PERMANENT CONTRACEPTION: STERILISATION
Tubal ligation. Having the fallopian tubes ‘cut and tied’ or ‘clipped’ provides a fairly neat way of preventing sperm going up the tubes and eggs going down the tubes, so it is an effective way of avoiding getting pregnant, particularly if you are certain you won’t want any future pregnancies.
The procedure is done under a general anaesthetic, and is usually performed using a laparoscope, or less frequently now a laparotomy. The fallopian tubes are identified and either blocked with special little clips, or cut, a piece removed, and the ends tied off.
The whole business is not without potential problems, for example the risks associated with having a general anaesthetic, or the clips not working, or bleeding, etc. The risks of these things happening are very small. The failure rate of the procedure as a contraceptive is about one in 1,000.
Tubal ligation has also been in the news because of suggestions that it can cause problems with the ovary. The truth, or otherwise, of these claims is still the subject of further research.
Some women report that their periods are heavier and more painful following tubal ligation. This may in part be due to the fact that they cease the oral contraceptive pill after the procedure, and the effect of the pill on the periods is lost, and more ‘normal’ periods return.
However, it is a relatively safe, effective form of permanent contraception. The big word is ‘permanent’. Embarking on sterilisation thinking that it is a reversible procedure is not a good idea. Yes, it is true that many women and men have reversals of their sterilisation procedures, but it is a tricky business. Technically it involves a major operation, and there are no guarantees that it will work. The success rate varies, averaging between 30 to 60 per cent. If a woman does get pregnant following a reversal of sterilisation, she runs an increased chance of that pregnancy being ectopic, which is a life-threatening condition.
Doctors will often want to be sure that the person undergoing tubal ligation understands the permanent nature of the procedure. It is unusual for doctors to offer it to young women, as there is a higher rate of requests for reversal in women under the age of 27. It is not recommended that women should have this procedure done at the time of either a caesarean delivery or termination of pregnancy for the same reasons, as women are often in a state of emotional vulnerability at these times. However all cases are judged on individual circumstances.
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