Overview

Female sterilisation is an operation to permanently prevent pregnancy. The fallopian tubes are blocked or sealed to prevent the eggs reaching the sperm and becoming fertilised.

Depending on the method used, you would either have a general anaesthetic, where you're asleep during surgery, or local anaesthetic, where you'd be awake but not feel any pain.

Facts about female sterilisation

• Female sterilisation is more than 99% effective at preventing pregnancy.
• You do not have to think about protecting yourself against pregnancy every time you have sex, so it does not interrupt your sex life.
• It does not affect your hormone levels and you'll still have periods.
• You'll need to use contraception up until you have the operation, and until your next period or for 3 months after the operation (depending on the type of sterilisation).
• As with any surgery, there's a small risk of complications, such as internal bleeding, infection or damage to other organs.
• There's a small risk that the operation will not work. Blocked tubes can rejoin immediately or years later.
• If the operation fails, this may increase the risk of a fertilised egg implanting outside the womb (ectopic pregnancy).
• Sterilisation is very difficult to reverse, so you need to be sure it's right for you.
• Sterilisation does not protect against sexually transmitted infections (STIs), so you may need to use condoms as well.

How it works

Female sterilisation works by preventing eggs travelling down the fallopian tubes, which link the ovaries to the womb (uterus).

This means a woman's eggs cannot meet sperm, so fertilisation cannot happen.

Eggs will still be released from the ovaries as normal, but they'll be absorbed naturally into the woman's body.

How female sterilisation is carried out

The surgeon will block your fallopian tubes (tubal occlusion) by either:

• applying clips – plastic or titanium clamps are closed over the fallopian tubes
• applying rings – a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut
• tying, cutting and removing a small piece of the fallopian tube

This is a fairly minor operation and many women return home the same day.

Tubal occlusion procedure

The surgeon accesses your fallopian tubes by making a small cut either near your belly button (laparoscopy) or just above your pubic hairline (a mini-laparotomy).

They'll then insert a long, thin instrument that has a light and camera (a laparoscope) to clearly see your fallopian tubes.

A laparoscopy is usually used because it's faster, but a mini-laparotomy may be recommended for women who:

• have had recent abdominal or pelvic surgery
• are obese
• have a history of pelvic inflammatory disease, a bacterial infection that can affect the womb and fallopian tubes

The fallopian tubes are then blocked by applying clips or rings, or by tying, cutting and removing a small piece of the tube.

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has not worked, the tubes may be completely removed. This is called a salpingectomy.

Is sterilisation right for me?

Almost any woman can be sterilised, but it should only be considered by women who do not want any more children or do not want children at all.

Once you're sterilised it's very difficult to reverse it, so consider all options before making your decision.

Sterilisation reversal is not usually available on the NHS.

You may be more likely to be accepted for the operation if you're over 30 and have had children.

You may also want to consider which method of contraception suits you, such as long-acting reversible contraception (LARC) like an implant, device or injections.

Before the operation

Your GP may recommend counselling before referring you for sterilisation.

Counselling will give you a chance to talk about the operation in detail and discuss any doubts, worries or questions you might have.

If you have a partner, discuss it with them before you decide. If possible, you should both agree to the procedure, but it's not a legal requirement to get your partner's permission.

Your GP can refuse to carry out the procedure or refuse to refer you for it if they do not believe it's in your best interests.

If the GP agrees with your decision, they'll refer you to a female reproductive specialist (gynaecologist) for treatment at your nearest NHS hospital.

You'll need to use contraception until the day of the operation and right up until your next period after surgery if you're having your fallopian tubes blocked.

Sterilisation can be performed at any stage in your menstrual cycle.

Before you have the operation, you'll be given a pregnancy test to make sure you're not pregnant because, once you have been sterilised, there's a high risk that any pregnancy will become ectopic.

Recovering after the operation

You'll be allowed home once you have recovered from the anaesthetic, been to the toilet and eaten.

If you leave hospital within hours of the operation, take a taxi or ask a relative or friend to pick you up.

The healthcare professionals treating you in hospital will tell you what to expect and how to care for yourself after surgery.

They may give you a contact number to call if you have any problems or questions.

If you have had a general anaesthetic, do not drive a car for 48 hours afterwards. Even if you feel fine, your reaction times and judgement may not be back to normal.

How you will feel

It's normal to feel unwell and a little uncomfortable if you have had a general anaesthetic, and you may have to rest for a few days.

Depending on your general health and job, you can normally return to work 5 days after tubal occlusion, but avoid heavy lifting for about a week.

You may have some slight vaginal bleeding. Use a sanitary towel, rather than a tampon, until this has stopped.

You may also feel some pain, like period pain. You can take painkillers for this.

If the pain or bleeding gets worse, try contacting the specialist who treated you, your GP or NHS  Wales111.

Caring for your wound

If you had tubal occlusion, you'll have a wound with stitches where the surgeon made the cut.

The stitches would need to be removed at a follow-up appointment, unless dissolvable ones were used.

If there's a dressing over your wound, you can normally remove this the day after your operation. After this, you'll be able to have a bath or shower.

Having sex

Your sex drive and sex life should not be affected. You can have sex as soon as it's comfortable to do so after the operation.

If you had tubal occlusion, use additional contraception until your first period to protect yourself from pregnancy.

Sterilisation does not protect against sexually transmitted infections (STIs), so you may need to use condoms.

Advantages and disadvantages of female sterilisation

Advantages:

• more than 99% effective at preventing pregnancy
• blocking the fallopian tubes and removal of the tubes should be effective immediately – but use contraception until your next period
• it will not affect your sex drive or interfere with sex
• it will not affect your hormone levels

Disadvantages:

• it does not protect against STIs, so you may need to use condoms
• it cannot be easily reversed, and reversal operations are rarely funded by the NHS
• it can fail – the fallopian tubes can rejoin and make you fertile again, although this is rare
• there's a very small risk of complications, including internal bleeding, infection or damage to other organs
• if you get pregnant after the operation, there's an increased risk it'll be an ectopic pregnancy

Can I get a sterilisation reversal on the NHS?

Sterilisation reversal is not usually available on the NHS.

Success rates vary, and depend on factors like age and the method that was used in the original operation.

It's possible to have a sterilisation reversal done privately, although it'll cost several thousand pounds.

There's no guarantee that you'll be able to get pregnant after a sterilisation reversal.

Where to get more information on sterilisation

You can get more information on sterilisation from:

• GP surgeries
• contraception clinics
• sexual health or genitourinary medicine (GUM) clinics
• some young people's services

Find a sexual health clinic.