Female Sterilization, Tubal Ligation

About a million American women elect to have surgery to tie their fallopian tubes, known as tubal ligation. Some women have a hysterectomy (removal of the uterus and sometimes also the ovaries) each year but usually not only for birth control.   

Most US women who have undergone sterilization experience either a postpartum minilaparotomy procedure or an interval (timing of the procedure does not coincide with a recent pregnancy) procedure. A postpartum laparotomy consists of a small incision near the navel right after childbirth. An interval tubal sterilization is usually done with the use of small instruments inserted into a woman’s abdomen and is called laparoscopic surgery. Interval minilaparotomy - a small abdominal incision in bikini area - is performed in surgically challenging circumstances, such as when severe pelvic adhesions are present and laparoscopy is deemed inappropriate. 

The fallopian tubes (through which the egg passes from the ovaries and where the egg is fertilized by the sperm) may be blocked with Falope rings, clips, bands, segmental destruction with electrocoagulation, or suture ligation with partial salpingectomy. Female sterilization prevents fertilization by interrupting the passage through fallopian tube. 

• How effective: Sometimes this method does not provide permanent birth control. The United States Collaborative Review of Sterilization has examined the failure rate of female sterilization. Rates vary according to the procedure performed. The cumulative 10-year failure rate with each method of tubal ligation is as follows: spring clip method is 3.7%, electrocoagulation is 2.5%, interval partial salpingectomy (partial removal of tubes) is 2%, silicone rubber bands is 2%, and postpartum salpingectomy (tubes cut after delivery) is 0.8%.  
  
  
• Advantages: Female sterilization does not involve hormones. It is a permanent form of birth control. There are no changes in libido (sexual desire), menstrual cycle, or breastfeeding ability. The procedure is usually a same-day procedure done in a surgical outpatient clinic.  
  
  
• Disadvantages: The procedure involves general or regional anesthesia. It is permanent form of birth control, and some women may regret the decision later. The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child. Regret also has been shown to correlate with external pressure by the clinician, spouse, relatives, or others.

Regret is difficult to measure because it encompasses a complex spectrum of feelings that can change over time. This helps to explain that while some studies have shown "regret" on the part of 26 percent of women, fewer than 20 percent seek reversal and fewer than 10 percent actually undergo the reversal procedure.

Sterilization does not protect you from sexually transmitted diseases. Sterilization involves all of the risks of surgery. Occasionally, sterilization cannot be done laparoscopically, and an abdominal incision may be necessary to reach the fallopian tubes. There is some short-term discomfort. Tubal sterilization does not protect against sexually transmitted diseases.