Contraception - tubal ligation

What is tubal sterilization?#

Tubal sterilization, also known as tubal ligation or ‘having your tubes tied’, is a permanent method of contraception. You can choose it if you are sure that you do not want to have children in the future.

Using keyhole surgery, the surgeon puts clips on the fallopian tubes to block the sperm and egg from meeting. In some cases, the fallopian tubes are removed rather than clipped.

How tubal sterilization prevents pregnancy#

When you ovulate, an ovum (egg) is released from the ovary and moves down the fallopian tube. If the ovum meets a sperm, conception may happen.

Tubal sterilization blocks the path of the sperm through the fallopian tube. Eggs are still released by the ovaries, but they are broken down and safely absorbed by the body.

The ovaries are not affected by sterilization. They continue to release the same hormones, so the procedure does not cause menopause or affect your sex drive or enjoyment of sex. Your periods will keep happening as usual.

Issues to consider#

Even though tubal sterilization can sometimes be reversed, it is considered a permanent method of contraception. If you are thinking about it, issues to discuss with your doctor include:

• your reasons for wanting to be sterilized
• whether tubal sterilization is the best option for you
• whether removal of the fallopian tubes is a good option
• whether it is recommended for someone of your age
• whether other methods of contraception might be more suitable
• any side effects, risks or complications of the procedure

Consent and capacity#

Sterilization is regarded as a special medical procedure. A person is considered unable to consent to such a procedure if they cannot understand its general nature and effect, or cannot indicate whether or not they consent. Where a person does not have the capacity to consent, a guardian cannot provide consent for sterilization on their behalf, and an appropriate legal or tribunal process may be required.

The operation#

Tubal sterilization is usually done under general anaesthetic using a procedure called laparoscopy. Between one and 3 small cuts are made around the navel (belly button). A telescopic device called a laparoscope is inserted through one of the cuts. A small camera at the tip of the laparoscope sends an image to a screen so the surgeon can see the internal organs.

Working through these small openings, the surgeon may:

• put clips on the fallopian tubes, or
• put clips on the fallopian tubes and cut them, or
• cut and seal the fallopian tubes with heat (diathermy), or
• remove the fallopian tubes

After tubal sterilization#

After the operation you can expect to:

• have some pain and nausea in the first 4 to 8 hours (you may need pain medication for a short time)
• have some abdominal pain and cramps for 24 to 36 hours
• go home the same day
• have no changes to your periods
• have the stitches taken out after 7 to 10 days
• see your surgeon for a check-up at about 6 weeks

Caring for yourself#

It is important to follow the advice of your doctor or surgeon. Suggestions include:

• Avoid intense exercise for 7 days.
• Take pain medication to manage discomfort, but see your doctor if the pain is very strong.

You can usually go back to work within a few days. You can start having sex again as soon as you feel ready, because the procedure starts working straight away.

Risks and complications#

Possible risks and complications of the operation include:

• an allergic reaction to the anaesthetic
• damage to nearby organs, such as the bowel or ureters
• infection, inflammation and ongoing pain
• infection of the wound or one of the fallopian tubes
• haemorrhage (very heavy bleeding)
• pregnancy
• ectopic pregnancy (where a pregnancy develops outside the womb, usually in the fallopian tubes, rather than in the uterus)

The method is more than 99% effective, but there is a very small chance of the tubes becoming unblocked, which could allow a pregnancy to happen.

Reversing tubal sterilization#

A person usually chooses sterilization when they are sure they do not want children in the future, but circumstances can change.

Tubal sterilization can sometimes be reversed, but this is not always successful. Success rates depend on the age of the person having the reversal and the way the original procedure was performed. If the fallopian tubes were removed, the sterilization itself cannot be reversed, although IVF may be possible.

To reverse the procedure, the fallopian tubes are reached through a cut in the abdomen, and the surgeon re-joins the cut tubes using very small stitches. Generally, the chance of getting pregnant after a reversal is about 60%, with about 50% having a baby. The partner’s age can also affect the chance of pregnancy.

The risk of ectopic pregnancy after a successful reversal is quite high, because scar tissue can stop the fertilized ovum from moving down the fallopian tube.

Tubal occlusion#

Tubal occlusion is a sterilization procedure that is no longer available. It involved placing a tiny, flexible device called a micro-insert into each fallopian tube. After the procedure, the body grew scar tissue around the micro-inserts, which blocked the fallopian tubes.

Other methods of contraception#

Other contraceptive methods include:

• hormonal implants
• hormonal and copper intrauterine devices (IUDs)
• hormonal injections
• oral contraceptive pills, such as the combined pill and the progestogen only (mini) pill
• vaginal rings
• barrier methods, such as condoms
• vasectomy, a relatively simple method of permanent contraception

Protection from STIs#

Sterilization does not protect you from sexually transmissible infections (STIs). It is important to practise safer sex. The best way to lessen the risk of STIs is to use barrier methods such as condoms with all new sexual partners. Condoms can be used for oral, vaginal and anal sex to help stop infections from spreading.

Many community health services and public hospitals have a family planning clinic, a sexual health clinic or a women’s health clinic where you can book an appointment. Some private clinics that offer abortion also offer contraceptive services.

Key points#

• Using keyhole surgery, the surgeon puts clips on the fallopian tubes to block the sperm and egg from meeting.
• It is important to follow the advice of your doctor or surgeon after the procedure.
• You can have sex again as soon as you feel ready, because the procedure starts working straight away.
• The risk of ectopic pregnancy after a successful reversal is quite high, because scar tissue can stop the fertilized ovum from moving down the fallopian tube.

Where to get help#