Sterilization

Sterilization means many kinds of body modification that make a person's body so that it can never make children. Sterilization is part of many kinds of gender-validating surgeries that transgender and transsexual people (including some nonbinary people) may want in order to change their reproductive organs and genitals ("bottom surgery"). However, in many places, transgender and intersex people get sterilized even if they don't want to be.

Coercive sterilization
In many places, transgender and intersex people get sterilized even if they don't want to be. Intersex people are often sterilized without their permission before they become adults. In some countries, transgender people are coercively sterilized. The country's laws require that in order to change one's legal gender, one must be sterilized. These are both issues that need to be addressed by activism, to change laws to protect the rights of intersex and transgender people to choose what happens to their own bodies.

Seeking sterilization
Many transgender people, including some nonbinary people, want kinds of bottom surgery that also happen to sterilize them. For some such people, sterilization itself may be what they want. For others, sterilization is just a side-effect of what they want, and they may or may not feel great about that side-effect.

Some kinds of bottom surgery that generally involve sterilization include some kinds of changes to the gonads, such as castration (taking away gonads of any kind), orchiectomy (taking away the testicles), emasculation (taking away the penis and testicles), and oophorectomy (taking away the ovaries). It also includes many kinds of hysterectomy (taking away at least some of the uterus), vaginectomy (taking away the vagina), and alternatives to hysterectomy such as tubal ligation (tying the fallopian tubes) and uterine ablation (stopping the menstrual flow). Genital nullification can involve sterilization. Of all these, health insurance that covers birth control usually covers vasectomy and tubal ligation, even in people with no health problems that require them to get sterilized.

How easily a person can persuade a doctor to sterilize them depends on that person's sex, not because of physical differences, but because of sexist attitudes in society. It is relatively easy to persuade a doctor to sterilize a person who was assigned male at birth (AMAB) or a person who is perceived as a man (PPM). If such a person asks for the most simple kind of sterilization, called a vasectomy, doctors will usually do it in the same day, with no complaint. It is most difficult to persuade a doctor to sterilize people who were assigned female at birth (AFAB) or people who are perceived as women (PPW). This is because of misogynistic views in society that place a woman's value in her ability to have children. For PPW, doctors will try their hardest to talk them out of it, and health insurance companies often force a mandatory one to six month waiting period for AFAB people before sterilization "in case you change your mind".

Before you go to the doctor's appointment, find all the relevant paperwork and consent forms on the websites of the doctor and your health insurance company. Bring the paperwork with you to the appointment. The doctor might try to postpone things by saying that not all the paperwork was on hand. They might also try to put off signing and submitting the paperwork, telling you to do it in another appointment, or to mail it in. If the doctor agrees to sterilize you, make sure you fill out and hand in all the paperwork during that same appointment, or else it could get put off for months longer.

Fill out the consent form perfectly, or they’ll deny it. Make sure the copy of the consent form that you use is a perfectly legible print. Make sure that you fill out the consent form in ink, very legibly and neatly, that you write the same full name for all the places where it’s required, and that for your signature, you use your usual legal signature. Make sure you consistently refer to the procedure by the same terms on all parts of the consent form, not with other names or abbreviations. Make sure that the doctor prints their name below their signature, and that both their signature and their name are legible.

Talking to the doctor
If you want to ask a doctor to sterilize you, here are some things that you can expect to talk to the doctor about, and some advice to make it more likely that the doctor will agree to sterilize you.

The doctor may try to make you postpone talking about sterilization for later in the future, such as six months away, or ten years away, to give you more time to think it over. Tell them that you cannot wait that long, and that you want sterilization within the next couple of months at the longest. Say, "If you impose a waiting period, then I will seek another doctor instead who doesn’t make me wait. I have already had [years] to think about this. I made my decision a very long time ago. I’ve spent [time period] researching the details of what I want to make sure that this is an informed decision and that I know exactly what I’m asking for."

DO stay polite, confident, and calm. Stand your ground without antagonizing the doctor or being hostile, crying, or being emotional. If you act emotional, doctors have been known to respond to this by saying you seem too immature to make this decision, or may say they'd prefer to discuss your options in another appointment after you've had time to calm down, or may prefer not to do business with you at all, out of concern that you might get upset and sue them after they sterilize you. “Just as … you should never show fear when facing an angry animal, you should NEVER show any doubt or sign of wavering when up against a doctor, because they can smell it. And it smells … like ‘future malpractice suit’ to them.”

DON'T give the idea that you would raise children if you had them by adoption, or if your partner already had them. If the doctor thinks that you might ever want children, in any way, then they won't let you get sterilized. They'll think you'll most likely want children by birth, and that you'll regret sterilization. In order to get sterilized, you need to give the idea that you are confident that you never want children, not even by adoption. Even if you secretly would like to adopt children, you'll have to pretend to be "childfree," meaning someone who chooses to never have or raise children.

DON'T give the idea that you resent children and people who have children. Your doctor may be a parent, and if they feel you are antagonizing or insulting them, they won't want to do business with you. DO give the idea that you respect these people, and just want to live a different life than a parent. If the doctor tells stories about their own life as an example of the importance of having children, point out that you aren’t judging the doctor for how they live their own life, because it’s their own business. Your own life choices are not personal insults to them.

DON'T leave out relevant information in your medical paperwork, and DON'T tell lies in your medical paperwork. Either of these might count as insurance fraud.

If you have relevant health problems that would make it risky for you to reproduce, DO play them up. Go into detail about how you have lots of valid concern about that.

Bingo questions
During the consultation appointment, the doctor will ask you a lot of questions-- some of which may be creepy and emotionally manipulative-- to try to persuade you to get a temporary form of birth control instead of sterilization. Anticipate these questions, and prepare your answers to them in advance, like you would for a job interview. During the appointment to talk about it, the doctor may surprise you with some of these questions during a physical examination, in order to take you more off guard and make you uncomfortable.

Among people who choose not to have children (the childfree community), the word "bingo" or "bingoing" means getting asked all the common questions about why a person doesn't want children. It's like covering all the squares on a Bingo card. When acquaintances ask these questions, you can give joke answers, but with a doctor, it's very important to calmly give a serious, polite answer, in order to get the kind of help that you want from them. If you've chosen your favorite polite answer to all of the common questions, and rehearsed this canned answer so you can say it even under stress, you'll do much better at keeping calm. Here are some suggestions for some answers to these frequently asked questions. Use these examples as inspiration to come up with your own answers that reflect your own unique life experience and views.

Relationships
The doctor will ask questions to find out about how your relationships with others might undermine your interest in sterilization. In particular, your doctor will want to know if any romances you might have could change how you feel about it. Here are some of the kinds of questions they might ask about relationships, and some good ideas for what to say in reply.

Q: "What if you meet 'the one', and they want children? Or if they already have children?"

A: "If they want children, then they’re not 'the one' for me." DON'T say that you might adopt children or raise someone else's. If you do, the doctor will decide you don't really want sterilization. They will instead recommend a temporary kind of birth control.

Q: "Someday you’ll meet someone who’ll change your mind about this." Some of these questions aren't questions, but statements about the doctor's beliefs or suspicions about you.

A: "Nobody will ever change my mind." Show that you are confident. The doctor should have no reason to think you might regret it after you get sterilized.

Q: "What do your parents think about no grandchildren?"

A: "My parents understand that I get to make my own big life decisions, and they respect that." If you have siblings who had children, say that these are your parents' grandchildren.

Q: "You're not a real family if you don't have children." Or, "You don't love your spouse if you refuse to give them children." These aren't questions, but statements of belief to challenge.

A: "There are lots of kinds of families, and the kind of family I’d be happy in is the kind of family that doesn’t have children."

Alternatives
The doctor will ask about how you feel about alternatives to sterilization, and will try to persuade you to use them instead. Your doctor will likely ask you about each kind of birth control that could apply to you. Before the appointment, research all the kinds of birth control that apply to you, so that you can tell your doctor about your concerns about each of their risks, or why they're each not suited to you.

Q: "Why don’t you just use non-permanent kinds of birth control?"

A: "I want a permanent kind, because I never want to have children."

Q: "Will you look at these pamphlets about other kinds of birth control?"

A: "I'll look, but my mind is already made up. I've already researched them all."

Q: "Why don't you use condoms instead?"

A: "I'd like a permanent method of birth control that I can just set up once, instead of having to negotiate with it every time I have sex. Plus, sterilization is something that a sex partner can't remove, damage, or tamper with. I know I would still need to use condoms to protect against sexually transmitted infections (STIs), and they're very effective as birth control. It's wise to use more than one kind of birth control at once, and sterilization is a great back-up for condoms."

Q: "Why don't you get an Intra-Uterine Device (IUD) instead?" (A kind of temporary birth control they'll try to get you to use instead, if you have a uterus.)

A: "My concerns about an IUD include that it is a foreign object that stays in the body, it can result in organ perforation. It can also get partly dislodged, so that I can't be sure if it's still working as birth control. I like using a menstrual cup, and those have been known to make an IUD fall out." (If you haven't used menstrual cups, or didn't like using them, you can still bring this up as a concern.)

Q: "Why don't you go on the Pill instead?" (A kind of temporary birth birth control they'll try to get you to use instead, if you have a uterus.)

A: "My concerns about the Pill include that it works by changing one's hormone balance. I don't want to do that." If you have past experience with the Pill, it would be appropriate to talk about it.

Q: "Why don't you just get an abortion after an unwanted pregnancy?" This question is meant to take you off guard by seeming flippant about a serious matter.

A: "I'd rather prevent unwanted pregnancies in the first place. I don't want to have to deal with the health risks and the moral dilemma of an unwanted pregnancy. Sterilization is much safer for my physical and mental health than an abortion."

Changeability
The doctor will want to know whether your views on this matter are changeable. If you might change your mind about it in the future, the doctor will see this as trouble for them, and won't want to do business with you.

Q: "What makes you think you won’t change your mind when you’re older and wiser?" The doctor thinks this might be a phase that you'll grow out of, or that it will be natural for you to want children when you're more mature.

A: "Because I have held this same opinion for my entire life without ever changing my mind about it. I will never change my mind." For people who are able to get pregnant, it's also relevant to bring up that being 35 or older means that a pregnancy is automatically considered risky. Raising a child is harder at that age, too. If you're not 35 yet, you can say that you would be glad about having been sterilized a long time before then.

Q: "What if you regret it after you get sterilized?" Or, "What would you do if you were sterilized and then decided you wanted to have children?"

A: "I'm confident that you will never want children, by adoption or otherwise. I'm never going to change my mind." It's appropriate to explain in more detail about why you know you'll never want children. Just keep a respectful tone about children and people who have children, because if you personally offend the doctor by insulting their life choices, they might not want to do business with you. "I'm confident that I won't regret it. How about this offer: I could write and sign a paper, a release form that says I won't sue you or hold you liable for that reason. Would that satisfy your concerns?"

Q: "You would feel differently about children if you had a child." This isn't a question, but a statement that the doctor believes that you'll someday change your mind.

A: "More likely, if I had a child, it would confirm that I do not want a child, just as I always knew to be the case. Having an unwanted child would be a cruel and pointless experiment."

Children
Some of the common questions try to make you imagine your future, what it would be like to have children, or to live without children, as if you hadn't thought about it before.

Q: "If you don't have children, who will take care of you when you're old?" It's strange that everyone asks this question, since in the Western world, children usually don't take care of their elderly parents.

A: "With the money I save by not having children, I hope to be able to afford a hired caretaker, if I end up seriously needing one." You might also talk to your family members and friends of your age or younger if they can help you when you're old, particularly your spouse.

Q: "What if you had a child who cured cancer?"

A: "I will not have a child, so this question is moot. Many other people are having children, and they might cure cancer, and that’s the way that I prefer it."

Q: "But you're so smart/beautiful! Your children would be so smart/beautiful!" (This isn't a question, but an attempt to see if flattery could change your mind.)

A: "I'm not going to have children."

Q: "If you don’t have a child, you’ll miss out on a great experience."

A: "If I do have a child, then I might miss out on a lot of experiences precluded by taking care of a child."

Q: "You know it's possible to have a career and a child, right?"

A: "Some people manage it, and they're amazing, because it's very difficult to balance both. That would be beyond me. People are more likely to be able to balance both if they first have a reliable source of income, lots of savings, a sturdy marriage, and a supportive family. Personally, I don't think I can count on those things."

Q: "The best thing I did in the world was have children." Or, "My children are the most important thing in my life." These aren't questions, but an attempt to compare their life with yours.

A: "That's wonderful, but I know what's most important in my life." Make sure you know.

Q: "You would make a great parent."

A: "I wouldn't. I would make a good [career], though, so I want to spend most of my time working on my career."

Q: "You were a child too, once."

A: "When I was a child, I decided that I never wanted children. I didn’t like younger children, even when I was a child. I always got along better with adults, because they exercise better self-control, communicate more clearly, and take more responsibility for themselves."

Cruelty
Some of the common questions they might ask just seem to be cruel. They might insult you outright, bring up topics that they think might trigger a post-traumatic response, or say very sexist things. The idea might be to shock you into changing your mind, or saying something that the doctor can use as reason not to sterilize you. You might decide you don't want to work with a doctor who says these kinds of things, even if they just said it to test your resolve. Still, do your best to stay calm and polite, just in case you decide this doctor is still your best option. It's better to let yourself be cross about a rude doctor after you've escaped their presence, not during the appointment.

Q: "Do you want this because you had a bad childhood or were sexually abused?" This is a really inappropriate and mean question to ask, even for a doctor. Nobody should ever ask such a cruel question of anybody.

A: (Is there a really polite response to this? Especially since doctors have been known to use this as reason not to let someone get sterilized. In other contexts, a good answer is "That's an inappropriate question, and I don't have to answer it," but in this context, the doctor might see it as antagonistic, or might insist on an answer before continuing.)

Q: "If you don’t want a child, then you’re very selfish/horrible/sad." This isn't a question, but a judgment and an insult.

A: (Is there a really polite response to this? One that doesn't insult people who do choose to have children?)

Q: "What if your parents thought the same way? How would you feel if they didn’t have you, never even conceived you?" This is a bizarre and rude question, meant to disturb.

A: "If so, then I wouldn't complain." While true (you wouldn't do or feel much of anything if you were never conceived, at least in any sense we know of), this is a rude answer for a rude question, and the doctor might see it as antagonistic. There might be a more polite response that overlooks the bizarreness of the question, such as "I would respect their life decision."

Q: "It’s unnatural not to want children."

A: "Many good things in my life could be seen as unnatural, such as money, clothes, and houses."

Q: "Childbirth is a woman's greatest achievement." This isn't a question, but an expression of an attitude that could be seen as misogynistic.

A: "Perhaps for some, but I want to make other great achievements." Give some examples from your long-term goals.

Q: "You're not a real woman (or man) if you don't have children." Not a question, but a flatly sexist statement.

A: "There are women (or men) who don't have children, and they are very real women (or men)." Or, "I would be pleased to not be a real woman (or man)." However, it might not be wise to hint at nonbinary gender identity to a doctor with such a crude attitude.