The usual method of sterilisation used in Scotland is to block the tubes with small clips so eggs and sperm cannot meet to start a pregnancy.
Sterilisation is a safe procedure, but all operations have risks which you should be aware of before making a decision.
Read the Faculty of Sexual and Reproductive Healthcare guideline: FSRH Clinical Guideline
Read more via: Female sterilisation | NHS inform
Image Source: Adobe Stock Images / Sizesquare’s
Hello and welcome to Research Pod! Thank you for listening and joining us today.
In this episode, we look at female sterilisation, also known as fallopian tube occlusion, a procedure offered to women in the UK, whereby clips are placed on the fallopian tubes. Sterilisation is a permanent and irreversible form of contraception, and this is why it is important to be informed about its risks and benefits, as well as alternative contraception options, before deciding that sterilisation is right for you.
A woman can become pregnant when a man’s sperm fertilises one of her eggs. Family planning allows people to choose how many children to have, and choose the period of time between pregnancies. It is achieved with the use of contraception, the process of preventing an unintended pregnancy by keeping the sperm and eggs apart.
Female sterilisation is a life-long form of contraception which usually cannot be undone. The common method used in the UK, is to block the tubes between the ovary and the womb with small clips during keyhole surgery, so that the eggs and sperm cannot meet to start a pregnancy. Most sterilisation procedures are carried out as day cases, which means a patient is able to go home on the day of their surgery.
The procedure will be performed while the patient is asleep under anaesthetic. A doctor will first examine the vagina to position the womb. Next, the surgeon makes a small cut just below the tummy button for a telescope, known as a laparoscope, to pass through so that they can see inside the tummy including the womb, tubes, and ovaries. With the help of a fine instrument through another tiny cut on the tummy, they will then place the clips on the tubes. The surgical procedure takes approximately 20 minutes. Most women can go back to their normal activities within 5 days. In some cases, the doctor may decide that keyhole surgery is not the right choice and that the patient will need a bigger cut on the lower tummy instead.
Like any other medical intervention, sterilisation has advantages and disadvantages. On the one hand it is a very reliable form of contraception which does not affect periods, does not have long term side effects or interfere with a person’s sex life.
On the other hand, female sterilisation is almost always irreversible, does not help with any potential period problems, and does not protect against sexually transmitted diseases. During the operation there is a small risk of bleeding and damaging the bowel or the bladder, as well as a wound infection afterwards. If the patient is very overweight it may also make it impossible for the doctor to perform the operation safely. More specifically, if the body mass index is over 35, the patient cannot have the procedure at all. Sterilisation is not 100% effective and about 1 in 200 sexually active women become pregnant after being sterilised. This may happen because the egg can occasionally bypass the clips, even though they may have been placed correctly during the original procedure.
Before making a final decision, it’s important to be informed on all available methods of family planning. Alternative options which are just as good at preventing pregnancy include an IUD, which stands for intrauterine device, and is a plastic and copper coil that a trained doctor or nurse can place inside the womb. This can last for up to 10 years and is more than 99% effective in preventing a pregnancy. The “ Hormone Coil” , or LNG-IUD, is a similar device that releases a progestogen hormone into the womb . It lasts up to 6 years and besides preventing a pregnancy it can also help with heavy periods.
Depo provera or Sayana press, also known as the ‘jag’ or the ‘injection’, prevent pregnancy by releasing progestogen. It is given every 13 weeks and it often stops periods. If always given on time, it can be 99% effective in preventing a pregnancy. The contraceptive implant works similarly and is more effective than the injection with only 1 in 1000 women using it getting pregnant. It lasts for 3 years.
All contraception can cause unwanted side effects in a few people. Anything with hormones in can cause side effects like headaches, irregular bleeding , spots and mood changes. Copper IUCDs don’t contain hormones but in some people they make periods a bit heavier and longer.
There are other contraceptive methods available, but they require women to remember to use them every day or every time they have sex. These include the combined pill, the contraceptive patch and the contraceptive ring which contain 2 hormones to prevent eggs from maturing., and the progestogen only pill which has a single hormone. If taken correctly these are more than 99% effective in preventing a pregnancy. However, it has been experienced that approximately 8 in 100 women using pills, patches or rings get pregnant every year, mostly because they don’t always remember to take it.
Condoms are a little bit less effective in preventing pregnancy, with an 88% success rate in real life, as they require learning how to use them correctly and rely on remembering to use them every time you have sex. Condoms, both male and female have a clear advantage against the other methods of birth control: they can protect both the woman and her partner from sexually transmitted infections like chlamydia, gonorrhoea and HIV. However, female condoms have proven to be less efficient in preventing pregnancy than male condoms. Another less effective means of contraception is the diaphragm, a device made of silicone that is inserted inside the vagina just before sexual activity. Diaphragms don’t have side effects but they are less effective than most of the other methods, and doesn’t protect a person from sexual transmitted diseases.
Couples who don’t wish to use any of these methods can consider a vasectomy, a minor procedure to block the tubes that carry sperm from the testicles to the penis. The procedure takes only a few minutes and is usually carried out under local anaesthetic, and has a lower failure rate and fewer complications than female sterilisation. Similar to female sterilisation, it is considered an irreversible procedure. Vasectomy is very effective in preventing pregnancy with only one in 2,000 sterilised men getting a woman pregnant during their life after surgery.
Experience shows that women are more likely to regret sterilisation if they have just lost a baby or have just broken up with their partner. They are also more likely to make a wrong decision if they are feeling stressed or feel pressured by someone else to have the procedure. Women under 30 are also more likely to regret having sterilisation compared to older women that have potentially already completed their family. If you are in one of these groups, or if there is still a small chance you might want a baby in the future, do not make a decision in a hurry. Family planning is important, and being sterilised is a big decision. You might want to consider using an alternative method for a few years before making the decision to use a more permanent type of contraception like sterilisation.
Besides being absolutely certain that you have completed your family or that you don’t anticipate wanting any more children, you also need to remember that although female sterilisation is a safe and minimal procedure, all surgical operations have risks which you should be aware of and weigh up before making your final decision.
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