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Soon after the Supreme Court overturned the right to a legal abortion, searches for female sterilization skyrocketed. With Supreme Court Justice Clarence Thomas expressing his intention to revisit past decisions, including those related to access to contraceptives, you might be considering whether permanent birth control, such as tubal sterilization, is the best option for you.
If you're still in your child-bearing years and are absolutely certain you don't want more children, sterilization could be the ideal choice for preventing unexpected pregnancies. Although the procedure is more invasive and takes longer to recover from compared to having your partner undergo a vasectomy, the advantage is that it directly eliminates the risk, as you are the one who can become pregnant.
The Two Methods of Tubal Sterilization
There are two main types of tubal sterilization procedures, each differing in how they block the fallopian tubes. For a quick refresher on reproductive anatomy, each month, an egg is released from one of your ovaries and travels down your fallopian tube, where it may become fertilized. If fertilization occurs, the egg can then implant in your uterus.
Sterilization procedures work by either blocking or removing the fallopian tubes, which prevents sperm from reaching an egg. There are two surgical options to achieve this: a tubal ligation or a bilateral salpingectomy. Tubal ligations involve closing, cutting, or removing a small section of your fallopian tube. Bilateral salpingectomies involve the complete removal of both fallopian tubes.
Bilateral salpingectomies were previously less common than tubal ligations, but in recent years, the number has been rising as studies have shown they offer greater effectiveness in reducing the risk of ovarian cancer.
Is Sterilization the Right Choice for Me?
Planned Parenthood does not suggest sterilization for individuals who are uncertain about wanting children in the future, those who are feeling pressured by others, or people who believe sterilization will solve temporary problems, like marital or financial struggles. Additionally, it does not offer protection against STDs.
When it comes to effectiveness, sterilization is over 99% effective at preventing pregnancy. If you're looking for a reversible birth control option with a similar level of effectiveness, IUDs and implants also have more than 99% effectiveness in preventing pregnancy.
What If I Later Regret My Decision?
Since sterilization is a permanent procedure, there's always a chance you might regret your choice later. A study published in March 2022 found that about 10% of women who undergo sterilization experience regret.
While reversing a tubal ligation is technically possible, it's not a practical option due to the high cost of surgery, and insurance often doesn't cover it. Success rates for pregnancy after reversal range from 40-85%, and this is only possible if you're eligible for the procedure.
One alternative to becoming pregnant after sterilization is through in vitro fertilization, where eggs are fertilized outside the body and then implanted into the uterus. However, this process comes with a substantial cost, ranging from $15,000 to $30,000 per cycle, with no guarantee of success.
How Can I Undergo a Sterilization Procedure?
If you decide that sterilization is the right choice for you, you will need to consult with your doctor. Many women face significant (often sexist) barriers when seeking the procedure. Women have reported being denied based on their age, lack of children, or not having enough children. Some doctors may even require spousal consent. For those on Medicaid, a 30-day waiting period often applies.
If you encounter resistance from a doctor, it may be helpful to refer them to the statement on ethical sterilization practices issued by the American College of Obstetricians and Gynecologists' Committee on Ethics. This 2007 document, reaffirmed in 2020, outlines the best approaches to evaluating whether sterilization is an appropriate choice.
According to their opinion, the ACOG emphasizes that “the individual woman’s reproductive autonomy should be the primary concern,” “coercive or forced sterilization is unethical and must never occur,” and “obstetrician-gynecologists should offer presterilization counseling that focuses on a woman’s reproductive goals, placing her wishes at the forefront of care.”
The ACOG deems it ethically acceptable to sterilize patients who have not had children, provided that it is their personal decision. Additionally, the organization advises that a young woman’s request for sterilization, despite not having children, should not automatically lead to a mental health consultation. They emphasize that while physicians understandably want to prevent future regret regarding sterilization, they must avoid adopting a paternalistic approach.
Unfortunately, paternalism remains pervasive in medicine, just as it is in other areas of life. If your doctor refuses your request, you may need to seek out another one—ideally one who respects your right to make autonomous decisions about your own body. Some organizations for the childfree community have compiled lists of doctors who perform sterilizations without imposing unnecessary obstacles.
What to Expect During the Procedure
Should you choose to undergo the procedure, it will typically be a laparoscopic procedure, where the surgeon makes small incisions through which a camera and surgical tools are inserted. This technique minimizes the extent of the cuts required, leading to a quicker recovery process.
For laparoscopic sterilization, the surgeon will create a small incision near the belly button to insert the laparoscope, followed by another small incision to either block or remove the fallopian tubes.
For individuals who are pregnant and scheduled for a C-section, another possibility is to undergo sterilization during the procedure. The doctor can perform this by utilizing the same incision used for delivering the baby.
The recovery period will vary depending on your general health, but the most challenging part should subside within a few days. However, it’s advised to refrain from heavy lifting for at least a week. Regarding the sterilization procedure, it takes effect immediately, though you should consult your doctor on when it’s safe to resume sexual activity.
Updated June 30, 2021 to add information about having the surgery during a planned C-section, and again on Sept. 1, 2023 to reflect current style.
