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