Female sterilisation at Warwickshire Hospital

What is female sterilisation?

Female sterilisation permanently closes off the fallopian tubes, the passageway linking your ovaries to your womb, so sperm can no longer reach an egg. You might also hear it called tubal ligation, or having your tubes tied.

Who is female sterilisation suitable for?

This might be worth considering once your family feels complete, or if having children isn't something you want at all. Since there's no going back once it's done, other lasting contraceptive options are usually discussed with you first.

What are the benefits of female sterilisation?

Preventing pregnancy is something this method does extremely well, put at over 99% in most descriptions of it. Figures on how often it fails vary though: some place the number of women who become pregnant afterwards at somewhere between 2 and 10 per 1,000, others closer to 24 to 30 per 1,000.

Your hormones stay untouched by the procedure, so periods continue as normal, and there's nothing further to remember or apply once it's been carried out.

Are there different types of female sterilisation?

There are two broad approaches:

• an operation known as tubal ligation, where the tubes are cut, sealed with a clip or band, or have a section removed and closed over, generally reached through keyhole access
• a mini-laparotomy, a somewhat larger opening used on the occasions keyhole access isn't achievable
• a method that avoids cuts in the abdomen altogether, instead placing small devices into the tubes by way of the vagina and womb

What happens before female sterilisation?

Ahead of the date itself, a pre-assessment visit at the hospital gives the team a chance to look over how you're doing generally and set out exactly what's ahead.

• keep whatever contraception you're currently using going right through to the morning of the operation
• if a general anaesthetic is planned, you'll be given a cut-off time for food and drink beforehand
• counselling may be offered to help firm up your decision, and talking things over with someone close to you, where relevant, is often worthwhile too

Combining the operation with a caesarean birth or an abortion is an option, though leaving a gap of several weeks between the two events tends to be the recommendation.

What happens during female sterilisation?

1. A general anaesthetic puts you to sleep for the whole procedure.
2. Beforehand, a pregnancy test confirms you're not already expecting.
3. Your surgeon opens two or three small cuts close to your navel.
4. Gas is pumped into your abdomen so your internal organs are easier to see.
5. A slender, camera-equipped instrument (a laparoscope) is guided through to find your fallopian tubes.
6. Each tube is then sealed shut, or has a section removed and closed over.
7. The openings are closed with either surgical adhesive or stitches that dissolve on their own.

Keyhole access is the standard route for this, wrapping up in around 20 to 30 minutes. Where that approach won't work, your surgeon switches to a mini-laparotomy, a modestly larger opening, instead.

What does recovery look like?

You can normally go home from hospital the same day. Anyone who's had a general anaesthetic will need someone else to drive them home, and having company for that first night afterwards is also a good idea.

A few days of tummy discomfort and light vaginal bleeding are common afterwards. Before you're discharged, staff will run through wound care and suitable pain relief with you.

• give yourself roughly a week away from work (stretching to 2 to 4 weeks where a mini-laparotomy was involved)
• follow the wound-care guidance you're given to keep things clean
• reach for paracetamol or ibuprofen if your tummy aches
• a wrapped hot water bottle can settle bloating or trapped wind
• reach for pads rather than tampons if you notice light bleeding
• steer clear of heavy lifting, exercise and sport for around a week, or a longer stretch of 4 to 6 weeks where a mini-laparotomy was carried out
• hold off driving until a seatbelt and a sudden stop wouldn't cause you pain, which for some takes as long as six weeks where a mini-laparotomy was involved
• wait at least 7 days before having sex again

Your existing contraception still needs to carry on for a week after the operation, given a slim chance of pregnancy remains during that time. An implant is the one exception, since it can come out whenever suits, with no further protection required afterwards. Where a device was fitted rather than an operation performed, allow up to 3 months before relying on it alone, using another method of contraception in the meantime while scar tissue completes the job.

What are the risks and complications?

Complications are uncommon, and where they do happen, they tend to be minor and treatable. Possible risks include:

• a blood clot forming, sometimes called DVT (deep vein thrombosis), which can rarely travel onward to your lungs
• infection, either at the wound site or in your urinary tract, generally cleared up with antibiotics
• accidental injury to a nearby organ, blood vessel or nerve during the operation, something the team carrying out the surgery will typically fix on the spot
• an ectopic pregnancy, should the sterilisation not fully work and pregnancy occur afterwards

Get urgent GP advice or call NHS 111 if you've had this procedure recently and develop a fever or chills, notice your wound has become swollen, sore, or is leaking blood or pus, find a leg has turned warm, swollen and throbbing, feel stinging or need to pee unusually often, have stomach pain alongside vomiting, start struggling to breathe out of nowhere, or bring up blood when coughing.

If breathing becomes severely difficult, you develop discomfort across your chest or the upper part of your back, or your heart starts racing, treat it as an emergency and call 999 or go to A&E.