Birth Control Bingo: Tubal Ligation or Bilateral Salpingectomy

Tubal ligation or bilateral salpingectomy is:

• More than 99 percent effective, according to Planned Parenthood.external link, opens in a new tab
• “Fewer than 1 in 100 people will become pregnant after the procedure, making it one of the most reliable options for those certain they do not want to conceive in the future,” says board-certified obstetrics-gynecologist⁠ (gynecologist: (Pronounced guy-na-coll-o-jist) A doctor that specializes in the health of the uterus, ovaries, vagina, and vulva. . They may also be referred to as “OB/GYNs” or, informally, “gynos”.) Melanie Bone, MD OB-GYN. 

The What, the Why, the Where, the When, and the How-to: A tubal ligation is a surgery that removes, cuts, closes, or otherwise blocks off the fallopian tubes⁠ (fallopian tubes: Two tubes that lead from the ovaries to the uterus. If and when an ovum is fertilized by a sperm, fertilization typically happens within the fallopian tube.(oviducts)) . The fallopian tubes are the pathways that eggs travel from the ovaries⁠ (ovaries: The reproductive organs that contain and release ova.) to the uterus⁠ (uterus: An internal, muscular reproductive organ in the pelvis. During pregnancy, this is where a fetus will develop. The lining of a person’s uterus is also the thing that sheds every menstrual cycle in what we call a period.) , as well as the place where fertilization typically occurs. By closing them off, sperm⁠ (sperm: Reproductive cells of people with penises which can fertilize an ovum and create pregnancy.) cannot reach the egg, which prevents fertilization and therefore pregnancy⁠ (pregnancy: The state of carrying a developing embryo or fetus within the uterus. Medically, someone is considered to be pregnant when an egg has been fertilized by sperm, cells divide, and the fertilized egg is implanted within the lining of the uterus.) . 

There are two main variations of this procedure, and they have similarly high success rates. A tubal ligation involves blocking, tying, or cutting the fallopian tubes, but leaving some portion of the organ behind. A bilateral salpingectomy involves removing the fallopian tubes entirely. Tubal ligation usually costs $0 to $6,000 and is easier to access than the bilateral salpingectomy which usually ranges between $3,000 and $13,000 dollars. 

Each variation is typically performed as an outpatient surgery by an obstetrician-gynecologist at a hospital, health clinic, or private doctor’s office. Both begin with the administration of general anesthesia through either an IV line or inhaled gas. Sometimes surgeons will elect to numb the area by giving you a localized anesthetic shot in your belly, back, or spine. 

Once the medication has kicked in, the surgeon will make a small incision in your lower abdomen, a few inches below your belly button. A thin tube with a light and camera (called a laparoscope) will be inserted into the opening, which will serve as a guide for the rest of the procedure. A small amount of gas may be pumped into the belly to expand the area for easier viewing. 

Next, the surgeon makes a second tiny incision a little lower down, which they will use to reach the fallopian tubes. From here, the tubes will get sealed with a special thread, closed off with a medicalized rubber band or clip, cut and cauterized with sutures and heat, or removed entirely. Finally, the laparoscope is removed, and the incisions are closed with dissolvable sutures and/or steristrips, a type of skin tape. 

Recovery from a laparoscopic tubal ligation is generally straightforward and takes one to three weeks. 

Due to a combination of the incision, additional gas, and medication, most people experience mild pain, bloating, nausea, and fatigue for a few days to a week after surgery. Rest, neutral foods, and a heating pad will all help. 

Before you get the go-ahead from your doctor during a follow-up visit, you should avoid: 

• Heavy lifting to prevent reopening the incision
• Bathing or swimming to avoid infection⁠ (infection: When harmful microbes, or germs, or harmful levels of microbes/germs, enter the body and multiply, causing illness. The common cold, flu viruses, sexually transmitted infections, chickenpox, impetigo, rabies and diphtheria are some kinds of infections.)
• Using certain washes, lotions, and detergents to prevent irritation
• Having sex⁠ (sex: Different things people choose to do to actively express or enact sexuality and sexual feelings; often this involves genitals, but not always. ) of any kind to allow for adequate healing internally and externally 

You should ask your doctor about their recommendations for menstrual⁠ (menstrual: Having to do with menstruation.) products and showering during this time. 

To be sure it’s clear, sterilization procedures should be considered permanent because they most often are. “Tubal ligation is considered permanent,” says Dr. Bone. Tubal ligation reversal, also called tubal reanastomosis, is complex, costly, and has no guaranteed success in restoring fertility⁠ (fertility: The ability to become pregnant or other things having to do with becoming pregnant (eg, “the fertility clinic”).) . Estimatesexternal link, opens in a new tab suggest that only about 50% to 80% of people can become pregnant after having their fallopian tubes repaired and reattached. Full tube removal, bilateral salpingectomy, is not reversible. 

What will/might I need to discuss with a partner⁠ (partner: In a sexual context, a person with whom someone is having some kind of sex. The term “partner” can be used for all kinds of relationships, not just serious ones. “Partner” can also mean the person someone is with in a romantic or familial partnership.) ?

• If you or they are interested (or not) in having kids in the future—and why
• What, if any, circumstances would open you to the possibility of children in the future
• How you want to be supported during the healing period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.)
• What makes this option more appealing than other birth control⁠ (birth control: Any number of methods people use to intentionally prevent unwanted pregnancy, including the condom, the cervical barrier, the implant, the patch, the pill, the rhythm method, the ring, the shot, the IUD, spermicide and withdrawal.)  methods
• Whether this procedure changes relationship⁠ (relationship: An ongoing interaction or association with another person, place or thing.) agreements regarding safer sex⁠ (safer sex: Practices which aim to reduce the risk of sexually transmitted infections, such as use of latex/nonlatex barriers, regular testing for infections and limiting the number of sexual partners.)  practices
• Current STI⁠ (STI: Sexually transmitted infections: illness, infection and/or disease which is often or can be transmitted through sexual or other intimate contact, like HIV, Chlamydia or Herpes. Some people call STIs STDs.) status and testing protocol for the future 

When Good Birth Control Does Bad Things: Tubal ligations are highly effective and generally considered safe, however, the surgery is unlikely to be granted to minors. Some states and countries have a minimum age an individual must be to legally consent⁠ (consent: To freely and actively agree to do a specific thing with someone else with all the information about what that thing is, and the right to change your mind.) to a tubal ligation. Additionally, many doctors will not perform the procedure on people who do not have children, due to the belief that they do not understand the permanent nature of the procedure and will regret it. 

If I can’t get or don’t want permanent birth control, what are some of my longest-term options?

• Depo-Provera (The Shot)
• Intrauterine Devices (IUD⁠ (IUD: Intra-uterine device. A long-term birth control method inserted into the uterus by a healthcare provider. Also called an IUS (Intrauterine system) or IUC (Intrauterine contraceptive).) ⁠)
• the Vaginal Ring (Nuvaring)

What are my shorter-term birth control options? 

• External Condoms
• Internal Condoms
• Withdrawal
• Cervical Barriers (Diaphragms, Lea’s Shield and Cervical Caps)
• the Sponge
• Spermicide
• Combined Oral Contraceptives (The Pill)
• Progesterone-Only Oral Contraceptives (Mini Pills)
• the Contraceptive Implant (Implanon)
• the Contraceptive Patch
• Fertility Awareness (FAM⁠ (FAM: Keeping records of periods, body temperature and cervical mucus to try and predict fertility.) ⁠)

Why would tubal ligation be a good option for me? If all of the following are true: 

• You want a method of birth control that is forever.
• You never want the ability to get pregnant
• You are okay with a multiple-week recovery period.
• You want a method that doesn’t change how sex feels
• You want a method that doesn’t change anything about your hormones⁠ (hormones: Chemicals – via our endocrine system – that send messages across our bodies and brains. They both naturally exist and can also be made in a lab.) , your menstrual cycle⁠ (menstrual cycle: The whole of the phases of menstruation, which include, but are not limited to, the menstrual period.) , or create any side effects (after the healing time is up)

This is part of Scarleteen’s Birth Control Bingo. Need to start over or anew?

Don’t forget: Tubal ligation is highly effective at preventing pregnancy, but it does not offer any protection against STIs. Statistically speaking, sexually active⁠ (sexually active: Someone who has had or is currently having some kind of genital sex with a partner or partners.) ⁠ young adults⁠ (adults: People whose age in years exceeds the legal age of majority, people considered to be adults by law, or people who a culture or individual considers to have reached an adult stage of life.) ⁠ are as, if not more, likely to acquire a sexually transmitted infection⁠ (STI) as you are to become pregnant. 

Condoms are the only method of birth control which also provide protection against STIs. You can read all about safer sex⁠ here – Safe, Sound & Sexy: A Safer Sex How-To – but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual⁠ (sexual: About or relating in some way to sex or sexuality.) monogamy, and then TWO full STI screenings for each partner – once at the start of that six months, once at the end – before ditching latex barriers when having oral, vaginal or anal. 

Another option to consider is Pre-Exposure Prophylaxis (PrEP⁠ (PrEP: Pre-exposure prophylaxis. A daily medication that is taken regularly (before and after exposure) to prevent HIV. It is meant to prevent HIV exposures that occur on an occasional to frequent basis.) ). Made for people who are currently HIV⁠ (HIV: A virus that attacks cells of the immune system, weakening the body’s ability to fight infections and diseases.) -negative, PrEP is a daily medication that, when taken consistently, can reduce the risk of HIV infection by 99 percentexternal link, opens in a new tab if exposed.