Tubal Ligation: The Female Sterilization

Tubal ligation, colloquially known as "getting your tubes tied," is a surgical procedure women undergo to end their ability to become pregnant. The fallopian tubes, organs through which an egg travels to get from an ovary to the uterus, are blocked: cut, tied, clamped or electrically sealed off. With no egg for sperm to fertilize, pregnancy is impossible.

The procedure is performed under local or general anesthesia at an outpatient clinic or in a hospital. Patients typically resume normal activity within a few days. Sex and heavy lifting should both be avoided for at least two weeks to provide adequate healing time. Tubal ligation can be performed independently or in combination with another procedure, such as a C-section. For this reason, some women choose to undergo the procedure when they give birth.

According to a 2008 study, 700,000 tubal ligations are performed annually in the United States. Almost half are within 48 hours of childbirth.

Risks

Abdominal pain or cramping, fatigue, dizziness and bloating are common side effects. Infection, bleeding at the incision site or inside the abdomen, damage to abdominal organs, or side effects from anesthesia are also possible in the case of a laparoscopic tubal ligation, which is different from a vaginal procedure.

An ectopic pregnancy, when a fertilized egg implants outside the uterus, is possible after tubal ligation and can be life-threatening if untreated. If a fallopian tube isn't entirely blocked, pregnancy can result (this occurs in about 1 in 200 women). Women who are overweight or have a history of diabetes, abdominal surgery, lung disease or pelvic inflammatory disease are more likely to experience surgical risks.

Benefits

A woman will continue to experience her normal menstrual cycle after tubal ligation and her sexual function will be unimpaired. Many women report improved sexual satisfaction due to decreased anxiety about contraception and possible pregnancy. Not having to use other contraception also eliminates the ensuing side effects and costs. However, a tubal ligation does not protect against sexually transmitted infections (STIs) or diseases (STDs).

A woman's risk of ovarian cancer may be reduced after the procedure, especially if both fallopian tubes are removed (a bilateral salpingectomy).

Reversal

Although performed as a permanent form of birth control, tubal ligations can, in very rare cases and with great difficulty, be reversed. About 1 percent of patients opt to undergo a second procedure in which the fallopian tubes are reattached, and the risks are similar to those of the original operation.

However, only 50 to 80 percent of women are able to get pregnant after a reversal. Tubal ligations that were performed with little scarring are more likely to have a successful reversal, and women under age 35 are more likely to experience success. Candidacy for reversal depends on body mass, scarring, existing damage to the fallopian tubes, remaining tubal length and other fertility factors.

Women have other ways—such as in vitro fertilization (IVF)—to get pregnant if a reversal is unsuccessful or not deemed a safe choice. In fact, most patients will be referred for IVF in place of a reversal.

Takeaways

Tubal ligation is an excellent option for women who don't want to get pregnant. However, the procedure is not recommended for women seeking temporary or semipermanent birth control.

No woman should be pressured by a partner, or anyone else, into having the procedure. There are numerous forms of available birth control, including a number of semipermanent options known as long-acting reversible contraceptives (LARCs).

If you are considering tubal ligation, read testimonials from other patients and speak to your gynecologist with regard to your suitability as a candidate and to discuss risks. Your doctor can also inform you about other long-term birth control options.

Make the decision that's right for you. If you have a partner, be sure they understand your reasoning, as well as the procedure itself. If you're single, be sure to consider the possibility of wanting to have children in the future.