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    Tubal ligation


    Definition of tubal ligation

    A tubal ligation — also known as having your tubes tied or tubal sterilization — is a type of permanent birth control. During a tubal ligation, the fallopian tubes are cut or blocked to permanently prevent pregnancy. A tubal ligation disrupts the movement of the egg to the uterus for fertilization and blocks sperm from traveling up the fallopian tubes to the egg. A tubal ligation doesn’t affect your menstrual cycle.

    A tubal ligation can be done at any time, including after childbirth or in combination with another abdominal surgical procedure, such as a C-section. It’s possible to reverse a tubal ligation — but reversal requires major surgery and isn’t always effective.

    Why it’s done

    Tubal ligation is one of the most commonly used surgical sterilization procedures for women. Tubal ligation permanently prevents pregnancy, ending the need for any type of contraception. A tubal ligation may also decrease the risk of ovarian cancer.

    Tubal ligation isn’t appropriate for everyone, however. Your doctor or health care provider will make sure you fully understand the risks and benefits of this procedure. Your doctor may also talk to you about other options, such as hysteroscopic sterilization. Hysteroscopic sterilization involves placing a small coil or other insert into the fallopian tubes through the cervix. The insert causes scar tissue to form and seal off the tubes.

    Risks of tubal ligation

    Tubal ligation is an abdominal operation. Risks associated with tubal ligation include:

    • Damage to the bowel, bladder or major blood vessels
    • Adverse reaction to anesthesia
    • Wound doesn’t heal properly or becomes infected
    • Prolonged pelvic or abdominal pain

    You may be at higher risk of complications from a tubal ligation if:

    • You’ve had previous pelvic or abdominal surgery
    • You have a history of pelvic inflammatory disease, obesity or diabetes

    A tubal ligation won’t protect you from sexually transmitted infections.

    In the first year after a tubal ligation, an estimated 1 out of 100 women will get pregnant. The younger you are at the time of a tubal ligation, the more likely the sterilization is to fail. If you do conceive after having a tubal ligation, there’s a higher chance that the pregnancy will be ectopic — when the fertilized egg implants outside the uterus, usually in a fallopian tube.

    How you prepare for tubal ligation

    Before you have a tubal ligation your health care provider will likely:

    • Review the risks and benefits of reversible and permanent methods of contraception
    • Ask about your reasons for choosing sterilization and discuss factors that could lead to regret, such as a young age or marital discord
    • Explain the details of the procedure
    • Discuss the causes and probability of sterilization failure
    • Share information about tubal ligation reversal
    • Help you choose the best time to do the procedure, such as shortly after childbirth or in combination with another abdominal surgical procedure, such as a C-section

    If you’re not having a tubal ligation shortly after childbirth or during a C-section, you should use contraception for at least one month before the procedure and continue using contraception until your next period to decrease the likelihood of pregnancy. Having the procedure done during your period or during the days between your period and ovulation also reduces the chance of pregnancy at the time of the procedure. Your health care provider may give you a sensitive pregnancy test on the day of surgery to make sure you’re not pregnant.

    What you can expect

    Tubal ligation is usually done with a laparoscope — a thin tube equipped with a camera lens and light — under short-acting general or regional anesthesia. It can be done while you’re recovering from vaginal childbirth (minilaparotomy) or during a C-section delivery. It can also be done as an outpatient procedure (interval tubal ligation) separate from childbirth.

    During the procedure

    If you have a tubal ligation as an outpatient procedure, a needle is inserted through your navel and your abdomen is inflated with gas (carbon dioxide or nitrous oxide). Then a small incision is made, and the laparoscope is inserted into your abdomen. In some cases, your doctor may make a second small incision to insert special grasping forceps. Using instruments passed through the abdominal wall, your doctor seals the fallopian tubes by destroying segments of the tubes or blocking them with plastic rings or clips.

    If you have a tubal ligation after vaginal childbirth, your doctor will likely make a small incision under your navel, providing easy access to your still enlarged uterus and fallopian tubes. If you have a tubal ligation during a C-section, your health care provider will use the incision that was made to deliver the baby.

    After the procedure

    If your abdomen was inflated with gas during the procedure, the gas will be withdrawn. You may be allowed to go home several hours after the procedure. If you have the procedure in combination with childbirth, the tubal ligation isn’t likely to prolong your hospital stay.

    Whether or not you have the tubal ligation in combination with childbirth, you’ll need to rest for at least a day after the procedure. You will have some discomfort at the incision site. You might also experience:

    • Abdominal pain or cramping
    • Fatigue
    • Dizziness
    • Gassiness or bloating
    • Shoulder pain
    • Sore throat

    You may take acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) for pain relief, but avoid using aspirin, since it may promote bleeding. You may bathe 48 hours after the procedure, but avoid straining or rubbing the incision for one week. Carefully dry the incision after bathing.

    Avoid strenuous lifting and sex for one week. Resume your normal activities gradually as you begin to feel better. Your stitches will dissolve and won’t require removal. Make an appointment to see your health care provider a week after the procedure to make sure you’re healing properly.

    Contact your health care provider immediately if you experience:

    • A temperature of 101 F (38.3 C) or greater
    • Fainting spells
    • Severe abdominal pain that’s persistent or gets worse after 12 hours
    • Bleeding from your incision that’s persistent or gets worse after 12 hours, despite use of pressure and bandages
    • Discharge from your incision that’s persistent or gets worse

    If you think you’re pregnant at any time after the tubal ligation, contact your health care provider immediately.

    Keep in mind that although tubal ligation reversal is possible, the procedure is complicated and not guaranteed to be effective.