Female sterilisation is an effective and permanent form of contraception. There is a very small failure rate. Sterilisation is only for people who have decided they do not want any children, or further children in the future. It is considered a permanent method of contraception. Reversal is a complicated operation which is not always successful. Reversal is not usually available on the NHS.
How is it done?
The tubes between the ovary and the womb (the Fallopian tubes) are cut or blocked with rings or clips. This stops the eggs which are released by the ovary from reaching the sperm.
The operation is usually done under general anaesthetic. For most women the operation is done with the help of a special telescope called a laparoscope. The laparoscope is inserted through a very small cut in your abdomen. It allows the surgeon to see what they are doing. Another small cut is then made to insert an instrument to apply clips or rings to your tubes. The clips or rings provide a block in the tubes and prevent egg meeting sperm. A larger cut may have to be made, and a more traditional operation done, in some women. This is more likely if you are overweight or have had previous operations.
A newer procedure is available in clinic under local anaesthetic. This is called hysteroscopic sterilisation. You will be awake and the doctor places an instrument in the vagina, similar to having a cervical screening test. A small camera and tube (hysteroscope) are then passed through the vagina and cervix. A very small implant (called a micro-insert) is placed into each Fallopian tube, using specialised narrow surgical instruments that are passed through the hysteroscope. The presence of the micro-inserts causes scar tissue to form in the Fallopian tubes. This eventually blocks them.
How reliable is female sterilisation?
It is more than 99% effective. Fewer than 1 woman out of 200 will become pregnant after sterilisation. (When no contraception is used, more than 80 out of 100 sexually active women will become pregnant within one year.) Woman become pregnant because the tubes can, rarely, come back together again after being cut. If they were blocked, the clips can work their way off - even when they have been put on correctly.
Hysteroscopic sterilisation is as effective as laparoscopic sterilisation. The woman should use an additional form of contraception until the implants have been shown to be in the correct place. This is usually done by X-ray or ultrasound.
What are the advantages of female sterilisation?
It is permanent and you (and your partner) don't have to think about contraception again.
What are the disadvantages of female sterilisation?
As it is permanent, some people may regret having the operation in future years, particularly if their circumstances change.
Laparoscopic sterilisation is also not as easy to do, or as effective, as male sterilisation (vasectomy). There is a risk from the insertion of the laparoscope which is done 'blind'. This means the surgeon cannot see exactly where they are putting the instrument and it may damage things inside the abdomen. This sounds worrying, but the surgeon will take other precautions to try to avoid causing any harm and, in most cases, this does not happen.
As with any operation there is a risk of a wound infection and the slight risk from a general anaesthetic.
In hysteroscopic sterilisation there is no cut. The surgeon can also see what they are doing more easily. However, this is a newer procedure and quite fiddly. There may not be surgeons available yet at your local hospital who are trained to do this procedure.
How soon is it effective?
Laparoscopic sterilisation should be done whilst you have your period. This means you will not have produced an egg yet. In this case the procedure is effective immediately.
Hysteroscopic sterilisation cannot be done during a period, as the blood blocks the surgeon's view. It is best done as soon after your period ends as possible. It can be done later if you are sure you are not pregnant. It should not be seen as being effective immediately. The consultant will need to check the microstents are in the correct place and working well. This may take up to 3 months. You should use additional contraception until you know that the microstents are in the correct place.
Will it reduce my sex drive?
No. Sex may seem more enjoyable, as the worry of pregnancy and contraception is removed.
Some points to consider
Don't consider having the operation unless you and your partner are sure you do not want children, or further children. It is wise not to make the decision at times of crisis or change - for example, after a new baby or termination of pregnancy. Don't make the decision if there are any major problems in your relationship with your partner. It will not solve any sexual problems.
Doctors normally like to be sure that both partners are happy with the decision before doing this permanent procedure. However, it is not a legal requirement to get your partner's permission. If you have any doubts and questions, make sure you discuss these with your doctor or practice nurse.
Have you considered the alternatives? Female sterilisation is not 100% effective. Other reversible methods of contraception are more effective, such as the intrauterine system (IUS), contraceptive implants and injections. Also, male sterilisation is easier to do and more effective.
Your GP and practice nurse are good sources of information if you have any queries.
The fpa (formerly the family planning association) also provides information and advice.
Helpline: England 0845 122 8690, Northern Ireland 0845 122 8687 or visit their website www.fpa.org.uk
Further reading & references
- Male and female sterilisation, Royal College of Obstetricians and Gynaecologists (2004)
- Hysteroscopic sterilisation by tubal cannulation and placement of intrafallopian implants, NICE Interventional Procedure Guidance (September 2009)
- Contraception - sterilization, Prodigy (Sept 2007)
|Original Author: Dr Tim Kenny||Current Version: Dr Hayley Willacy||Peer Reviewer: Dr John Cox|
|Last Checked: 16/05/2012||Document ID: 4247 Version: 39||© EMIS|
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