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Birth Control: How a Tubal Ligation Works

3 of 12 in Series: The Essentials of Safe Sex

Tubal sterilization (or tubal ligation, and often known as getting your tubes tied) is the most commonly used birth control method for women over the age of 34. After all, getting your tubes tied is a one-time event that is extremely effective against unintended pregnancies without affecting sexual functioning. If you’re looking for a permanent method of birth control and you’re not at risk of contracting an STD, tubal ligation might be right for you.

Permanency, coupled with the security of knowing that the risk of getting pregnant is extremely small, leads so many people to choose this method — especially those who have reached an age when they think they don’t want children anymore. But, sterilization, which involves at least minor surgery, can result in complications as well. Make sure you talk to your doctor about all of the risks before making your decision.

What is tubal ligation?

Tubal ligation is the female method of sterilization. Tubal sterilization can actually be performed in a variety of ways, not all of which call for tying the tubes.

The tubes in tubal ligation are the fallopian tubes, in which the egg is fertilized by the first sperm that finds it. If these two tubes are cut and tied, the eggs and sperm should never be able to come together. In rare instances, the tubes grow back, and a woman can become pregnant, but this only happens in about 12 out of 1,000 cases. If you include instances when the surgery was improperly done, the risk rises to 18 in 1,000.

Cutting and tying off the fallopian tubes prevent sperm from reaching the egg.
Cutting and tying off the fallopian tubes prevent sperm from reaching the egg.

Women have several kinds of tubal sterilization from which to choose, and usually the method a woman chooses depends on other medical factors.

Here's a look at the different types of tubal ligation:

  • Operative laparoscopy: One of the two most common types. The abdomen is inflated with an injection of harmless gas (carbon dioxide), which allows the surgeon to see the organs more clearly. The surgeon then inserts a rodlike instrument, called a laparoscope, through a small incision. The laparoscope has a “camera” and light to help locate the tubes. Finally, either with the same instrument or another, the operation to cut and tie the tubes is performed. Complications are rare.

  • Mini-laparotomy: The other most popular method. It is similar to the laparoscopy, but it doesn’t require a viewing instrument. It is done within 48 hours of giving birth, when the abdomen is still enlarged and viewing is easier for the surgeon.

  • Full laparotomy: Rarely performed. This is a major surgery requiring a much larger incision than an operative laparoscopy or mini laparotomy. The patient undergoes full anesthesia and requires hospitalization for two to four days, followed by several weeks of further recovery.

  • Vaginal procedures: Rarely performed because of the higher risk of infection.

  • Hysterectomy: The surgical removal of the uterus. This, too, is major surgery, and it is rarely used merely as a method of sterilization. Instead, a hysterectomy may be performed to correct another medical problem, with sterilization occurring as a side effect. With a hysterectomy, the tubes may not actually be involved, but without a uterus, pregnancy is impossible.

With any of the tubal methods of sterilization, the woman’s organs function normally so she still ovulates, has her full set of female hormones, and has her monthly period. The eggs, which continue to be released monthly, simply dissolve the way any unused cells do. (Remember, the egg is microscopic in size, so it really can’t do any damage floating inside of you for a while.)

After sterilization, sexual functioning also remains the same, or is sometimes improved because the woman no longer has to concern herself about becoming pregnant.

Disadvantages of tubal ligation

As you may guess, tubal ligation requires a surgical procedure, but most women can undergo it on an outpatient basis (either in a hospital or clinic), under local anesthesia, and in under 30 minutes. The costs can vary from $1,000 to $6,000, but this is a one-time charge as opposed to other methods that involve a cost for every use, such as the condom or birth control pill. Insurance may cover some or all of the cost, depending on the individual policy.

Complications with the procedure are possible, including bleeding, infection, or a negative reaction to the anesthetic. In most cases, however, these complications are rare, and you can easily deal with them.

Remember, if you undergo one of these procedures, you have to assume that you will never have children again. If you “never say never,” this is not the right choice for you.

Most important is to note that sterilization does not protect against STDs. If you have unprotected sex, you will not get pregnant — but you could contact any number of infections, including HIV.

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