Sterilisation for women

What is female sterilisation?

During the latter part of the twentieth century, sterilisation became one of the most popular methods of birth control in the world. Indeed, in 2009 about 160 million women are believed to have had the operation.
However, there are now signs that it is becoming a little less popular. In April 2009, I attended a lecture by a leading gynaecologist in which he revealed that sterilisation rates in the UK and in Ireland have dropped recently.
The reason for this is not clear. No new and alarming ‘side-effects’ of sterilisation have been discovered. However, it seems that some women are turning to other ways of limiting their families, such as the Mirena ‘coil’ or intra-uterine system (IUS).
Also, the sociological changes of recent years, with more and more people forming new relationships or deciding on a second marriage, seem to have made some women feel that – instead of getting sterilised – they should keep alive their options of having a second family.

What is female sterilisation?

‘Sterilisation’ means preventing the woman from becoming pregnant by means of various different operations in which her Fallopian tubes are blocked or cut through – thus making it very difficult for her eggs to reach her womb.
Please note that it’s not quite impossible for those eggs to get through; there is in fact a small ‘failure rate’ for this operation, generally estimated at around 1 in 200. (However, it varies with the method used. You should ask your surgeon to tell you what he or she estimates the success rate of her method to be.)
There is an increasing tendency for gynaecologists to offer newer types of sterilisation operation, in which they do not make any cut in your abdomen. Instead, they work through the vagina, inserting an instrument into the womb and using it to insert a blocking device into each Fallopian tube.
The new Essure method involves fitting a small coil into each Fallopian tube. But please note that, like other methods of contraception, it has a small failure rate.
There are other operations which can cause sterility – for instance hysterectomy (which is removal of the womb). But in general, when a gynaecologist offers you a sterilisation ‘op’, she’s talking about the operation on your tubes.

Who can be sterilised?

Almost any woman can be sterilised – and even today thousands of British couples choose this as their method of contraception. As of 2009, about 13 per cent of all UK females who are of reproductive age have had the operation.
Although surgeons are generally more willing to perform it for women who are over 30 and who have had children, some younger women who have never had a baby do opt for sterilisation.
However, if you are young and childless, you should think very carefully before agreeing to be sterilised; do bear in mind that you might change your mind later on in life – and that reversal of the operation would be very difficult indeed.

Are there ever any medical reasons for not having the op?

Yes: surgery could be a bit difficult – but not impossible – if you’ve ever had one of these conditions:

• prolapse
• fibroids
• cysts on the ovary
• pelvic inflammatory disease (PID), including chlamydia infections and salpingitis.

If you are seriously overweight, it can be quite tricky for the surgeon to get at your tubes. Also, if your general health is poor, then you might not be an ideal candidate for surgery.
You need to take the advice of the surgeon or anaesthetist on this and all matters connected with the operation.

How do you go about getting sterilised?

Personally, I think that in most cases you should begin by contacting your GP. Most good family doctors will want to discuss sterilisation with you in depth, as it is something that should be considered very carefully indeed.
The doctor should tell you about the operation, and about its associated risks. Also, most importantly, he should make it clear that – as we have stated above – sterilisation is not 100 per cent effective against pregnancy. The failure rate is usually about 0.5 per cent – but is a little higher in younger women.
Your GP will then refer you to a gynaecologist, either privately, or under the NHS. Some clinics in the family planning field offer a sterilisation service. These include the British Pregnancy Advisory Service (Tel: 08457 30 40 30) and Marie Stopes Clinics (Tel: 0845 300 0212). They do ‘contract sterilisations’ for the NHS, and also private ones.
You can if you wish go directly to a reputable sterilisation clinic such as Marie Stopes or BPAS, without involving your own doctor, and pay them privately. At the present moment (2009) BPAS charges £950 for a sterilisation. They will usually want to write to him after the operation, to tell him it’s been done – but this isn’t compulsory, and a few women don’t actually want to inform their GPs.

Do women regret being sterilised?

You have to accept that once you are sterilised, you will almost certainly not be able to have any more children, since reversal of the operation is difficult. Nowadays, many women have more than one long-term relationship or marriage, and it has become quite common for a sterilised woman to later want another baby if she has a new man in her life.
For the sake of completeness I should add that a woman who has been sterilised, but then really wants to have a baby, does nowadays have the opportunity of ‘in vitro fertilisation’ (IVF treatment). Indeed, one of the world’s first ‘Test tube babies’ was born to a mother who had had her tubes removed. However, IVF is extremely expensive – and only works in a minority of cases.

What is done in the operation?

If you are certain of your decision, the operation itself should be fairly straightforward. The Fallopian tubes (where the egg is fertilised by the sperm) are blocked by the surgeon in one of several ways, thus making fertilisation unlikely – unless you have very bad luck!
Your periods should not be affected by the operation though it is sometimes claimed that post-sterilisation periods are heavier in some women. Recent scientific evidence (2009) does not support this.
Your hormone production and libido should remain the same – unless the operation has somehow affected you psychologically.
In the old days, most women were admitted to hospital for the operation – and stayed in for some days. Nowadays, most sterilisation operations are conducted as day-cases – in other words, you’ll probably be able to go home that evening.
The traditional way of sterilising somebody was through a cut (a few inches long) in the lower part of the tummy. Alternatively, the cut could be made in the topmost part of the vagina. Both these procedures nearly always required a general anaesthetic.
However, in recent years it’s become much more common to do the ‘milder’ and less upsetting laparoscopic operation. (It’s sometimes referred to as ‘the Band-Aid op’ – because incisions in your tummy can be covered by just a small piece of sticking-plaster.)
It is carried out through either one or two tiny ‘nicks’ in your lower abdomen. Generally, the surgeon makes the first little incision immediately below your navel – where a scar isn’t likely to be very visible. Through this incision, she inserts a laparoscope.
A laparoscope is a thin metal 'telescope' that lets the surgeon see your two Fallopian tubes. With the aid of the laparoscope, she can ‘seal off’ the tubes, using rings or electrical coagulation. However, some surgeons prefer to put clips on your tubes. To do this, another instrument has to be inserted through a second small incision.
Although quite a few sterilisations are still carried out under general anaesthetic, recent years have seen an increasing tendency for the operation to be done under ‘local’ – which many women prefer. Also, local anaesthetic is safer for you than having a ‘general'.
At the large charitable clinics, such as Marie Stopes, they tend to use ‘twilight’ techniques – which means combining a local anaesthetic with enough sedation to make you quite pleasantly ‘woozy'.
Obviously, you must not drive yourself home on the day of the operation!

What is the cost of the operation?

In recent years, female sterilisation has become rather more difficult to obtain free – ie under the National Health – in many parts of the country. So, many people go to private gynaecologists, or to large charitable organisations like BPAS or Marie Stopes. Charges at charitable bodies currently range between £950 and £1,300.
A private surgeon can charge whatever the ‘market’ can stand – currently up to £3,000.

Does sterilisation work immediately?

Sterilisation of women should work immediately, but it's important that you're not already pregnant when the op is done – or have active sperm inside you from love-making the night before !
Some women continue using their current method of contraception for a little while – for instance, till the next period. A few will keep a coil (IUD) in for a short time.

What is the risk of pregnancy after sterilisation?

Please note that as we have said above, every now and then a woman who has been sterilised does get pregnant. The approximate risk is usually estimated at 1 in 200 patients, but it might be higher with certain newer ‘quick sterilisation’ methods.
If pregnancy does occur, you must appreciate that it could be an ectopic one – that is, one which develops outside the womb, probably in the remains of the Fallopian tube.
So if you ever miss a period, you should get a pregnancy test done. Pain is often a warning sign of an ectopic pregnancy. If in doubt, ring your doctor.

Are there any other health risks from sterilisation?

Any type of surgery can go wrong, and this is particularly true of laparoscopic surgery.
Very occasionally, a gynaecologist may damage the bowel or womb, or the urinary apparatus. In general, the more experienced the surgeon, the less likely it is that any of these complications happens.
General anaesthetics carry a small risk to health (greater than that of ‘locals’), which is one reason why in 2009 there’s an increasing tendency to opt for local anaesthesia. (Also, the cost is less.)
A new development, reported in 2009, is a 15-minute operation which involves putting a tiny ‘transmitter’ device into each Fallopian tube . It gives out a low-level radio signal which creates heat and thus blocks the tube. How effective this will be still remains to be seen.