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Sterilization: Should you tie the (other kind of) knot?

If pregnancy isn’t in your future plans, here’s what you should know before talking to your doctor.

by Colleen Denny, MD

We spend a lot of time here at Bedsider talking about the many different forms of birth control that can help you choose whether and when to get pregnant.

But what if you know for sure that you never want to be pregnant again, or even pregnant ever? You might be thinking about having your “tubes tied,” or going through a permanent sterilization procedure. But talking to your doctor about sterilization can be tricky! Especially if you’re young, you may worry that your doctor won’t take you seriously or will try to talk you out of it.

What’s the best way to talk to your doctor about sterilization? The best way to advocate for yourself is to educate yourself. You’ll want to go to your appointment thoroughly understanding the decision you’re making and why you’re making it. A good physician will be more receptive if you’ve clearly done your homework and thought about your decision carefully.

Know: What am I getting into?

If you want your doctor to take you seriously, you’ve got to know what you’re asking for. Don’t be caught unaware of these fast facts:

  • Sterilization procedures are permanent. Forever-ever. No takebacks. There is no “un-tying” fallopian tubes, or putting them back in. If you’re not completely, 100% sure that you don’t want any pregnancies in the future, this is the wrong choice for you.

  • Sterilization procedures are really good at preventing pregnancy. They have a failure rate (i.e. an unplanned pregnancy rate) of <1%.

  • All sterilization procedures require at least a small surgery. There are a few different ways to do a female sterilization, but all of them work by blocking or totally removing the fallopian tubes so that eggs can no longer get inside the uterus to form a pregnancy. These surgical procedures usually take 1-2 hours, depending what procedure you choose. Like any surgery, that means sterilization carries risks like bleeding, infection, and complications with anesthesia.

  • It’s also important to know what sterilization doesn’t do. 1) It doesn’t protect you from STIs, so you might need to use condoms even after your procedure. 2) It doesn’t affect your periods. Any period symptoms you had before, like cramps or heavy bleeding, won’t change.

Know: Why do I want this?

Before talking to your doctor, think about what it really means to make an irreversible decision like sterilization and why sterilization is better for you than other non-permanent and non-surgical forms of birth control. Here are some of the most common reasons people consider sterilization, and where the discussion with your doctor might lead:

1. "I don’t want any (more) kids."

As mentioned above, sterilization is a good way to make sure you don’t have any pregnancies in the future. Most patients who are thinking about sterilization are excited about that! But as doctors, we also know that a small number of people regret their decision to have a sterilization and wish (too late) that they hadn’t done it. It’s hard to predict who will regret their sterilizations, but we do know that women who have sterilizations when they’re younger than 30 regret them more often.

Are you someone who might regret having a permanent sterilization? It’s difficult to know for sure, but one step we recommend is playing the “What If” game:

  • What if when my kids are older, I want more children?

  • What if I have a different partner in five or ten years, and we want to have children together?

  • What if something happened to my kids?

It’s hard to imagine these things, but you owe it to yourself to remember that life sometimes goes differently than we think it will.

If some of these “What Ifs” make you feel less than 100% sure about sterilization, what about other non-permanent ways of avoiding future kids? There are ways of avoiding pregnancy that are just as good as female sterilization but aren’t permanent, especially IUDs and implants. Both methods have unintended pregnancy rates of <1% but can be taken out, so they leave the possibility of future pregnancy open if you change your mind.

2. "I don’t want hormones or implants."

Some people lean away from non-permanent forms of birth control because they had unpleasant side effects (or worry that they will). It’s true that some people do experience side effects or changes in their periods when using hormone-containing birth control. Most people find these side effects mild and aren’t bothered by them, but other people find them intolerable. Since sterilization uses no hormones, people in the second group might find it more appealing.

If this resonates with you, great! But remember to consider two things that your doc will probably bring up. First, consider the hormone-free copper IUD! It’s good for over a decade and involves no meds. Second, remember that having a sterilization procedure involves risks and side effects too, including all the risks of anesthesia. It’s not unreasonable to choose sterilization, but it’s important to carefully weigh your feelings about hormones/implants versus these small but real surgical risks.

3. "It’d be dangerous for me to be pregnant."

Pregnancy takes a huge toll on the body and mind for the better part of a year, and there are many people who know that being pregnant would seriously threaten their physical or mental health. If this is true for you, be sure to mention it to your doctor! It shows you’re taking initiative in protecting your own health. At the same time, remember again that sterilization requires a small surgery and anesthesia. Depending on your health condition, it may be safer to use a long-acting birth control like the IUD or implant rather than having a more involved procedure.

And hey, if you can share the responsibility with a long-term partner, even better—vasectomy can sometimes be a good choice when one person in a couple has health issues. If your partner is open to having a vasectomy, it’s safer and less invasive than female sterilization and works just as well to prevent pregnancy.

4. "Carrying a pregnancy wouldn’t fit my gender identity."

This is an important issue for some LGBTQ people, who might worry that dealing with an accidental pregnancy would be a huge source of psychological stress. Further, it can feel particularly uncomfortable discussing this reason with a provider.

First, make sure you find an LGBTQ-friendly provider who makes you feel comfortable discussing all of your health history, not just your sterilization-related concerns! The GLMA has a great provider directory. Next, remember that sterilization only takes care of a person’s ability to become pregnant—it doesn’t, say, stop heavy periods or get rid of the need for pap smears, to name just two common health issues that can stress the psychological health of people with non-cis gender identities. If this is the main reason driving you towards sterilization, explore with your doctor what kind of procedures or other treatments might be most appropriate.

It can feel awkward to approach your doctor with a specific request, especially something big like sterilization. But if you’ve taken the time to think through your options, you owe it to yourself to speak up! After all, you know your life and your needs better than anyone.

Remember: Just because a doctor wants to talk through your decision doesn’t mean that he or she is trying to talk you out of your decision or deny you care. Good doctors should take the time to explore your reasons for sterilization and talk through the risks and alternatives associated with the procedure. It’s their job. And it’s your job to be a savvy and confident partner in your own care. Armed with the above, you and your doctor can have an honest conversation about how, when, and whether sterilization is the right move for you.

Colleen Denny, MD, is an attending ObGyn at Bellevue Hospital in New York City and a clinical assistant professor with the NYU School of Medicine. She enjoys taking care of women in all phases of life and is especially interested in issues related to contraception access and public health. Outside of work, she’s a runner, a dancer, and a bit of a crossword puzzle nerd.

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