V-NOTES Versus Laparoscopy for Sterilization and Sexual Function

The goal of this randomized clinical trial is to compare two minimally invasive surgical approaches, transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) and conventional laparoscopy, in women undergoing bilateral tubal ligation or bilateral salpingectomy for sterilization. The main questions it aims to answer are: * Does V-NOTES have a different effect on postoperative sexual function compared with conventional laparoscopy? * Does V-NOTES improve postoperative recovery, including pain, discharge time, and return to normal activity? * What surgical or medical problems occur with each surgical approach? * Researchers will compare V-NOTES with conventional laparoscopy to see whether one approach provides better postoperative sexual function and recovery outcomes after sterilization surgery. Participants will: * Undergo bilateral tubal ligation or bilateral salpingectomy using either V-NOTES or conventional laparoscopy. * Complete sexual function questionnaires before surgery, at 6 weeks after surgery, and at 6 months after surgery. * Be evaluated for postoperative pain, discharge time, return to normal activity, need for additional pain medication, complications, and perioperative laboratory changes. * Attend scheduled postoperative follow-up visits at 6 weeks and 6 months after surgery.

Inclusion Criteria: * Women aged 30 to 45 years * Sexually active women * Women who have completed childbearing and request permanent surgical sterilization * Scheduled to undergo bilateral tubal ligation or bilateral salpingectomy for contraceptive purposes * Able and willing to attend scheduled postoperative follow-up visits at 6 weeks and 6 months * Able to provide written informed consent Exclusion Criteria: * Stage 2 or higher pelvic organ prolapse * Active vaginal infection * History of rectal surgery * Suspected rectovaginal endometriosis * Suspected malignancy * Pregnancy * Menopause * Unable or unwilling to attend scheduled postoperative follow-up visits