Sterilization (sterility)

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This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

Under sterilization ( sterilization ) refers to a medical procedure, the barren, so incapable of a human or animal for breeding does. Male and female sterilization are reliable methods of definitive contraception .

In men, sterilization called vasectomy is carried out by tying ( ligature ) or cutting ( resection ) both vas deferens . In women, sterilization is performed by ligating the fallopian tubes ( tubes ), removing a piece of the fallopian tubes or removing the fringed funnel (fimbrial funnel). In order to prevent an ectopic pregnancy, the approach of the tubes to the uterus ( uterus ) should also be electrically obliterated.

This form of contraception has been introduced in several countries around the world since the beginning of the 20th century , partly because of societal interests that took precedence over individual interests, and in some cases it was even enforced (e.g. voluntary or state-enforced sterilization for reasons of eugenics ) approved for individual motives. See also : sterilization laws

statistics

In Germany about 1.45 million women (8% of all women of reproductive age) and about 0.45 million men (about 2% of all men) are currently sterilized.

Pearl index of sterilization:

  • for men 0.1
  • in women 0.1–0.3

The situation in other countries is very different, especially in developing and emerging countries. With the young population (in India, for example, 50% of the Indian population is under 25 years old), there are significantly more people of reproductive age and overpopulation is already a problem. Therefore, sterilization is state subsidized. Every woman who undergoes sterilization receives a one-time bonus of € 30. In addition, the former patients take part in a raffle, with the chance of a car or a refrigerator as the main prize.

Sterilization of the man (vasectomy)

Implementation and consequences

The procedure is usually performed under local anesthesia, but in many clinics also under anesthesia , and takes just under an hour. The pain during and after the operation is bearable, especially the tension on the vas deferens and blood vessels is described as uncomfortable.

The success of the sterilization, i.e. H. The imperviousness of the vas deferens must be proven by several ejaculate samples at monthly intervals in order to ensure reliable contraception. The first ejaculations after the vasectomy still contain sperm, since the seminal vesicle and the end of the vas deferens on the prostate side still contain sperm. Contraception is typically guaranteed about three months after the procedure and should be confirmed by laboratory analysis.

The sterilization (after about three days of wound healing) has no physical influence on the man's libido and erectile function . The appearance and amount of ejaculate do not change noticeably. The germ cells (sperm) that are no longer required, whose natural transport route has been blocked by the operation, die off after production and are broken down by phagocytes . Their basic components are reused in the metabolism.

costs

The sterilization of men in Germany has not been paid for by the statutory health insurance since January 1, 2004. It costs between 450 and 500 euros (as of 2019).

Sterilization of the woman

execution

Using a laparoscopy under general anesthesia, the gynecologist can access the fallopian tubes, which are either heat-sealed ( electrocoagulation ) or clamped off with a clip. The way from egg cells through the fallopian tube to the uterus is blocked and sperm cells can no longer reach the egg cells. Ovulation continues; the egg then gets into the abdominal cavity and is easily broken down by the body there.

costs

Here the costs are between 600 and 1000 euros. Until the end of 2003 the statutory health insurance companies were obliged to pay for all sterilizations. Since January 1, 2004, the health insurances have differentiated between medically necessary sterilization and sterilization as part of personal life planning. Sterilization is considered medically necessary if pregnancy would endanger or worsen a woman's physical or mental health and the woman cannot tolerate birth control pills or intrauterine devices . The medically necessary sterilization will continue to be covered by the health insurance companies.

Legal basis for sterilization in Germany

General

Like any other medical measure, sterilization requires the patient's consent ( § 223 , § 228 StGB ). As long as a patient has the necessary insight and control (i.e. is able to grasp the consequences and scope of the sterilization), only he himself, but not a legal representative, can consent. Sterilizations due to a handicap of the person to be sterilized are prohibited according to Art 23 Paragraph 1 c) of the “ United Nations Convention on the Rights of Persons with Disabilities”. This convention came into force in the Federal Republic of Germany on March 15, 2008.

Consent from legal representatives

A particularly serious decision is the consent to sterilization, because it is closely linked to the personality of the person concerned and irrevocably determines his life in a very important point. Parents (or guardians ) cannot consent to the sterilization of a child . A sterilization of minors is not permitted ( § 1631c BGB), that of an adult is only possible under the strict restrictions of § 1905 BGB.

A full age to consent Supervised may allow use in its sterilization only itself, the lack of consent can not be replaced. In order for a legal supervisor ( sterilization supervisor ) (according to § 1896 BGB) to make a decision, there must always be a permanent inability to consent in addition to other requirements . The sterilization must not take place against the natural will of the person being cared for. It is subordinate to all other methods of contraception .

It must also be assumed that without the sterilization there would be a pregnancy (of the person being cared for or the partner of the person being cared for) and that this pregnancy or the consequences can be expected to pose a serious physical or psychological risk to the person being cared for. This also includes measures in the context of a withdrawal of custody according to § 1666 BGB (child welfare endangerment) after the child's birth.

For the sterilization consent, a separate sterilization supervisor must always be appointed specifically for this measure ( Section 1899 Paragraph 2 BGB), whereby the supervisory authority itself (or a care association as such) cannot be appointed as a supervisor for this task ( Section 1900 Paragraph 5 BGB ).

Sterilization Permit Judicial Procedure

A decision on sterilization under care law must always be approved by the guardianship court ( Section 1905 (2) BGB, Section 297 FamFG ).

There is always a guardian ad litem to order for the approval procedure. Expert reports must be obtained prior to judicial approval. These have to consider the following aspects:

  • Psychological aspect: ability to consent? Effects of a possible pregnancy ?
  • Social aspect: level of education, financial circumstances, apartment, overall situation.
  • Special educational aspect: life perspective of the person concerned.
  • Sexual pedagogical aspect: Can the person affected be taught how to use contraceptives reliably?

At least two experts are to be involved; they must examine or question the person concerned personally before the report is issued; they must not be the same person as the doctor performing the sterilization. The person concerned must be heard personally by the judge ( Section 297 (1) FamFG).

The supervisory authority and the spouses, parents, foster parents, children, confidants should be heard (verbally or in writing) ( Section 297, Paragraphs 2 and 3 FamFG).

The decision of the judge , through which the consent to the sterilization is approved, must be made known to the person concerned with the reasons. The approval becomes effective with the announcement to the curator ad litem and the sterilization supervisor ( § 297 Paragraph 7 and 8 FamFG), i. H. with the later date. Sterilization can only be carried out two weeks later at the earliest ( Section 1905 Paragraph 2 Clause 2 BGB). The method that allows refertilization should be given preference.

In 2004, 187 permit applications were submitted in the Federal Republic of Germany in accordance with Section 1905 (2) BGB, 154 of which were approved (source: Federal Ministry of Justice, special survey procedure under the Care Act ).

Pet sterilization

In the case of pets, the vet can sterilize them under anesthesia if the animal is not to be neutered.

See also

Web links

Individual evidence

  1. ^ Sterilization in India. February 27, 2017. Retrieved February 27, 2017 .
  2. ↑ Federal Center for Health Education: Sterilization of the man. Retrieved November 30, 2019 .
  3. ↑ female sterilization on frauenaerzte-im-netz.de ( Memento of 15 September 2008 at the Internet Archive )
  4. ^ Federal Center for Health Education: Sterilization of women. Retrieved November 30, 2019 .
  5. ↑ sterilization
  6. ^ Federal Center for Health Education: Sterilization of women. Retrieved November 30, 2019 .
  7. ↑ Federal Law Gazette 2008 II pp. 1419, 1420
  8. ↑ Pet magazine: should I neuter or neuter my dog?