Female Sterilization (Tubal Ligation)

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tubal ligation

Tubal ligation

Female sterilization, also called “tubal sterilization” is a huge decision because it’s a permanent type of contraceptive. This means that it protects against pregnancy forever. Women who choose this option usually do not want any children, or do not want any more, or cannot carry a pregnancy because of a medical condition. Another option for permanent birth control is male sterilization (vasectomy).

Out of 100 women using female sterilization
Typical use: 1 or fewer women become pregnanticon representing less than 1 pregnant woman
Perfect use: 1 or fewer women become pregnanticon representing less than 1 pregnant woman

What is tubal ligation?

“Tubal” refers to a woman’s fallopian tubes. Ligation means to tie off, cut or close. Tubal ligation involves having minor surgery.

Why are the “fallopian tubes” sterilized?

The fallopian tubes (see picture above) is where an egg and sperm meet, and where the egg becomes fertilized before it moves to the uterus. By closing off the tubes, sperm can’t get to the egg which means that pregnancy can’t happen.

How is female sterilization done?

Female sterilization can be done in an operating room or in a medical office depending on the type of procedure. It can be done while you are sleeping or while you are awake. If awake, you will be given numbing medicine so you don’t feel too uncomfortable. Depending on the type of method you choose to have, you could either have a small incision or cut in your abdomen (belly) or the procedure can be done vaginally (without any incisions or cuts).

A. Laparoscopic sterilization: This procedure is done in an operating room under general anesthesia (while sleeping). A small cut is made in the abdomen (belly) and then an instrument with a tiny camera (called a laparoscope) is placed inside the belly near the navel (belly button). The fallopian tubes (the tubes that carry eggs from the ovaries to the uterus) are then closed shut with another instrument. It can be done at any time during a woman’s cycle except immediately after she delivers a baby. It works immediately so using additional kinds of birth control to prevent pregnancy isn’t necessary. However, you should continue to use condoms to prevent STIs.

The fallopian tubes are cut and tied, removed, stitched with suture material, or burned. The fallopian tubes can also be entirely removed.

  • Sterilization using electrical current:An electrical current is used to burn and destroy the fallopian tubes after they have been cut. Sterilization done with an electrical current cannot be reversed.
  • Silicone band (tubal ring):Through the laparoscope, the surgeon will insert a special tool that stretches a plastic band, picks up a small loop of the fallopian tube, and places the plastic band over the loop. The tube is then clamped shut.
  • Spring clips:There are two types of clips that are used to clamp off the tubes. One, shaped like a clothespin, is placed over the fallopian tube and is held closed by its spring clip. The other type is a rounded clamp, which is closed over the fallopian tubes. The clamp’s plastic liner gets bigger to keep the tube closed as the tube flattens.

B. Minilaparotomy: This procedure is also done in an operating room with general or local anesthesia (numbing medicine) usually within 1-2 days after a woman has a baby.

C. Hysteroscopic sterilization: This procedure is called the “Essure” method and is done in an operating or office setting using local anesthesia (numbing medicine) about 7-10 days after a woman’s period. While the patient is awake, the doctor inserts a thin instrument with a camera at the end, into the vagina, which is then passed through the cervix, uterus and finally to the fallopian tube where a tiny coil is placed. Scar tissue then grows which seals the tube shut. Since this takes time to happen, another form of birth control must be used for the first 3 months.

A follow-up test called the Essure Confirmation Test is done within 3 months after the procedure. This is similar to an x-ray which allows your doctor to see that your tubes are closed off. If the tubes are tightly sealed at this point, your health care provider will likely tell you that you can stop other forms of birth control. However, you should always use condoms to prevent STIs. Essure can usually be done anytime except immediately after a woman gives birth.

Are there any risks or complications with female sterilization?

Complications are rare and are usually from general anesthesia and not the procedure. Women who have other medical conditions that make surgery risky should have a thoughtful discussion with their health care provider about the procedure. There is a low risk of hurting the bowel, bladder or major blood vessel. If an electric current is used to destroy the fallopian tubes, there is a low risk of burning the skin and/or bowel or other internal organs. Other complications include bleeding and infection. The chance of becoming pregnant after being sterilized is rare. However, if pregnancy occurs, a woman is more likely to have a tubal or ectopic pregnancy (this means that the pregnancy is in her fallopian tube instead of in her uterus, which can be dangerous).

What should I expect after the laparoscopic surgery?

You may have symptoms after the laparoscopic surgery including:

  • Dizziness
  • Shoulder pain
  • Cramps
  • Bloated or gassy feeling

After your laparoscopic procedure, you will stay in the recovery room until you are wide awake and able to eat and drink light foods such as crackers and ginger ale. Most women go home within 2-4 hours on the same day. You’ll need someone to bring you to the hospital and take you home. Some women may have mild discomfort for a few days. If any of the symptoms below last longer than a couple of days, call your health care provider. Most women can go back to school or work within 1 week of having the procedure, but everyone is different so be sure to listen to what your health care provider tells you.

What should I expect if I have the hysteroscopic sterilization or “Essure” procedure?

Before you sign the consent to have the procedure, your health care provider should talk to you about the possible risks that include; infection, pelvic pain, incomplete blockage of the tubes, and the rare possibility of causing a hole in the uterus or fallopian tubes.

You may be given medicine before the procedure to help you relax and prevent spasms of the tubes. The procedure itself is usually takes about 30-45 minutes. You will be able to go home shortly after the procedure and go back to your normal activities later in the day.

You may have:

  • Dizziness
  • Cramps
  • Bleeding or spotting
  • Abdominal (belly) pain
*Call your health care provider right away if you have severe abdominal pain or if the coil comes out of your vagina.

Does female sterilization work?

Female sterilization is one of the best methods of birth control available. It’s close to 100% effective. This means that out of 100 women who have a sterilization procedure, less than 1 would expect to become pregnant each year.

Does female sterilization protect against sexually transmitted infections (STIs)?

Female sterilization does not protect against sexually transmitted infections. Using condoms every time you have sex is recommended and greatly lowers the risk of getting an STI.

Will female sterilization affect my sex life?

No. Female sterilization will not change anything such as your sexual performance or your ability to have orgasms. In fact, some women feel more relaxed during sex because they’re not worried about becoming pregnant. Neither you nor your partner will be able to feel the clips or rings that may have been used to seal off your tubes.

Will my periods be the same after female sterilization?

Your periods will likely be the same. Medical studies have shown that women who are sterilized may in fact have fewer days of bleeding with their menstrual cycle, have a lighter flow and less menstrual cramps. A very small number of women may complain of irregular periods and menstrual cramping after sterilization.

If you have any of the following symptoms, call your health care provider:

  • Late or missed menstrual period
  • Severe lower abdominal (belly) pain
  • Nausea – feeling like you want to throw up
  • Breast tenderness

What if I decide I want to get pregnant after I am sterilized?

The majority of women who choose sterilization are happy with the decision, but some women (14%) will ask about reversing the procedure. If you change your mind after your tubes have been closed off you may be able to have your tubes rejoined, however reversing sterilization is a major operation and only about 70% successful. Less than 1% of women get their tubes rejoined, because they are almost always sure that they do not want any more children at the time of the procedure. Women who choose female sterilization between 18-24 years old are 8 times more likely to have the procedure reversed. Medical insurance does not pay to have a woman’s tubes “untied” or reversed. Another option to become pregnant after female sterilization is in vitro fertilization (when an egg is fertilized with sperm outside of the body and then placed in the uterus). This procedure is also expensive, has risks, and is not always successful.

Female sterilization is safe and a good option for some women such as young adults who have a very serious medical condition, women who know they definitely don’t want any children, and for those who can’t use other types of contraception. It’s also a good method for women that are absolutely sure they do not want any more children. Becoming sterilized is a serious decision. Talk to your health care provider or gynecologist if you’re considering female sterilization. It’s important to think about the benefits and risks and have all of your questions answered before making your final decision. If you chose to be sterilized the type of procedure will be based on your medical needs and when you want to have it done. Some women are sterilized right after they have a baby or an abortion, while many others choose another time.