[Sterilization as a method of family planning].

More than 40 years of Swiss sterilization practice are surveyed from a medical and psychological viewpoint. Of the available female sterilization methods laparoscopic tubal sterilization using bipolar coagulation is the most currently used technic with the lowest failure or complication rate. For men, the procedure is vasectomy by cauterization or ligation using a scrotal approach under local anesthesia. Retrospective studies, mostly based on data of the Basel University Women's Hospital, point to the increase in abortion rate (from 2% to 21%) in the period from 1965-1974. This same period sees an increase in sterilization from 5%-25%. Reasons for this increase are: currently used method of tubal sterilization which decreases length of stay; age factors (more premenopausal women seek sterilization); change in social status of women; and change in attitude of women; change in religious affiliation and attitude. There are more social indications for sterilization. Medical or eugenic indications for the procedure are seen in younger women; it is associated with greater mental stress and low self-esteem. Direct motivation for increased sterilization is replacement of hormonal contraception. This increased from 18-79% between 1965-1974, although sterilization as initial contraceptive choice decreased from 57-15% in this period. A 5-year evaluation of sterilization versus contraceptives shows a 97% satisfaction with the sterilization decision where more than 50% are dissatisfied with the pill. Binder's (1937/38) criteria for sterilization are still applicable today: 1) to be done only by exception before 25th year; 2) fear of pregnancy coupled with fulfilled wish for children; 3) good marital relations; clear, conscious motivation; unforced decision; and 4) incompatibility of current contraceptive methods.