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Tubal Ligation

(Female Sterilization)

Tubal ligation is surgical procedure you may choose if you are an adult woman and you do not want to get pregnant in the future. You may have heard tubal ligation referred to as "getting your tubes tied."

The word tubal refers to the fallopian tubes that carry the egg released from an ovary to your uterus every month. The word ligation means to tie off. Since this procedure prevents the egg and male sperm from connecting, it prevents pregnancy from occurring. It is also called a female sterilization procedure.

Men can choose to become sterile by having a procedure called vasectomy. In the U.S., one out of every four couples relies on sterilization (vasectomy or tubal ligation) as their form of birth control.

Procedure overview

During tubal ligation surgery, both fallopian tubes are blocked or cut. The procedure is usually done in the hospital or in an outpatient surgical clinic. In most cases you will be able to go home on the day of surgery. You may have this surgery done under general anesthesia (being asleep), or local or spinal anesthesia (anesthesias that leave you awake, but unable to feel pain).

After tubal ligation, you will still have your periods and enjoy sex normally. In fact, many women feel more at ease with sex after tubal ligation because they do not have to worry about unwanted pregnancy.

You should consider tubal ligation as a permanent decision not to become pregnant. Although tubal ligation may be reversed by another operation, only about 50 to 80 percent of women are able to become pregnant after having their fallopian tubes reattached. You should also know that tubal ligation does not prevent sexually transmitted disease, so you will still need to practice safe sex.

Reasons for the procedure

Choosing sterilization as a form of birth control may be a good choice if:

  • You are an adult woman.

  • You are in a stable relationship in which both partners have agreed to permanent birth control.

  • Pregnancy would be a health risk for you.

  • You or your partner has a genetic disorder that you don't want to pass on to a child.

If you are unsure if you will want to become pregnant in the future or if you may have other partners in the future, which might make you reconsider getting pregnant, this form of birth control may not be the best choice for you.

Risks of the procedure

Tubal ligation is a safe procedure, but all surgeries carry some risks. Serious problems after tubal ligation occur in less than one out of 1,000 women. You will need to sign a consent form that explains the risks and benefits of the surgery and you should discuss these risks and benefits with your surgeon. Some potential risks of tubal ligation include:

  • Bleeding from a skin incision or inside the abdomen

  • Infection

  • Damage to other organs inside the abdomen

  • Side effects from anesthesia

  • Ectopic pregnancy (an egg that becomes fertilized outside the uterus)

  • Incomplete closing of a fallopian tube that results in pregnancy

Even though tubal ligation is a safe and effective form of birth control, about one out of 200 women may still become pregnant after tubal ligation. Having tubal ligation just after your period starts may avoid the possibility that an already fertilized egg will reach your uterus after surgery.

If you have diabetes or a history of previous abdominal surgery, pelvic inflammatory disease, or lung disease, or are overweight, you may have a higher risk for problems after tubal ligation. Having tubal ligation may decrease your risk of getting ovarian cancer.

There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.

Before the procedure

In the days before your surgery, tell your surgeon about any medications you take at home, including herbal supplements and over-the-counter medications. You may have to stop taking aspirin or other medications that thin your blood and may increase bleeding.

Other points to go over include:

  • Tell your doctor if you or someone in your family has any history of reaction to general or local anesthesia.

  • If you smoke, you may be told to stop smoking well before surgery.

  • On the day and night before surgery you may be given instructions for when to stop eating and drinking. If you are having general anesthesia, it is common to have nothing to eat or drink after midnight.

  • Ask your surgeon if you should take your regular medications with a small sip of water on the morning of the procedure.

  • Wear loose comfortable clothing on the day of surgery to have an easier time getting dressed afterward.

  • If you are having the surgery as an outpatient, arrange for someone to drive you home and stay with you during the early recovery period.

During the procedure

Before the procedure starts you will have an intravenous line (IV) started so you can receive fluids and medications to make you relaxed and sleepy. If you are having general anesthesia, medication may be given through the IV to put you to sleep and a tube may be inserted in your throat so that you can inhale the anesthesia through your lungs.

If you are having local or spinal anesthesia, you will be given a numbing medication in your abdomen or in your spinal area. You may remain awake during surgery, but you should not feel any pain. The actual surgery takes about 30 minutes.

Here is what typically happens during the procedure:

  1. One or more small incisions will be made near your belly button. Sometimes a small incision is made in the lower abdomen as well.

  2. Gas may be pumped into your belly to inflate it to give your surgeon a better view and more room to work.

  3. A narrow tube with a light and a camera on the end is inserted into your abdomen. This tube is called a laparoscope.

  4. Your surgeon will use long, thin instruments inserted through the laparoscope or through another tiny cut to locate and grab hold of the fallopian tubes.

  5. The tubes may be "ligated" by some combination of cutting, tying, clamping, and banding, or by sealing them off with an electric current. 

  6. After surgery is completed, the incisions in the skin will be closed, probably using one or two stitches, and covered with small dressings.

After the procedure

After your surgery, you will be taken to the recovery room to be observed while you recover from the anesthesia. Your IV will be removed once you can drink fluids. You will probably be able to go home in about three hours.

Here is what you can probably expect at home:

  • You will be able to gradually resume your normal diet.

  • Some discomfort is normal; you should ask your surgeon what medications to take for pain.

  • You may experience shoulder pain for a few days from the gas that was pumped into your belly. Lying down for a while often relieves this pain.

  • Your incision areas should be kept dry for a few days. Follow your surgeon's instructions on bathing and dressing care. You may need to go back to have your sutures removed. Keep all your follow-up appointments.

  • You should gradually be able to resume normal activities in a few days.

  • You should avoid heavy lifting for a few weeks. Ask your doctor when you can return to specific activities.

  • You may be able to return to sexual activity in about one week.

Notify your surgeon about any of the following:

  • Increasing pain or pain that is not relieved by medication

  • Any drainage, bleeding, redness, or swelling

  • Fever

  • Vomiting or persistent nausea

  • Dizziness or fainting spells