercive Contraceptive Care and Preferred Contraceptive Use.

Background/Objectives: Coercion in contraceptive care occurs when healthcare providers unduly influence patients to use or not use birth control. Contraceptive coercion is antithetical to quality patient-centered care. However, it is unclear how experiencing contraceptive coercion relates to patients' lives and contraceptive outcomes. In this study, we examined associations between contraceptive coercion and a patient-centered outcome: preferred contraceptive use. Methods: In 2023, we used the Prolific panel to recruit reproductive-aged people in the USA who were assigned female at birth. Our analytic sample included surveyed participants who had ever talked to a healthcare provider about contraception (N = 1197). We conducted chi-square and regression analyses to investigate associations between contraceptive coercion and preferred contraceptive use. We added context by mapping the current and preferred contraceptive method(s) for participants who experienced coercion and were not using their preferred method(s). Results: After adjusting for potential confounders, participants who reported downward coercion (pressure to not use birth control) at their last contraceptive counseling were less likely to be using their preferred contraceptive method(s). The odds of using preferred contraception did not differ significantly based on whether participants experienced upward contraceptive coercion (pressure to use birth control). Patterns in unmet contraceptive preference for patients experiencing coercion include use of the pill when it is not the desired method and unmet desire for permanent contraception. Conclusions: In this study, patients who perceived pressure from a provider to not use birth control were less likely to be using their preferred contraceptive method(s). Promoting reproductive autonomy requires comprehensive, patient-centered, and unbiased contraceptive care.

Long-acting reversible and permanent contraceptives utilization and its associated factors among married women who desire no more children in Ethiopia: A multilevel analysis.

This study aimed to investigate long-acting reversible and permanent contraceptives (LARPCs) utilization and its associated factors among married women who desire no more children in Ethiopia. Secondary datasets from the 2016 Ethiopian Demographic and Health Survey was used for the study. A total weighted sample of 3,756 married or in union reproductive age women who desire no more children were included in the analysis. Data was cleaned, weighted, and analyzed using STATA Version 14 software. A multi-level logistic regression analysis was conducted to consider the hierarchal nature of the demographic and health survey data. In a multivariable multilevel logistic regression model, an adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) and p value <0.05 was used to declare the significant associated factors of LARPCs utilization. The overall utilization of LARPCs among married women who desire no more children was 12% [95%CI: 10.99, 13.07]. In the multivariable multilevel analysis; being female household heads [AOR = 0.60; 95%CI: 0.40, 0.92], husband primary level of education [AOR = 1.57; 95%CI: 1.18, 2.07], employed women [AO R = 1.34; 95%CI: 1.04, 1.74], women from middle wealth index [AOR = 1.45; 95%CI: 1.02, 2.07], women who visited health facility in the last 12 months [AOR = 0.69; 95%CI: 0.54, 0.88], women residing in small peripherals [AOR = 0.20, 95%CI: 0.05, 0.82], and women from communities with low poverty [AOR = 2.25, 95%CI: 1.26, 3.99] were significantly associated with LARPCs utilization. In Ethiopia, LARPCs utilization among married women who desire no more children was very low. Both individual and community-level factors were significantly associated with LARPCs utilization. Thus, individual and community-level interventions that encourage husband education, maternal occupation, and giving special attention for women who live in small peripheral areas and female-headed households are better.

Knowledge of contraceptive methods among deaf women: a qualitative study

Objective To analyse the understanding of deaf women regarding contraceptive methods. Method We conducted a qualitative descriptive study in two referral centres for sexual and reproductive health (SRH) in São Paulo, Brazil, trough years 2020–2022. Twenty-eight deaf women who use Brazilian Sign Language (LIBRAS) were interviewed face-to-face and remotely via videocall using a semi-structured questionnaire containing sociodemographic and clinical data and questions about understanding and knowledge of contraceptive methods. We performed a content analysis through transcription, interpretation, and validation of the LIBRAS translation with the assistance of NVivo software. Results Communication barrier (28/28) was the primary factor associated with low knowledge about contraceptive methods. Regarding barrier methods, 20 (71%) participants reported be familiar with condoms, 13 (46%) with diaphragms, 20 (71%) about oral contraceptives, and 17 (60%) about injectable methods. Concerning long-acting reversible contraceptives (LARCs), 16 (57%) were aware about intrauterine devices and 7 (25%) with subdermal implants. Fifteen (53%) of participants were aware about female and male permanent contraception. Unplanned pregnancy rate was 59% and use of fertility awareness methods was reported by 6 (21%), barrier methods 5 (17%), short-acting methods 6 (21%), LARC 2 (7%) and permanent contraception among 4 (14%). Conclusion In our sample of deaf women, condoms and oral contraceptives were identified more often and were more in use. All interviewed deaf women cited communication as a barrier to accessing information about contraceptive methods, highlighting the low knowledge and use of LARC.

Reproductive Health Among School Employees in Vijayapura, Karnataka.

Background Cervical cancer typically progresses over 10-20 years, making it a preventable disease and underscoring the importance of screening. In low-resource settings, Papanicolaou (Pap) smears and visual inspection with acetic acid (VIA) serve as primary screening tools. This study was conducted as part of the noncommunicable disease camps organized by the government of Karnataka, India. Additionally, it aimed to evaluate the knowledge, attitudes, and practices related to contraception among women of reproductive age. Methods This cross-sectional study was conducted from June to August 2022 in primary health centers, community health centers, and government schools across all the Talukas of Vijayapura District, Karnataka, India. A total of 6,257 women participated in the study. The researchers interviewed all participants, obtained detailed medical histories, and performed pelvic examinations as part of the evaluation. Additionally, they conducted both VIA and Pap smears. Results A total of 6,257 women were sensitized for cervical cancer screening, of whom 5,114 registered, resulting in an acceptance rate of 81.73%. However, 1,143 participants (18.27%) refused screening, with the most common reason being unwillingness to undergo an examination. Only 3,316 women (53.91%) were aware of cervical cancer, and just 1,689 (27.1%) understood that it could be detected at an early stage. The VIA results indicated that 9.1% (n = 865) of the women tested positive. Among those screened, seven women (0.1%) were found to have a high-grade squamous intraepithelial lesion. Of these, four underwent colposcopy-guided biopsy, while three were lost to follow-up; all four biopsies were negative for malignancy. Additionally, two women presented with apparent cervical growths. Regarding contraceptive practices, 2,690 women (43.3%) expressed support for using contraception, with the permanent method of sterilization being the most preferred by 1,990 women (74.13%). Conclusions Screening with basic investigations such as Pap smears and VIA plays a crucial role in identifying premalignant and malignant lesions at their earliest stages, enabling timely treatment to reduce morbidity and mortality. Additionally, most women opt for permanent contraception once they have completed their families.

Retrospective evaluation of post-surgical orchialgia in men undergoing no-scalpel vasectomy.

Vasectomy is a form of permanent contraception in men that is safe and effective. Complications are relatively uncommon, although patients may experience postoperative pain. Current literature quotes a broad range in the incidence of chronic orchialgia following no-scalpel vasectomy from 0.6-26%, while pain negatively affecting quality of life is about 1-2%. We sought to evaluate our incidence of post-vasectomy pain and surgical management for this pain. A retrospective chart review was performed for all men who underwent a vasectomy at Men's Health Clinic Manitoba during a 22-month period. The presence of pain or complications was collected at a three-month followup appointment. Patients with pain were then followed every 6-8 weeks for continued assessment and management. A total of 350 men underwent elective no-scalpel vasectomy during this period. The majority of patients had no previous history of orchialgia (98%) or history of previous scrotal surgery (93%). At three months post-vasectomy, 38/350 (11%) of patients had ongoing pain and one patient required surgery (epididymectomy) for management of post-vasectomy pain syndrome three months following vasectomy. Our retrospective analysis of 350 men who underwent no scalpel vasectomy shows a significant proportion of post-vasectomy pain at the three-month followup appointment, although most cases are resolving or minor and only one patient has required surgical management. This highlights the importance of counseling men undergoing vasectomy regarding the risks of post-procedure orchialgia and the small proportion of men who will require additional surgical intervention.

Patient and OBGYN Perspectives on Considering Long-Acting Reversible Contraception for Postpartum Patients Who Desire Permanent Contraception

Objective(s)We sought to understand patients’ and obstetrician-gynecologists’ priorities in seeking or recommending long-acting reversible contraceptive methods (LARC; intrauterine devices and contraceptive implants) versus permanent contraception in the postpartum period when permanent contraception was the patient’s initial contraceptive preference. Study DesignWe interviewed 81 postpartum patients who desired permanent contraception and their delivering obstetrician-gynecologist (n=67) from four U.S. institutions to explore patient and OBGYN perspectives navigating permanent contraception counseling and decision-making. We used thematic content analysis to analyze interview transcripts using NVivo 12 Pro software. ResultsOur analysis revealed a mismatch between patient and OBGYN priorities when considering permanent contraception versus LARC. Many OBGYNs in our study described a preference for LARC methods over permanent contraception and often prioritized factors such as reversibility and menstrual suppression. However, many patients sought permanent contraception for reasons that were not adequately addressed by LARC methods such as method permanence, desire to avoid menstrual suppression, cancer prevention, prior negative experiences with LARC, and a preference to avoid a foreign body. Conclusion(s)These results suggest that priorities in selecting a preferred contraceptive method may sometimes not be aligned between patients and clinicians and that LARC methods may not always be an acceptable alternative for patients who desire permanent contraception. The findings from this study highlight the importance of eliciting and centering a patient’s goals and desires for pursuing permanent contraception during contraceptive counseling. Clinicians should be aware of the various perspectives and values patients have on these methods and include them in patient-centered share decision-making.

Definition of a European pre-vasectomy scoring system to identify patients at risk of vasectomy regret.

Vasectomy is a widely used, safe, effective method of permanent contraception and contributes to healthy sexuality. We have conducted a 3-step observational clinical study to develop a vasectomy regret risk score and guide patients and clinicians when discussing a vasectomy. A 3-step approach has been followed. First, experts involved in male health have proposed risk factors for regret (remorse) after vasectomy, defined by a vasectomy reversal surgery or medically assisted reproduction. The selected factors were evaluated in 1200 patients vasectomized in the last 15years. Finally, the expert panel has constructed a score for predicting regret after vasectomy. Fifty-two international experts identified 17 risk factors for vasectomy regret. Five of the risk factors were significant: an age <35years old, a high Barrat Impulsivity Score, a low level of education, and a patient who didn't understand that the vasectomy might not be reversible or for whom the contraception responsibility is ideally feminine, or no responsible partner. On multivariate analysis, 3 risk factors and 2 "sine qua non" conditions were used to build the decision algorithm. A risk score ≥ 4 required information on sperm cryopreservation before vasectomy, and those with a risk score ≥ 7 required extra time for reflection. The scoring system was proposed to 52 international experts and accepted with 86.7% strongly agreeing. The model's sensitivity and specificity were 0.98 and 0.53, respectively. A decisional algorithm was established to identify patients requiring information on sperm cryopreservation before vasectomy or additional time for reflection to reduce the risk of vasectomy regret. The algorithm contains 3 risk factors and 2 "sine qua non" conditions.

A statewide analysis of uptake of highly effective contraception offered immediately postpartum in Massachusetts, 2017-2021.

To investigate provision of immediate postpartum (iPP) highly effective contraception in Massachusetts. We performed logistic regressions evaluating contraceptive implant, intrauterine device, and permanent contraception procedures occuring during delivery admissions between 2017 and 2021, analyzing outcomes by method reversibility and delivery type. Hispanic and privately-insured patients had higher odds of receiving any iPP method, whereas patients delivered at non-teaching hospitals had lower odds of receiving any method. Patients who were Hispanic, publicly-insured, or delivered atnon-teaching hospitals had lower odds of receiving reversible compared to permanent methods. Differential uptake of iPP contraception suggests programming opportunities to address unmet postpartum contraception needs.

Procedural and clinical outcomes of Adiana® hysteroscopic tubal occlusion in the Netherlands

Background: The Adiana® Permanent Contraception System was a hysteroscopic tubal occlusion device but was withdrawn from the market in 2012. Objective: To evaluate the safety, feasibility and efficacy of the Adiana hysteroscopic tubal occlusion. Materials and Methods: A prospective observational multicentre cohort study of 300 women undergoing hysteroscopic sterilisation using the Adiana® was conducted in the Netherlands between 2009 and 2012. All procedures were performed using the same study protocol. Three months after bilateral placement a hysterosalpingography (HSG) was performed to confirm tubal occlusion. In 2018-2020 follow-up questionnaires were sent to all women. Main Outcome Measures: The primary outcome was the success rate of the Adiana tubal occlusion technique. Successful tubal occlusion was defined as an uneventful procedure with occluded fallopian tubes according to the HSG after 3 months. Secondary outcomes were the success rate of the device placement, the number of complications during placement and the pregnancy rate. Results: Bilateral placement of Adiana devices was achieved in 93.5% of cases. Bilateral confirmed occlusion by HSG was accomplished in 87.9% of cases with successful Adiana placement. This was 77.1% in the intention-to-treat group. Complications and side effects were reported in 4.4% of women. The pregnancy rate was 3.6% in women with proven bilateral tubal occlusion. Conclusion: Hysteroscopic tubal occlusion using the Adiana technology is associated with a pregnancy rate of 3.6%. Although this technology was removed from the commercial market, this evaluation of the Adiana technology could provide useful information for the development of potential new, more effective hysteroscopic tubal occlusion devices. What’s new? Hysteroscopic tubal occlusion techniques are no longer available on the market. This evaluation of Adiana could provide useful information for the development of potential new hysteroscopic tubal occlusion devices.

Permanent contraception in the childfree population: An exploratory study

ObjectivesThis study aimed to describe the childfree population seeking permanent contraception, identify barriers to receiving care, and characterize the incidence of regret. Study designWe conducted a cross-sectional survey of people in the United States, aged 18 years and older, without biological children, and who are seeking or have previously sought a permanent contraception procedure. Participants completed an online REDCap survey distributed over social media platforms, including Reddit, TikTok, and Facebook. ResultsA total of 400 respondents completed the survey, of whom 151 (38%) underwent a permanent contraception procedure, 44 (11%) had found a doctor to perform a procedure but not yet undergone it, 32 (8%) had been unable to find a doctor to do the procedure, 83 (21%) were seeking a doctor, and 90 (22%) had not yet sought a doctor.Respondents were predominantly White (88%), identified as women (83%), and were diverse in sexual orientation (heterosexual 42%, bisexual 41%). Reasons for seeking permanent contraception included not wanting children (96%), fear of pregnancy/childbirth (70%), the current state of the world (68%), environmental reasons (59%), and medical reasons (32%). Barriers to care included cost of the procedure (30%) and inability to find a doctor who would perform the procedure (42%).Of the 151 respondents who had undergone a permanent contraception procedure, 70 (46%) asked more than one doctor for the procedure. Of those with permanent contraception, 97% answered “yes” to “Do you think sterilization as a permanent method of birth control was a good choice for you?” ConclusionsChildfree individuals have a variety of reasons for seeking sterilization and may be at a lower risk of regret than reported in the literature for parous people with permanent contraception. ImplicationsClinicians should be aware of the barriers to permanent contraception for patients who do not desire to have children. Providing patient-centered, individualized care to patients seeking permanent contraception can ensure that patients do not face unnecessary barriers to care and feel heard and empowered to enact their reproductive preferences.

Long-Acting Reversible Contraception Use after Non-Receipt of Postpartum Permanent Contraception: A Retrospective Analysis.

Objective: To evaluate long-acting reversible contraception (LARC) use versus permanent contraception (PC) use at hospital discharge through 1 year postpartum after an unfulfilled immediate postpartum PC request. Study Design: We present a secondary analysis of a retrospective cohort study of patients across four study sites between 2018 and 2019 with PC as their documented inpatient postpartum contraceptive plan. We abstracted demographic and clinical characteristics, contraceptive plans and time to contraceptive fulfillment, reasons for non-fulfillment, and pregnancy incidence up to 1 year postpartum from medical records. Results: Of 3,013 patients initially desiring PC, 1,759 patients (58.4%) received PC and 136 patients (4.5%) received LARC on discharge; with an additional 217 patients receiving PC and an additional 176 patients receiving LARC in the 1 year postpartum. Participants who received inpatient LARC were more likely to be younger, to be unmarried, to have Medicaid insurance, and to have delivered vaginally compared with participants who received inpatient PC. Of the 304 patients who received LARC rather than PC during the year postpartum, 49 (16.1%) expressed an interest in LARC prenatally. Reasons for non-fulfillment of PC were varied at different time points postpartum, with 50.3% stating they did not receive PC by 1 year postpartum because they had changed their mind. Conclusions: Ten percent of patients with an unmet postpartum PC request use LARC methods instead at 1 year postpartum. Patients who do use LARC are unlikely to bridge to receipt of PC. Institutions should prioritize fulfillment of desired postpartum PC prior to hospital discharge.

Examining Permanent Contraception for Children, Adolescents, and Young Adults With Intellectual Developmental Disorder: Ethical, Legal, and Medical Considerations: Clinical Report.

There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.

Use of Preferred Source of Contraception Among Users of the Pill, Patch, and Ring in the US

Individuals who use contraceptive pills, patches, and rings must frequently interact with the health care system for continued and consistent use. As options for obtaining these methods expand, better understanding contraceptive users' preferences for source of contraception can help facilitate access. To describe use of preferred source of contraception and to understand associations between prior reproductive health care experiences and preference for traditional in-person sources vs alternative sources. This was a cross-sectional nationally representative survey study fielded in the US in 2022 through NORC's population-based AmeriSpeak panel. Eligible panelists were assigned female sex at birth, aged 15 to 44 years, not infecund, and not personally using permanent contraception. Of the screened panelists, 3150 were eligible; 3059 completed the survey (97%). The analysis sample included 595 individuals who currently used a pill, patch, or ring contraceptive. Data were analyzed from January 25, 2023, to August 15, 2024. Primary outcomes were use of any preferred source and use of most preferred source when most recently obtaining contraception. Sources included in-person care, telehealth, pharmacist-prescribed, online service, and over the counter. A binary variable captured whether respondents most preferred traditional, in-person contraceptive care vs an alternative approach. Prior reproductive health care experiences included missing a pill, patch, or ring because they couldn't obtain it on-time and receipt of person-centered contraceptive counseling at most recent contraceptive visit. Sociodemographic characteristics and responses are presented as unweighted numbers with weighted prevalences. In this study, 581 of 595 unweighted respondents (weighted prevalence, 95.9%) of the analytic sample identified as female, 256 unweighted respondents (weighted prevalence, 64.4%) were ages 15 to 29 years, and 448 unweighted respondents (weighted prevalence, 73.8%) had most recently obtained their contraception in-person. Only 197 unweighted respondents (weighted prevalence, 35.6%) selected in-person care as their most preferred source. Additionally, 296 unweighted respondents (weighted prevalence, 49.7%) had most recently obtained their method through any preferred source, and 227 unweighted respondents (weighted prevalence, 39.8%) had obtained it through their most preferred source. In adjusted regression analyses, respondents who previously reported being unable to get their method on time (adjusted odds ratio [aOR], 2.57; 95% CI, 1.36-4.87) had higher odds of preferring an alternative source vs traditional in-person care. Those who recently received person-centered contraceptive counseling (aOR, 0.59; 95% CI, 0.35-0.98) had lower odds of preferring an alternative source. In this national study of individuals who used the pill, patch, and ring, most preferred alternative sources to obtain their contraception, and only half had most recently used a preferred source. These findings suggest that expansion of alternative contraceptive sources can better meet the needs of contraceptive users and support reproductive autonomy.

Reviving forgotten techniques: Vaginal salpingectomy in public health system, a retrospective cohort study.

To evaluate the viability of the vaginal route as an alternative to laparoscopy for patients seeking permanent surgical contraception. We conducted a retrospective cohort study in 2021, dividing patients into two groups based on their preference: vaginal and laparoscopic salpingectomy. The statistical analysis was conducted using STATA, employing standard statistical methods based on the distribution of variables. The study included 64 patients, with 34 undergoing the vaginal approach and 30 the laparoscopic route. No statistically significant differences were observed in baseline characteristics or complications between the two groups. Both surgical methods were found to be feasible. The vaginal route demonstrated a significantly shorter mean surgical time (P < 0.001). The laparoscopic route exhibited significantly less intraoperative blood loss (P < 0.001) and fewer hospitalization hours (P = 0.008). Postoperative satisfaction and pain levels did not show statistically significant differences. Vaginal salpingectomy is a feasible technique with low complication rates, making it a potential option for gynecologists to offer their patients. We propose vaginal route inclusion in the training curriculum for gynecologic surgeons during the residency program, without any subspecialty requirements.

Tubal Sterilization at Jos University Teaching Hospital, Jos: A Ten- Year Review

Introduction: Tubal sterilization is a form of permanent contraception that is offered to women of reproductive age group who have either completed their desired family size or in whom further pregnancy poses danger to their survival. Objectives: To review all the consecutive tubal sterilizations done at Jos University Teaching Hospital (JUTH) during the study period. Methodology: A retrospective study of all consecutive bilateral tubal ligations (BTL) at JUTH from January 2000 to December 2009. Data was obtained from patients’ case notes, records from association for voluntary surgical contraception (AVSC) clinic, booking registers as well as operation notes. The socio-demographic features, reproductive history, previous contraceptive history, surgical procedure done and its timing, of all the 1,217 consecutive tubal sterilizations done were extracted. The data was entered into personal computer and analyzed using Epi-Info Statistical Software, 2008. Results: One Thousand Two Hundred and seventeen (1217) tubal sterilizations were performed during the study period. The mean age and parity of the clients were 38.2 ± 4.2 years and 7.4 ± 2.1 respectively. Forty one point five percent of the clients were Berom women, that were married (97.7%) and without any gainful employment (39.4%). 80.8% of the clients had formal education and injectable hormonal contraceptive was the method of contraception used by 45.0% of the clients prior to the procedure. Pomeroy’s method was the only form of the procedure done, mainly via interval mini-laparotomy (88.4%). 78.5% of the clients knew of the procedure through family planning clinic, and the desired family size was the reason for the procedure in 80.6% of the clients. Conclusion: Tubal sterilization mainly via interval minilaparotomy, was found to be a method of contraception accepted by older clients with a higher parity in JUTH, Jos.

Comparative Analysis of Laparoscopic and Open Tubal Ligation: Insights from a Retrospective Study in a Tertiary University Hospital

Background: Female sterilization remains a prevalent contraceptive method globally, despite a declining trend in prevalence over the past decades. Methods: To compare the outcomes of tubal ligation between laparoscopic and open surgical approaches, conducted at the Jordan University Hospital from 2010 to 2021. Results: 242 females underwent tubal ligation with 131 had open surgery and 111 had laparoscopic surgery. The median follow-up period for the cohort was 8 years. For the entire study cohort, the mean age at the time of surgery was 37.77 years (standard deviation (SD) = 4.589). A statistically significant (p &lt; 0.0001) difference in age was found, with mean age being older in the laparoscopy group. However, there were no significant differences between the two groups in terms of gravidity (p = 0.9499) or parity (p = 0.4867). Remarkably, only two pregnancies were documented during the follow-up period, both of which were observed in the laparoscopic surgery group. Overall free-from-pregnancy rate at 8 years was 98.79%; 97.59% in the laparoscopy group and 100% in the open surgery group. Conclusions: Both open and laparoscopic tubal sterilization are equally effective permanent contraceptives. While our study contributes to the understanding of tubal ligation outcomes, further research, particularly in developing countries like Jordan, is warranted to address the unique needs and challenges of diverse populations in reproductive healthcare.

Psychosexual Implications of Tubal Ligation in a Sample of Iraqi Women

Background: Tubal ligation, recognized as a surgical intervention that ensures permanent contraception, has established itself as an option for women seeking a definitive solution for family planning. Objective: To assess the psychosexual implications of tubal ligation in a sample of women in Baghdad, Iraq. Methods: A prospective cohort study was conducted in a teaching hospital for 2 years, from the first of January 2022 to the end of December 2023, in which 203 women who underwent tubal ligation were included. Results: In the present study, we found that 158 (77.8%) had no depression, mild depression presented in 27 (13.3%), and moderate depression in only 15 (7.4%). While 163 (80.3%) of women did not suffer from anxiety, 32 (15.8%) had mild to moderate anxiety, and only 8 (3.9%) were presented with severe anxiety. 27 (13.3%) have changed in coital frequency this this week. 49 (24.2%) have a change in sexual desire, a change in pleasure, and 37 (18.2%) suffer from a change in orgasm. Conclusions: The current study concluded that there are noticeable psychosexual effects of tubal ligation in women.

(117) RETROSPECTIVE EVALUATION OF POST-SURGICAL ORCHALGIA IN MEN UNDERGOING NO-SCALPEL VASECTOMY

Abstract Introduction Vasectomy is a form of permanent contraception in men that is safe, effective, and widely utilized. While complications are relatively uncommon, patients may experience post-vasectomy pain syndrome (PVPS) postsurgically. Current literature quotes a broad range in the incidence of chronic orchalgia following no-scalpel vasectomy from 0.6% - 26%. Chronic scrotal pain associated with a negative impact on quality of life, occurs after vasectomy in about 1-2% of men. Current guidelines state that few of these men require additional surgery, but there is scarce data on the actual proportion of men who will go on to receive surgical treatment for pain. Objective We sought to evaluate our incidence of post vasectomy pain as well as the rate of surgical management of post vasectomy pain with the objective of better counselling patients on the risks of vasectomy and subsequent surgeries. Methods A chart review was performed for all men who underwent a vasectomy at the Men's Health Clinic during a 20-month period. Their baseline characteristics were collected including age, previous scrotal surgery and history of orchalgia. The presence of pain or complications was collected at a 3 month follow up appointment. Patients with pain were then followed every 6-8 weeks for continued management. Results A total of 350 men underwent elective no scalpel vasectomy during this period, with a median age of 37. The majority of patients had no previous history of orchalgia (98%), or history of previous scrotal surgery (94%) and there was no association between these variables on post vasectomy pain. At 3 months post vasectomy, 38/350 (11%) of patients had ongoing pain, while 89% did not report post-operative issues or pain. There was no statistical difference in age between both groups. Semen analysis was only completed by 227/350 (65%) of patients, with 96% of those patients azoospermic. One patient has required surgery (epididymectomy) for management of post vasectomy pain 3 months following vasectomy and now has complete resolution of his pain. Conclusions Our retrospective analysis of 350 men who underwent no scalpel vasectomy shows a significant proportion of post vasectomy pain of some degree at the 3-month follow-up appointment, although most cases are resolving or minor and only one patient has required surgical management. This data highlights the importance of counselling men undergoing vasectomy regarding the risks of post procedure orchalgia and the small proportion of men who will require additional surgical intervention. Disclosure No.

Uncertainty in Postpartum Permanent Contraception Decision-Making: Physician and Patient Perspectives

PurposeWe sought to understand how patients and physicians conceptualize uncertainty in the permanent contraception decision-making process. Basic ProceduresIn 2022–2023, we interviewed postpartum patients with a documented desire for permanent contraception (n = 81) and their delivering physicians (n = 67). Eligible patients gave birth at one of our four study hospitals in California, Ohio, Illinois, and Alabama. We used rapid content analysis and thematic content analysis to develop and refine themes related to uncertainty in permanent contraceptive decision-making. Main FindingsMost patients reported full certainty in their decision regarding permanent contraception, although some expressed doubts. After receiving permanent contraception, some patients discussed grief but overall affirmed their decision. One patient said they wished they had considered other contraceptive options. Physicians reported using a range of strategies to safeguard from patient regret, including ensuring patients were 100% certain with their decision, inferring certainty based on their characteristics, asking patients to think through all scenarios that could affect decision-making, and repeat counseling during multiple interactions. Principal ConclusionsPatient experiences reveal the depth, fluidity, and nuance of patients' contraceptive decision-making processes. Physicians sometimes failed to grapple with this nuance by centering potential regret in their counseling. Personalized and supportive contraceptive counseling that acknowledges the complexity of contraceptive decision-making is imperative. Shared decision-making can help ensure patients can make informed and autonomous decisions about their reproductive lives.