A comparison was made between sterilization by hysterectomy and by tubal ligation at the time of cesarean section and as an interval procedure. All operations were done at one institution and, essentially, by the same physician population, allowing for promotion within the residency program. The major deterrent to hysterectomy was the associated high incidence of necessary blood transfusion. However, a hysterectomy does offer the benefits of a permanent and completely effective procedure and the removal of an organ which ultimately may be the source of other problems. If another pathologic condition exists, making ultimate hysterectomy likely, it is the procedure of choice for sterilization, avoiding risks, costs, and the inconvenience of another operation. Methods of elective sterilization must be individualized. If the patient is appraised of the increased risk of hysterectomy and desires this more definitive procedure on the basis of informed consent, the incidence of complications is not prohibitive. These should not deter the well trained surgeon but should mandate use of all available skills, intensive evaluation of the patient, and concerned recognition of the potential adverse consequences.