To tie or not to tie, that is the question! Many women who feel that their family is complete consider having a tubal ligation or “tube-tie” operation.
A couple may decide that they do not wish, under any circumstances, to have more children. This must be a decision of the couple, not the woman alone, as the ability to have children is a joint property, not an individual one.
Because the operation is designed to be permanent, improbable circumstances, including the death of a child or marriage break-up, must be taken into consideration.
Some women succeed in having a successful microsurgical repair of a tubal ligation, but the success rate is not high and it is a long and expensive process. It is not a factor that should be considered when contemplating sterilization.
The Fallopian tubes are about seven centimeters long and they lead from each of the two ovaries to the womb (uterus). The egg released every month from the ovary moves down the tube and any sperm released by the man into the woman’s vagina moves the other way, through the uterus and up to the Fallopian tube where it may fertilize the egg.
The fertilized egg then continues its journey down the tube to enter the uterus where it grows into a baby. The aim of the operation is to close both Fallopian tubes so that the sperm and egg cannot meet.
In the open operation, the surgeon (usually a gynecologist) makes a cut just above the pubic bone, and through this he finds the tubes, cuts them and ties them off. Sometimes clips may be applied instead of cutting, or diathermy can be used to burn the tube. The woman is left with a small scar about seven centimeters long, usually below the line of all but the briefest of bikinis.
The more common and simpler operation is known as laparoscopy. In this, two small cuts, each one centimeter long, are made to the abdomen. One is usually placed in the umbilicus, the other low down on one side. Through these small cuts, small stainless steel tubes are placed. The surgeon looks through one tube and operates through the other.
With laparoscopy, the surgeon must operate with special very fine and long instruments through the steel tube. Because of this, it is not possible to cut and tie the Fallopian tube, so clips are normally used. Diathermy can be used too if necessary. Clips used are of several types, normally made from a rare metal such as platinum.
The operation takes only a few minutes, but it is usually done in hospital under a general anesthetic as a local anesthetic does not always give adequate pain relief.
The patient is in hospital only overnight to ensure that there are no after-effects from the operation or anesthetic. The woman can return to work about a week after the operation and there is only minor discomfort low down in the pelvis for a few days after the operation.
Tubal ligation can also be performed by using a laparoscope that is inserted through the top of the vagina instead of through the abdominal wall. This avoids any scars, but intercourse must be avoided for several weeks afterwards.
Some women elect to have the sterilization done at the same time as a C-section, as this avoids a second operation. This can usually be arranged with routine caesareans only, because discussion between husband and wife and obstetrician is necessary beforehand.
The complications of the operation are few, the main ones being bleeding into the pelvis or infection. The operation is safe and effective and it is extremely rare for pregnancy to occur afterwards.
The woman’s menstrual cycle is not affected in any way. She will continue with her monthly periods and will go through the menopause in due course as normal. Libido is also not affected, except that the woman may be more relaxed, because there will be no fear of pregnancy.
There is no increase in the number of hysterectomies (removal of the womb) after tubal ligation either. Women who need this second operation probably would have needed it anyway.
Sterilization is an excellent form of contraception, provided you and your husband are absolutely sure that you will never want any more children.