Female sterilization is a permanent procedure to prevent pregnancy. It works by blocking the fallopian tubes.
When women choose not to have children, sterilization can be a good option. It’s a slightly more complex and expensive procedure than male sterilization (vasectomy).
According to a survey from the Centers for Disease Control and Prevention, approximately 27 percent of American women of reproductive age use female sterilization as their form of birth control. This is equivalent to 10.2 million women.
This survey also found that black women were more likely to use female sterilization (37 percent) than white women (24 percent) and U.S.-born Hispanic women (27 percent).
Female sterilization is most common in developing countries. Women ages 40–44 years are more likely than all other age groups to use female sterilization, with 51 percent choosing it as their primary birth control method.
There are two main types of female sterilization: surgical and nonsurgical.
The surgical procedure is tubal ligation, in which the fallopian tubes are cut or sealed. It’s sometimes referred to as getting your tubes tied. The procedure is usually performed using a minimally invasive surgery called laparoscopy. It can also be done just after a vaginal delivery or cesarean delivery (commonly referred to as a C-section).
Nonsurgical procedures use devices placed in the fallopian tubes to seal them. The devices are inserted through the vagina and uterus, and the placement doesn’t require an incision.
Sterilization blocks or seals the fallopian tubes. This prevents the egg from reaching the uterus and also keeps the sperm from reaching the egg. Without fertilization of the egg, pregnancy can’t occur.
Tubal ligation is effective immediately after the procedure. Nonsurgical sterilization may take up to three months to be effective as the scar tissue forms. Results for both procedures are typically permanent with small risk of failure.
A doctor must perform your sterilization. Depending on the procedure, it can be performed in a doctor’s office or hospital.
For a tubal ligation, you will need anesthesia.
Your doctor inflates your abdomen with gas and makes a small incision to access your reproductive organs with the laparoscope. Then they seal your fallopian tubes. The doctor may do this by:
- cutting and folding the tubes
- removing sections of the tubes
- blocking the tubes with bands or clips
Some sterilization procedures require only one instrument and incision, while others require two. Discuss the specific procedure with your doctor in advance.
Nonsurgical sterilization (Essure)
Currently, one device has been used for nonsurgical female sterilization. It was sold under the brand name Essure, and is the process it’s used for is called fallopian tube occlusion. It consists of two tiny metal coils. One is inserted into each fallopian tube through the vagina and cervix. Eventually, scar tissue forms around the coils and blocks the fallopian tubes.
Essure has been recalled in the United States, effective December 31, 2018. In April 2018, the U.S. Food and Drug Administration (FDA) restricted its use to a limited number of health facilities.
Patients had reported pain, bleeding, and allergic reactions. Also, there have been instances of the implant puncturing the uterus or shifting out of place. More than 16,000 U.S. women U.S. women are suing Bayer over Essure. The FDA has acknowledged that there have been serious problems associated with the contraceptive and has ordered additional warnings and safety studies.
After the procedure, you’re monitored every 15 minutes for an hour to make sure that you’re recovering and that there are no complications. Most people are discharged that same day, normally within two hours.
Recovery usually takes between two and five days. Your doctor will likely ask you to return for a follow-up appointment one week after the procedure.
Female sterilization is nearly 100 percent effective in preventing pregnancy. According to the Society of Obstetricians and Gynaecologists of Canada, approximately 2–10 out of 1,000 women might get pregnant after tubal ligation. A study published in the journal Contraception found that 24–30 women out of 1,000 got pregnant after tubal ligation.
Female sterilization is a good option for women who want effective and permanent birth control. It’s safe for almost all women and has an extremely low failure rate. Sterilization is effective without leading to the same side effects as other methods, such as birth control pills, the implant, or even the intrauterine device (IUD). For example, the procedure does not affect your hormones, menstruation, or sexual desire.
Some evidence also suggests that female sterilization may slightly reduce the risk of ovarian cancer.
Because it’s permanent, female sterilization isn’t a good option for women who may want to get pregnant in the future. Some tubal ligations may be reversible, but reversals often don’t work. Women shouldn’t count on the possibility of a reversal. And nonsurgical sterilization is never reversible.
If there is any chance you may want a child in the future, sterilization is probably not right for you. Talk to your doctor about other options. An IUD may be a better choice. It can be left in place for up to 10 years, and removal of the IUD restores your fertility.
Unlike some other methods of birth control, female sterilization doesn’t help women who want or need to manage menstrual cycle problems. Female sterilization doesn’t protect against sexually transmitted infections (STIs) either.
There may be extra factors for some women to keep in mind when considering female sterilization.
For example, women who have a high risk of negative reactions to anesthesia may not be able to undergo a surgical procedure.
For women who want to undergo nonsurgical sterilization, there are other restrictions. At the moment, nonsurgical sterilization isn’t an option for those who:
- have only one fallopian tube
- have had one or both fallopian tubes obstructed or closed
- are allergic to contrast dye used during X-rays
There are certain risks involved in any medical procedure. Infection and bleeding are rare side effects of tubal ligation. Talk to your doctor about the risks before the procedure.
In rare cases, the tubes can spontaneously heal after sterilization. According to Planned Parenthood, there’s a chance any pregnancy that happens at this point will be ectopic. An ectopic pregnancy occurs when the fetus implants in the fallopian tube instead of the uterus. It’s a potentially very serious medical problem. If not caught in time, it can be life-threatening.
For sterilization using inserts, the risks have been found to be so serious that Essure has been taken off the market as of the end of 2018.
Vasectomies are permanent sterilization procedures for men. They work by tying, clipping, cutting, or sealing the vas deferens to prevent the release of sperm. The procedure may or may not require small incisions and local anesthesia.
A vasectomy typically takes between two and four months to become effective after the procedure. After one year, it’s slightly more effective than female sterilization. Like female sterilization, a vasectomy doesn’t protect against STIs.
Couples who choose to opt for a vasectomy may do so because:
- it’s typically more affordable
- it’s considered a safer and, in some cases, less invasive procedure
- it doesn’t raise the risk of ectopic pregnancy
On the other hand, couples who opt for female sterilization may do so because tubal ligation is effective immediately, while vasectomies may take a few months to be effective.
Make an appointment with your doctor to discuss female sterilization and determine if it’s the best birth control option for you. If you opt for nonsurgical sterilization, you’ll need to use another method of birth control for three months after the procedure. You’ll still have your period, and you won’t experience a drop in libido.
No lifestyle changes are necessary with female sterilization. It’s important to remember that while female sterilization prevents pregnancy, it doesn’t protect against STIs. If you need STI protection, use condoms.