A Guide To Tubectomy (Tubal Ligation)

In the realm of reproductive health and family planning, the name tubectomy or tubal litigation frequently comes in relation to women. So, what is tubectomy? Tubal ligation, aka tubectomy, stands as a significant medical procedure providing a permanent form of contraception for individuals who have decided to conclude their journey of childbearing. This comprehensive guide aims to shed light on tubectomy, discussing its process, benefits, considerations, and more.

What Is Tubectomy or Tubal Ligation?

Tubal ligation is also known as getting your ‘tubes tied.’ In this method of female sterilization, the fallopian tubes, which carry eggs from your ovaries, are blocked by clamping, sealing, or severing them. This prevents sperm from getting to the eggs and fertilising them, thus effectively preventing pregnancy. This type of tubal sterilization can be done through a laparoscopic procedure, mini-laparotomy, or tubal implants.

How Effective Is Tubal Ligation?

Tubal ligation is considered almost 100% effective. But there is a 0.5% chance (5 in 1000) that women who have had tubal ligation will become pregnant one year after the process. In the five years after the procedure, there is a 1.3% chance of pregnancy, and by 10 years, the estimate of sterilization failure could rise to 1.8%. Improper surgery, being pregnant during the procedure, and recanalisation of tubes are reasons why a pregnancy might occur after tubal ligation.

Is Sterilization Right for You?

Sterilization is recommended only for those women who are sure that they do not want any more children. It is also a good option for those who have health issues that might worsen due to pregnancy and for those with some serious hereditary condition that you do not want to pass on. Discuss it with your spouse, family, and doctor before you arrive at a decision on whether this is a good option for you.

Is Tubal Ligation Painful?

In some types of tubal ligation, an incision will have to be made on your body. Your doctor will also administer general or local anaesthesia, depending on the type of sterilization you have opted for. When general anaesthesia is given, you will go to sleep and wake up only after the procedure while local anaesthesia keeps you awake the entire time, but the area is numbed, so you do not feel anything during the surgery.

Types of Tubal Ligation Procedures

The common types of tubal ligation procedures can be classified as those that require an incision and those that do not. Laparoscopy and mini-laparotomy belong to the former category (with an incision), while tubal implants, also known as Essure, are in the latter category (with no incision).

1. Incision Sterilization

The two methods of incision sterilization are laparoscopy and mini-laparotomy, with both requiring either local or general anaesthesia.

Laparoscopy – is preferred for its quicker recovery time, being less painful and less invasive. The entire procedure takes only about 30 minutes and causes minimal scarring. Most women can return home the same day.

A mini-laparotomy – is considered a major surgery and is usually done under general anaesthesia during the first day or two of childbirth. It is also performed during a C-section. The recovery postpartum will not be any different with or without the sterilization done during C-section.

2. Tubal Implants

The process of putting in tubal implants or Essure does not require any kind of incisions as it is performed through the cervix and the vagina. Metal springs are inserted into the fallopian tubes, and gradually scar tissue forms around it, causing a permanent blockage in the tubes.

How to Prepare for the Sterilization Procedure?

Tubal ligation can be done at a hospital and also in some outpatient clinics. Your doctor will discuss the reasons why you are opting for this procedure and want to know if this is a well-thought-out decision. You will be informed of the type of sterilization procedure best suited to your circumstances. Many women choose to have this surgery shortly after childbirth or in combination with some other surgery. If you are not having this procedure immediately after childbirth, you might be asked to use contraception for one month prior to and one month after the procedure. 

1. Procedure for Incision Sterilization

The laparoscopic procedure for tubal ligation and the mini-laparotomy are termed incision sterilization.

In laparoscopic sterilization, you will be administered local or general anaesthesia, after which the doctor pumps gas into your stomach cavity to help visualize the organs better. A couple of small cuts will be made near the belly button, through which the doctor will insert a laparoscope to pinpoint your fallopian tubes. Once located, the tubes will be closed off, and the procedure is completed. The entire procedure takes about 30 minutes.

A mini-laparotomy is commonly done after childbirth, and after general anaesthesia is given, the doctor will make a cut near the belly button. The fallopian tubes are brought up through this cut, and clips are used to block them while, in some instances, a section of the tubes is cut off.

2. Procedure for Tubal Implants

If tubal implants are the method of sterilization, there is no need for any kind of anaesthesia. Your doctor will dilate the cervix just before the procedure and then pass a thin catheter through the vagina and cervix up to one of the fallopian tubes. This catheter will place an implant in the tube and repeat the process with the other tube. X-rays will be taken afterwards to ensure the implants have been placed correctly and the tubes blocked.

How Will You Feel After Tubal Ligation?

You may experience cramps like during menstruation or experience some amount of vaginal bleeding as a result of uterus movement during the procedure. If you had a laparoscopic procedure, the gas used might cause your stomach to be swollen for a day or two. The gas might also cause back or shoulder pain for a while. It is important to call your doctor immediately:

• if your incision starts to bleed
• you get a fever or a rash
• you find it difficult to breathe
• there is continuous pain in your belly
• you see an unusual discharge from your vagina

Even after a tubal ligation, your periods will continue as before until you reach menopause. Sterilization does not bring about any hormonal imbalances, unlike birth control methods that rely on hormonal factors.

How Long Does It Normally Take to Recover After Tubal Ligation?

Recovery times will vary depending on your lifestyle, your health prior to the procedure and the kind of tubal ligation you opted for. After laparoscopic tubal ligation, you will likely go home the same day. Recovery from a mini-laparotomy may take a few days. If you had tubal implants, you are likely to be able to return to your normal routine the same day. A follow-up examination will be scheduled for a couple of weeks after the procedure.

Can Tubal Ligation Be Reversed?

In some instances, tubal ligation can be reversed though it is a major surgery, and you might have to stay in the hospital for a few days. The chances of a successful reversal will depend on factors such as the type of tubal ligation done, your age, the time elapsed since the procedure, and the damage your tubes have experienced. Pregnancy rates after reversal vary greatly and range between 30% and 85%.

Reversal of tube ligation puts you at a higher risk of ectopic pregnancy, which can be a life-threatening condition.

Risks and Complications

Since tubal ligation is an abdominal surgery conducted with anaesthesia, there are certain risks and complications that can occur, such as:

• Organ damage to the bowel, bladder or major blood vessels
• Reaction to anaesthesia
• Failure of the wound to heal and a possibility of infection
• Pain in the pelvis or abdomen that lasts for a long time
• Permanent scarring at the site of the incision
• The risk of complications is higher if you have had abdominal or pelvic surgery prior to this. A history of obesity or diabetes also increases the possibility of complications after tubal ligation.

How Soon Can You Have Sex After Sterilization?

Your doctor will be able to give you a timeline on when it is safe to resume having sex after a sterilization procedure though most people wait for a week or two. If the tubectomy has been done soon after childbirth, the wait time might go up to four weeks at a minimum. Some women may experience pain or discomfort during sex for up to a year after Essure implants.

Does It Provide Protection Against STDs?

No, tubal ligation is only a form of permanent sterilization and does not offer any kind of protection from Sexually Transmitted Diseases (STDs) for men or women. Sterilization is only a means of effective birth control. Using a condom is the best way of lowering your chances of contracting or spreading STDs, as male or female sterilization methods are of no help here.

After tubal ligation with incision method, no backup birth control is required. But when it comes to tubal implants, it is recommended that you use some other form of birth control for about three months. After this period, an X-ray can help confirm that the procedure has been successful, and you can stop using other methods of birth control. It is normal to think that sterilization might change you in some way. However, you will not gain weight, grow facial hair, or bring on menopause. Just make sure that sterilization is the best choice for you before you move ahead with the decision.

Disclaimer: This information is just a guide and not a substitute for medical advice from a qualified professional.

References/Resources:

1. Tubal ligation; MedlinePlus; https://medlineplus.gov/ency/article/002913.htm

2. Peterson. H. B, Xia. Z, et al.; The risk of pregnancy after tubal sterilization: Findings from
the U.S. Collaborative Review of Sterilization; American Journal of Obstetrics & Gynecology; https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.305.1070&rep=rep1&type=pdf; April 1996

3. Tubal Ligation; University of Rochester Medical Center; https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=135&contentid=27

4. Ectopic Pregnancy; University of Rochester Medical Center; https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=p02446

5. Postpartum Sterilization; University of Michigan; https://www.med.umich.edu/1libr/Gyn/PostpartumTubalLigation.pdf

6. Post Tubal Ligation Syndrome; NCCRM; https://www.nccrm.com/tubal-reversal-surgery/post-tubal-ligation-syndrome/

7. Contraception; CDC; https://www.cdc.gov/reproductivehealth/contraception/index.htm

8. Sterilization for Women and Men; The American College of Obstetricians and Gynecologists; https://www.acog.org/womens-health/faqs/sterilization-for-women-and-men

9. Tubal Ligation; Johns Hopkins Medicine; https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation

Also Read:

Tubal Ligation Reversal
Postpartum Tubal Ligation
Pregnancy After Tubal Ligation