A B C D E F G H I J K L M N O P R S T U V W

STERILIZATION (FEMALE)

Why is Female Sterilization ?

Sterilization is usually done at the couple's own request and may be done on either partner. Most couples make the decision when they have completed their family and other contraception is not acceptable. Occasionally a woman may be advised by her doctor that she ought to be sterilized on medical grounds. The medical reasons include some forms of cancer or heart disease. If a woman has had more than three Caesarean operations, sterilization might be suggested. On whatever basis the decision is made it must be discussed fully beforehand. The following points must be understood before signing consent. The operation should be regarded as irreversible. It is possible to reverse some sterilizations but it is a major operation with no guarantee of success. Sterilization should not be approached in the belief that it can always be reversed if desired. There is a small failure rate with a one in two hundred chance of becoming pregnant at some point following sterilization. If pregnancy does occur in a woman who has been sterilized there is a greater risk that this will be an ectopic pregnancy. Please refer to the separate information sheet on vasectomy (male sterilization).

Preparations needed for Female Sterilization

FEMALE STERILIZATION This is usually done as a laparoscopy. At most, women are in hospital for two nights and usually only as a day case. Contraception should continue until the operation. A general anaesthetic is usually required, and the doctor should be told about any allergies or drugs being taken. If the operation in is done during the second half of the monthly cycle (i.e. more than14 days after the start of the last period) and the woman has had unprotected intercourse since her last period there is a risk of pregnancy occuring. This is because the fertilised egg may already have travelled down the tube into the womb. Return to work is possible in a few days. Occasionally a laparoscopy will not be appropriate and a more formal operation is needed. In this case, hospital care is needed for 2 to 3 days, and you will be off work for 4 to 6 weeks.

What Happens during Female Sterilization

The process of fertilization has been briefly described in ectopic pregnancy. The idea of sterilization is to make it impossible for the sperm and egg to meet in the tube. LAPAROSCOPY There will be a small cut in the navel through which the telescope is inserted. The surgeon can see the tubes clearly. A tiny second incision is made in the lower abdomen and a thin instrument introduced. This is designed to put either plastic clips or rings on the tube. The surgeon checks that the clips or rings are correctly placed by looking down the telescope. OTHER PROCEDURES If an operation such as a Caesarean is being done, the tubes can be tied and cut at the same time. They may also be removed completely. Sometimes if a woman is having very troublesome periods she may prefer a hysterectomy. Occasionally in the case of breast cancer, removal of the ovaries may be suggested. This may be beneficial to the cancer and guarantees no further pregnancies.

Possible Complications during Female Sterilization

The bigger and longer an operation, the greater the risk. Laparoscopy is a short operation and the risks are very small. There is a small risk of injury to the bowel or blood vessels inside the abdomen. If this occurs a larger operation may be needed to repair the damage. Sometimes it is not possible to see the tubes clearly to place the clips. In this case the surgeon will do a small, open operation and abandon the laparoscopy. If the abdomen is opened in this more formal way it means a longer operation. It also means a longer hospital stay. It is possible but very rare to conceive after sterilization. If so, the doctor should be contacted immediately. The pregnancy could be ectopic. Some women regret sterilization, especially if they remarry. Therefore the decision should be very carefully thought out. Some women notice heavier periods after sterilization. This is usually because they have been using the contraceptive pill before sterilisation and this tends reduce the heaviness of periods. When they stop the pill after sterilisation their "normal" period pattern returns and this may be heavier or more irregular. Sterilization will not alter hormone levels or sexuality in any way. Very occasionally women who have had a clip or ring on the tubes get pain which lasts many months. This is rare but may require the removal of the tubes.

Afterwards

After female sterilization the periods will continue unless the ovaries or womb have been removed. Intercourse can be resumed as soon as desired. If the woman was on the contraceptive pill she should continue to take this until her next period. If she has a coil (IUCD) in the womb this can be removed at the same time as sterilisation provided this is carried out in the first half of the monthly cycle otherwise it will need to be left in until the next period. If properly counselled, love life should, if anything, be better. Menopause can be expected at the normal time.

If Female Sterilization is not performed

Obviously contraception would need to continue. It is vital that such an important step is fully discussed and understood before making the final decision.