"...for the choice of "permanent" sterilization. 38.6.19 "strongly discourages surgical sterilization as an elective form of birth control" and then allows for limited exceptions.
I
expect that 38.6.4 is a better representation of God's truth on the
matter (that birth control -- including surgical sterilization when a
couple decides they will not have more children -- is a private matter
that should be left between the couple and the Lord), and that 38.6.19
will eventually get edited and corrected when the bureaucracy can get to
it (but what does some random internet busybody like me really know).
For now, there is still some tension in the Handbook about just how far a
couple can go in deciding these things for themselves." ~ David N
I'm
not sure I see a conflict in the two policies. I can see why it would
be "discouraged". When a couple goes in for surgical sterilization, the
doctor has to sit them down and make sure they fully understand what
they are electing to do. This is because many cases have had post
surgery remorse - whether it was spiritually or years down the road
changing their mind about wanting children. If a man is sterilized,
should his wife die and he remarries, his new wife may want a child.
Sure he can get a reversal, but it can cost $8-10,000. There is
generally not the same issue with other forms of birth control. This is
the only reason I can see it being "discouraged". Though it is
discouraged, I was not able to find anywhere where sterilization would
be a action that would affect temple worthiness or be a cause for
membership restrictions or a church court. Bishops are not being told to
ask about sterilization in interviews. So, in that, I'm still seeing
the church keeping themselves out of the decisions they make concerning
birth control. The only reason I can see why it would be put as a
"discouragement" in the handbook would be in case a member ask a church
leader about it. The church leader could then tell them "well, the
handbook say's it's discouraged, but is a decision to be made between
you, your spouse and the Lord." This is one of the reasons I wrote my
article "Is the Bishop in Your Bedroom". As youth in the church we can
culturally get so hung up on taking anything sexual to the Bishop that
some don't realize they don't have to take what they do sexually with
their spouse to the Bishop. As married couples, our sexual activities
with our spouse are between spouses and the Lord. In fact, the Bishop
really doesn't want to hear it and I've had a bishop tell me as much. 
~ Coach Sam Zaragoza
~ Coach Sam Zaragoza