Monday, February 15, 2010

Contraception - Female Sterilisation

Monday 15th February 2010

Female sterilisation is an effective and permanent form of contraception.

The operation usually involves cutting, sealing or blocking the fallopian tubes, which eggs travel through from the ovaries to the womb. This prevents the eggs from reaching the sperm and becoming fertilised.

How popular is it?

Every year, thousands of UK couples choose sterilisation as their method of contraception. It has become increasingly popular since the late 1960s. In 2001, one in 10 women aged under 50 was sterilised in the UK.

Who is it for?

Almost any woman can be sterilised. However, sterilisation should only be considered by women who do not want any more children, or do not want children at all. Once you are sterilised, it is very difficult to reverse the process (see Risks, above), so it is important to consider the other options available (see box, right).

Surgeons are more willing to perform sterilisation for women who are over 30 and who have had children, although some younger women who have never had a baby choose it.

How effective is it?

Female sterilisation is more than 99% effective, and only one in 200 women will become pregnant after the operation. It can be reversed, but the success rate is much smaller, with only 50-80% of fertility returning, depending on age and what sterilisation methods were used.

How sterilisation is carried out

Sterilisation is usually done using a technique called tubal occlusion (blocking the fallopian tubes), where a cut is made in your abdominal wall to access your fallopian tubes.

In 2004, the National Institute for Health and Clinical Excellence (NICE) published guidelines (see Useful links) on a relatively new technique that does not involve cutting into the body. This is called hysteroscopic sterilisation, and involves inserting implants into the fallopian tubes. However, the technique is not yet widely available.

Both procedures are described below.

Tubal occlusion

First, doctors need to examine your reproductive organs, using either laparoscopy or mini-laparoscopy.


This is the most common method of accessing the fallopian tubes. The doctor makes a small cut in your abdominal wall, and inserts a laparoscope (a long, thin tube with a tiny camera lens attached), which lets them clearly see your fallopian tubes. Additional cuts can be made if other instruments, such as surgical scissors, need to be inserted.


This involves a smaller incision than a laparoscopy (usually less than two inches), just above the pubic hairline. The fallopian tubes are pulled out of the incision, operated on, and then put back into place. This procedure may be appropriate for women who have just had a baby, or have had recent abdominal or pelvic surgery.

Blocking the tubes

The fallopian tubes can be blocked using one of the following methods:

  • Applying clips: plastic or titanium clamps are closed over the fallopian tubes.
  • Applying rings: a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut.
  • Tying and cutting the tube: this destroys 3-4cm of the tube.
  • Sealing the tubes (electrocoagulation): a harmless electrical current is used to burn a small portion of each fallopian tube and seal it closed.

Fallopian implants

These are usually inserted under local anaesthetic. A tiny piece of titanium metal called a microinsert is guided through your vagina and cervix and into each of your fallopian tubes, using a small flexible tube (a hysteroscope) and a guidewire. This means that the surgeon does not need to cut into your body.

The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

Recovering from sterilisation

Your doctor will tell you what to expect and how to care for yourself after surgery.

If you have had a general anaesthetic, you should not drive a car for 12 hours after the operation. If you leave hospital within hours of the operation, do not try to drive home. Ask a relative or friend to pick you up, or take a taxi.

How you will feel

It is normal to feel unwell and a little uncomfortable for a few days if you had a general anaesthetic. You may have to rest for about a week.

Also, you may notice some slight bleeding and pain. There is no need for concern, but see your GP if it gets worse.

Having sex

Your sex drive and enjoyment of sex will not be affected. You can have sex as soon as it is comfortable to do so after the operation, but if you had tubal occlusion, you will need to use contraception until your first period to protect yourself from pregnancy.

If you had an implant fitted, you will need to use another form of contraception for the first three months after surgery. After three months, X-rays will be used to check that the implants are in the correct position.

Remember, sterilisation will not protect you from sexually transmitted infections, so continue to use barrier contraception, such as condoms, if you are unsure of your partner's sexual health.

This information was sourced from the NHS website.




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