Ask the expert


Female sterilisation

I'd like some advice about female sterilisation. I have two children and do not want anymore. I've tried different types of pill, coil and implant over the years and suffered various side effects. Thanks.

1 March 2021

Female sterilisation is an effective way of preventing further pregnancies that involves preventing the ovum passing along the fallopian tubes to be fertilised by the sperm.

It is known to be about 99% effective and is usually considered if both partners are absolutely certain that they do not wish to have any more children.

Once this decision has been made, counselling is often recommended to ensure that the procedure method and effects are understood, as reversal of the procedure is often difficult to achieve.

Sterilisation is generally performed by laparoscopic means (keyhole surgery) or by laparotomy (incision through the abdomen to gain access to the abdominal cavity). It may also be done by hysteroscopy, in which the uterus is accessed via the vagina using a narrow telescope with a light and camera at the end.

The procedure is usually carried out as a day case. Anaesthesia given will be general or local depending on methodology of the sterilisation.

The usual methods of sterilisation involve either blocking the fallopian tubes with implants; occluding the fallopian tubes by the use of rings and clips; tying and cutting the fallopian tubes.

Blocking the fallopian tubes with implants

This is performed by means of a hysteroscopy where implants are inserted into the fallopian tube by means of a tube being passed through the vagina, through the uterine cavity and into the fallopian tubes. It is a non-surgical means of sterilisation.

The implant is left in place and causes an inflammatory reaction, which causes scarring to occur. This scarring builds up and means that the fallopian tubes will not be able to allow an ovum to pass through. A scan will need to be performed after a few months to ensure that the tubes are effectively blocked.

Contraception will need to be used until confirmation of successful sterilisation has been given.

Clipping or ring method of sterilisation

This procedure is surgical and will involve small incisions being made at the umbilicus (navel or tummy button) and pubic hair regions. These incisions are to allow the use of camera equipment to guide the surgeon and to allow access to the fallopian tubes so that these forms of ligature can be applied. Rings or clips are applied to a section of the fallopian tube and these are then tightened to block off any access and therefore prevent ovum passing through to the uterine cavity.

Tying and cutting (Salpingectomy)

This again is done by laparoscopic means and involves the cutting of a section of the fallopian tubes and each of the ends being tied.

Sterilisation at time of caesarean section

Sterilisation by means of  cutting/ligation can be considered at the time of having a caesarean section, providing you have been appropriately counselled and are sure that you should not wish to have more children.

The technique is the same as ligation sterilisation otherwise but it is important that you are aware that there is a slightly raised risk of failure or the tubes re-joining and pregnancy/ectopic pregnancy resulting.

There is approximately about 1:200 risk of sterilisation failing if down at caesarean section.

Sterilisation - preparation and recovery

Before the sterilisation procedure the risks and benefits should be discussed fully. It is essential that effective contraception is used leading up to the surgery to prevent a pregnancy occurring. A pregnancy test will be performed on the day of the procedure to confirm that there is no pregnancy present.

Following surgery, recovery should be straight forward and after the first few days where discomfort will be felt normal activities should be able to be resumed. If there are wounds from surgery these need to be kept clean and the stitches if not dissolvable will need to be removed. Signs of infection and bleeding should observed for and medical help sought in event of this happening.

Contraception will need to be continued as advised by your surgeon until confirmation of successful sterilisation has been given. This is usually for 1-3 months depending on the type of sterilisation performed.

Sterilisation does not interfere with intimacy and does not mean that you will undergo menopause earlier.

Answered by the Health at Hand team.

Further information

Women's health hub - AXA Health

Female sterilisation - NHS guide

The Royal College of Obstetricians and Gynaecologists (RCOG)

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