Female sterilization is an effective form of contraception that permanently prevents a woman from becoming pregnant. Sterilization does NOT protect against sexually transmitted infections (STIs), including HIV.
The operation involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb. This prevents the eggs from reaching the sperm and becoming fertilized. It can be a fairly minor operation, with many women returning home the same day.
In most cases, female sterilization is more than 99% effective, and only one in 200 women will become pregnant after the operation.
Almost any woman can be sterilized. However, sterilization should only be considered by women who do not want any more children, or who do not want children at all. Once a woman is sterilized, it is very difficult to reverse the process, so it is important to consider other contraceptive options.
Couples often decide upon sterilization mutually, when they both feel they do not want any more children. If a couple decides upon sterilization as their preferred contraceptive method, either partner could be sterilized. If both options are acceptable, vasectomy is preferable. It is simpler, safer, easier and less expensive.
More frequently, sterilization is performed when women are over 30 years old and have had children, although some younger women who have never had a baby choose it.
Some clients incorrectly believe that female sterilization will cause women to develop cancer of the reproductive organs (uterus, cervix, or ovaries).
Female sterilization does not increase the risk of cancer of the reproductive organs which are defined below. In fact, several studies have reported a reduced risk of ovarian cancer after tubal occlusion. Very little research has been done to investigate the relationship between breast cancer and female sterilization, but so far there is no evidence of such a link.
Uterine Cancer: Cancer that forms in tissues of the uterus (womb). Two types of uterine cancer are endometrial cancer (cancer that begins in cells lining the uterus), and uterine sarcoma (a rare cancer that begins in muscle or other tissues in the uterus).
Cervical Cancer: Cancer that forms in tissues of the cervix (the lower end of the uterus). It is usually a slow-growing cancer that may not have symptoms, but can be found with regular screening.
Ovarian Cancer: Cancer that forms in tissues of the ovary. Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in cells that line the ovary) or malignant germ cell tumors (cancer that begins in egg cells).
Myth: General Procedure
Some clients incorrectly believe that female sterilization involves the removal of some or all of a woman’s reproductive organs, including the vagina.
During the sterilization procedure, the ovaries, uterus, and cervix are left in place. Only the fallopian tubes (the tubes which carry eggs from the ovaries to the uterus) are blocked or cut. The two most common surgical approaches are laparoscopy and minilaparotomy:
Minilaparotomy involves making a small incision in the abdomen (measuring 2-5 centimeters), and the fallopian tubes are brought to the incision to be tied and cut or else closed with a clip or ring. The doctor inserts a special instrument (uterine elevator) into the vagina, through the cervix, and into the uterus to raise each of the two fallopian tubes so they are closer to the incision.
Laparoscopy involves inserting a long thin tube with a lens in it (a laparoscope) into the abdomen through a small incision (measuring about 1 centimeter). This laparoscope enables the doctor to see and to close each tube with a clip, a ring, or block it by electric current.
Myth: Health Risks and Side Effects
Some clients incorrectly believe that female sterilization leads to health risks or side effects such as hysterectomy, poor health, pain, or hormonal imbalances.
There are no documented medical side effects of female sterilization. The few complications that do occur during or following sterilization, such as infection or abscess of the wound, can generally be kept to a minimum if appropriate techniques are used and if the procedure if performed in an appropriate setting. Local anesthesia is best for female sterilization because it has lower risks of complications than use of general anesthesia. The risks are lowest when local anesthesia is used without sedatives. If sedatives are used, providers should closely monitor the woman’s vital signs, such as pulse rate and blood pressure throughout the procedure.
Some incorrectly believe that sterilization will cause a woman to need a hysterectomy. Recent research shows that sterilization does not appear to increase the need for a hysterectomy, however. Sterilization has no biologic relationship with hysterectomy. Hysterectomies are often done to treat menstrual disorders and women who are sterilized may be more likely to consider having hysterectomies to treat such disorders because they are not worried about losing their fertility.
Female sterilization does not cause lasting pain in the back, uterus, or abdomen. There is often some minor pain during the procedure. Women receive local anesthetic to stop pain during the procedure, and, except in special cases, women remain awake. A woman can feel the health care provider moving her uterus and tubes. This can be uncomfortable. If a trained anesthetist or anesthesiologist and suitable equipment are available, general anesthesia may be chosen for women who are very frightened of pain. A woman may feel sore and weak for several days or even a few weeks after surgery, but she will soon regain her strength. She can take ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever, but not aspirin. Stronger pain reliever is rarely needed.
Female hormones are not affected by female sterilization, and there will be neither a loss of femininity nor any change in sexual functioning.
Myth: Mechanism of Action
Some people incorrectly believe that female sterilization prevents pregnancy either by stopping ovulation or by killing a woman’s egg.
Female sterilization does not stop ovulation or harm a woman’s egg in any way. An egg will still be released each month, but it will dissolve and be reabsorbed by the body.
Female sterilization prevents pregnancy by cutting or blocking the fallopian tubes (the tubes which carry eggs from the ovaries to the uterus) so that sperm cannot move up to meet the egg. There are several ways of blocking the fallopian tubes: tying them (ligation), removing a small piece of the tube (excision), sealing (cauterization), or applying clips or rings.
Myth: Menstrual Bleeding
Some clients incorrectly believe that female sterilization will cause irregular or heavier menstrual bleeding or make monthly bleeding stop (amenorrhea).
Most research finds no major changes in bleeding patterns after female sterilization. If a woman was using a hormonal method or IUD before sterilization, her bleeding pattern will return to the way it was before she used these methods. For example, women switching from combined oral contraceptives (COCs) to female sterilization may notice heavier bleeding as their monthly bleeding returns to usual patterns. Note, however, that a woman’s monthly bleeding usually becomes less regular as she approaches menopause.
Myth: Sexual Pleasure
Some clients incorrectly believe that female sterilization causes women to lose their sex drive or lose their sexual ability.
After sterilization a woman will look and feel the same as before. There is no loss of sexual drive or interest after female sterilization. She can have sex the same as before. She may find that sex is more enjoyable because she does not have to worry about getting pregnant.
Myth: Weight Changes
Some clients incorrectly believe that female sterilization will cause women to lose weight or to gain weight or that female sterilization will disfigure a woman’s body.
Sterilization does not cause any changes in weight, appetite, or appearance. However, older women are more likely to choose sterilization for contraception than younger women and most women gain weight as they age.
Myth: Who Can Use the Method
Some women avoid female sterilization because they incorrectly believe that only women of a certain age or who have a certain number of children can undergo female sterilization.
All women can undergo female sterilization safely with proper counseling and informed consent. There is no justification for denying sterilization to a woman because of her age, the number of her pregnancies or living children, or her marital status. Health care providers must not impose rigid rules about age, number of children, age of last child, or marital status. If a specific woman’s situation suggests to a provider that she could have regrets later, the provider should help the woman think through her decision carefully. Ultimately, however, each woman must be allowed to decide for herself whether or not she will want more children and whether or not to have sterilization.