Contraception: female surgical sterilisation
What is female surgical sterilisation?
Female surgical sterilisation is a form of permanent contraception that involves sealing off a woman’s fallopian tubes. It is sometimes referred to as tubal ligation, or ‘having your tubes tied’.
Hysterectomy (surgical removal of the womb or uterus) is also sometimes used as a female sterilisation technique if there are problems associated with the uterus.
How does it work?
Tubal ligation works by preventing the sperm from reaching the egg.
Normally, after an egg has been released by one of the ovaries (ovulation), it travels down the fallopian tube towards the uterus. Following ejaculation, sperm normally swim up to the fallopian tubes where an egg can be fertilised. Blocking the fallopian tubes prevents sperm from reaching and fertilising an egg.
Fallopian tubes can be blocked or sealed off by cutting and tying; or applying clips, clamps or rings.
How effective is it?
Tubal ligation is about 99.5 per cent effective at preventing pregnancy.
Reversing a tubal ligation is difficult. The success rate of fertility returning is only about 50 per cent, so sterilisation should always be thought of as a permanent measure.
How is it done?
Usually a surgeon performs minor surgery through a small incision below the navel — a procedure called a laparoscopy. With the aid of a laparoscope (a thin tube that allows a view into the abdominal cavity) the surgeon cuts and ties; or applies clips, clamps or rings to both fallopian tubes.
Doctors usually recommend using an alternative form of contraception until you have had your first period after the procedure.
Some of the advantages of surgical sterilisation are that:
- it does not affect sex drive;
- it does not interfere with spontaneity of sexual intercourse; and
- it does not affect intercourse, normal hormonal rhythms or periods.
Some of the disadvantages of surgical sterilisation include the following.
- It requires surgery, usually under a general anaesthetic.
- It is more complicated than vasectomy (male sterilisation).
- There is a risk, albeit low, of surgical complications such as internal bleeding, infection or damage to other organs.
- If a pregnancy should occur, there is an increased risk that it will be in the fallopian tubes (ectopic pregnancy), which can cause serious internal bleeding.
- It is very difficult to reverse the process, and so should be undertaken by women who are absolutely certain that they do not want any (more) children.
- It does not protect you from sexually transmitted infections (STIs).
2. Family Planning Victoria. Female sterilisation (updated Jan 2010). http://www.fpv.org.au/assets/Uploads/PDF-Downloads/SH-Info/Full-brochures/FSTERILE.pdf (accessed Aug 2013).
3. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Filshie clip tubal occlusion (updated July 2011). http://www.ranzcog.edu.au/publication/document-library/cat_view/656-college-statements/658-clinical-gynaecology/663-contraception.html (accessed Aug 2013).
4. NHS Choices. Female sterilisation (updated 10 Jan 2013). http://www.nhs.uk/Conditions/contraception-guide/Pages/female-sterilisation.aspx (accessed Aug 2013).