Sterilisation, female

Summary

• Female sterilisation is achieved by interrupting the patency of the fallopian tubes
• It should only be used if the woman does not wish to have any more children, as it is a permanent form of birth control
• It is usually carried out using low-risk surgical techniques
• There is a small failure rate of two to four pregnancies per 1000 operations
• Complications are rare

Which women may consider sterilisation?

Sterilisation is a permanent form of birth control and is used by women who have decided that their family is complete. Obviously this choice should be discussed with your partner.

Sterilisation can also be used when pregnancy would be a serious health risk.

All other methods of birth control e.g. long-term contraception (see intra-uterine contraceptive devices which are as effective) should be considered before choosing sterilisation, since it must be regarded as permanent.

What methods are available?

Sterilisations are carried out in hospitals or clinics with surgical units. They can be done under local anaesthetic or general anaesthesia.

The principle behind female sterilisation is to close off the fallopian tubes – the tubes that run from the ovaries to the uterus – preventing an egg from meeting sperm and being fertilised. There are several ways to do this:

• Cutting or tying the tubes – tubal ligation
• Sealing the tubes using an electric current which produces heat – cautery (not as effective and seldom done these days)
• Applying clips, clamps or rings
• Removing a small piece of tube and tying off the cut ends

A woman’s general health may indicate which procedure is best. Previous surgery and body weight are factors to be considered.

More than half the sterilisations performed are done shortly after childbirth or termination of pregnancy. The decision to combine sterilisation with other procedures must be made in advance.

Sterilisation is a low-risk surgical procedure and is usually carried out using one of the following techniques:

• Laparoscopy – this is one of the most common methods. A harmless gas (carbon dioxide) is injected into the abdominal cavity. This inflates it, allowing the organs to be seen more clearly. The surgeon then makes a small incision near the navel and inserts a laparascope – a rod-like instrument with a light and a viewing lens – into the abdomen.

  The surgeon may also insert an instrument used for closing the tubes, usually through a second small opening.

  The procedure can be performed at outpatient surgical clinics. It takes 20 to 30 minutes, and women generally go home the same day. There is very little scarring afterwards.

• Mini-laparotomy – this is also a common method, often used after childbirth. No gas or visualising instruments are used.

  A small incision is made in the lower abdomen, just below the umbilicus or above the pubic hair. The surgeon locates the tubes and then closes them using one of the methods described above.

• Laparotomy – this is major surgery and is less common than either of the above methods. The surgeon makes a larger incision in the abdomen, then locates and closes off the tubes. The operation requires spinal or general anaesthesia. The woman may be hospitalised for two to four days and may need a few weeks to recover at home.

What complications can occur after sterilisation?

Complications are unusual, but can happen after any kind of surgery.

These include:

• Bleeding
• Infection
• Reaction to the anaesthetic

Complications occur in one to four percent of sterilisations.

How effective is sterilisation?

There is a small failure rate – two to four pregnancies per 1000 sterilisations.

Frequently asked questions

Will sterilisation affect an existing pregnancy?

No, although sterilisation will not be performed if you are pregnant.

Will sterilisation affect menopause?

Sterilisation will not cause menopause because you are still producing hormones from your ovaries. It will not prevent you from entering menopause.

Will I still have a period?

Yes, most menstrual cycles are the same after sterilisation. Some women may find that their menstrual cycle is disturbed for a while if they stop using other contraceptive methods, e.g. the contraceptive pill.

Will I be as feminine after sterilisation?

Yes, your hormones are not affected since your ovaries are still working.

How soon after the procedure can I have sexual intercourse?

Ask your doctor’s advice and do not have intercourse until you feel comfortable. Recovery usually takes about a week, unless you were sterilised after childbirth, in which case most doctors advise waiting four weeks.

The procedure does not affect the ability to experience sexual pleasure.

Can sterilisation be reversed?

If you are thinking about reversal, do not consider sterilisation. Reversal procedures require complicated surgery and cost a lot of money. Even though the tubes can be rejoined in some cases, pregnancy is not guaranteed.

When to see the doctor

Discomfort after the operation depends on your general health, the type of operation you had and your pain tolerance.

You may feel tired and have slight abdominal pain. However, you should contact your doctor immediately if you:

• Develop a fever
• Bleed from an incision
• Have severe, continuous abdominal pain
• Have fainting spells

Reviewed by Dr PS Steyn, Head: Family Planning and Reproductive Health Care Unit, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Stellenbosch University and Dr P Roets, Clinical Research Fellow in Sexual and Reproductive Health, Family Planning and Reproductive Health Care Unit, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Stellenbosch University.