The gynecologist spoke about the pros and cons of female sterilization

In Russia, a record number of female sterilization operations has been recorded over the last 16 years. And since 2010, according to Rosstat, the number of such surgical interventions has increased by 20%. Sales of contraceptives are also growing in the country. “MK” learned from experts what these statistics are connected with and why Russian men are afraid of such operations like fire.

According to Medvestnik, which received data from the Rosstat report, after 2006, the number of sterilization operations for women in Russia steadily decreased, but the trend changed in 2014. After this, a short-term decline was observed only in 2020 against the backdrop of the COVID-19 pandemic: then 12.6 thousand operations were performed. And in 2022, 15 thousand such interventions were performed, or 44.6 sterilizations per 100 thousand women aged 15 to 49 years.

As WHO international expert in the field of reproductive health and family planning, member of the presidium of the European Society for Contraception and Reproductive Health, director of the Russian Association “Population and Development” gynecologist Lyubov Erofeeva told “MK”, surgical sterilization is a very popular method of contraception all over the world, and married couples who have realized the required number of children and no longer want to expose themselves to risks, resort to surgical termination of fertility.

“It’s completely safe for health.” On the contrary, if women have a number of diseases that may worsen during pregnancy, such operations are recommended. However, there is a small nuance: throughout the world, the leading method of surgical sterilization is male sterilization. This is generally an outpatient procedure, it is done quickly and is completely safe. There are countries in which 12–15% of men choose this method of contraception because they protect women’s health. And sometimes this is due to local legislation, which suggests that if a man divorces his wife and they have a certain number of children, he is obliged to support them after the divorce. And she may be left without anything if she has new children. Such strict laws apply in Germany, the Netherlands, and also in Brazil. In addition, in those countries where there are restrictions on terminating unwanted pregnancies in women, men take responsibility and are sterilized.

– However, this does not make them completely infertile?

— Before tying up the spermatic cords, a man can go and freeze his sperm for centuries, that is, leave a resource of germ cells that he can use at any convenient time or transfer the right to this to someone. In general, his subsequent ability to have children is not affected by sterilization. During IVF, frozen cells can be used. Women have a slightly different situation: in the vast majority of cases, they go for sterilization if a subsequent pregnancy could threaten their health or even life. And doctors recommend performing one or another operation. After she signs informed consent, her tubes are tied. There are also some interventions for surgical sterilization in women due to the fact that they simply do not want to give birth anymore.

— Russian law has established restrictions on such operations, who are they allowed to?

— Yes, we have legal restrictions on sterilization operations – they are allowed either over the age of 35, or if there are at least two children in the family. In addition, there may be somatic diseases that threaten a woman – heart defects, changes in the central nervous system, disorders in the endocrine system, which are indications for sterilization surgery.

But our population, both women and men especially, are reluctant to undergo such manipulations. For some reason we are afraid of them. Men just wave their hands! They think that the absence of germ cells in their sperm will somehow affect their sexual potency, which is, of course, a myth. Sexual health only improves after such intervention. If they know this, they will be more at ease with it. But we are a country prone to myths, a country that has lost large numbers of its population in wars, and for our men this is a difficult conversation. Therefore, there are few who motivatedly decide that since I already have seven shops, and in different families, then I have enough. If there were legislation like in the Netherlands and Germany, they would be more responsible towards their offspring and women’s health.

– But it seems that the situation is changing – the number of operations, although among women, is growing…

— This is new information for me, I didn’t expect a surge. Maybe it has something to do with the pandemic. Or growing awareness. Hard to tell.

— Do women who undergo sterilization operations still have any opportunities for procreation?

– Today, with the help of IVF, a woman, even who does not have tubes at birth, can become a mother. And after tubal ligation, too. The procedure of surgical sterilization in women sometimes leads to the fact that the tubes regain their patency. But it should be noted that there are different ways to carry out a sterilization operation: if the tubes are tied, IVF can be done; if they intersect, this is less likely. With good reproductive health, if a woman is ovulating, an egg can be taken from her – and there will be a test tube baby.

…At the end of last year, analysts reported a record increase in sales of contraceptives in the country over the past 6 years. According to the analytical company DSM Group, from January to September, more than 20.7 billion rubles worth of complex oral contraceptives were sold: the increase compared to the same period last year was 5%: over the 9 months of 2022, Russians bought 19.7 billion worth of such products billion rubles Well, if we compare it with 2021, then in its first three quarters, compatriots spent 15.3 billion rubles in pharmacies on oral contraceptives.

As the press service of the SRO Association of Independent Pharmacies told MK, in the last six months the demand for contraceptive drugs has been stable, but the price has changed. According to pharmacies that are members of the Association, the average price for this group of drugs from suppliers has increased by 10–12%. But, according to one owner of a pharmacy chain from the Tver region, purchasing prices have already increased three (!) times. Moreover, imported ones expectedly rose in price more actively than domestic ones. Pharmacists note that the price of contraceptives online is slightly lower than in traditional pharmacies. Some clients, in order to save money, order these drugs online for home delivery or purchase at any point convenient for them. Experts note that in the struggle for consumers, pharmacies are again and again forced to reduce markups so that drugs are at least somehow affordable for the population.