Tubal ligation: Difference between revisions
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{{Content warning|genitals, reproductive organs, surgery, sexism, and racism}} | {{Content warning|genitals, reproductive organs, surgery, sexism, and racism}} | ||
{{disclaimer|The Nonbinary Wiki is written by volunteers who are not necessarily experts on medical topics. This wiki and its editors make no representations or warranties of any kind. This wiki and its editors shall not be liable for any physical, psychological, emotional, financial, or commercial damages, prosecutions, or proceedings instituted against any person or entity as a result of the use of information from this file, or any loss, injury, or damage caused thereby. You claim full responsibility for your own health decisions. This wiki will not be held responsible for your actions. Any information here does not constitute legal, financial, medical, business, or other advice. This wiki should not be used to recommend a path for diagnosing or treating any medical condition. For that, you must consult your physician.}} | {{disclaimer|The Nonbinary Wiki is written by volunteers who are not necessarily experts on medical topics. This wiki and its editors make no representations or warranties of any kind. This wiki and its editors shall not be liable for any physical, psychological, emotional, financial, or commercial damages, prosecutions, or proceedings instituted against any person or entity as a result of the use of information from this file, or any loss, injury, or damage caused thereby. You claim full responsibility for your own health decisions. This wiki will not be held responsible for your actions. Any information here does not constitute legal, financial, medical, business, or other advice. This wiki should not be used to recommend a path for diagnosing or treating any medical condition. For that, you must consult your physician.}} | ||
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[[Tubal ligation]], also called getting one's tubes tied, is a form of sterilization. It works by stopping the egg cell from being able to travel through the fallopian tube to the uterus. For people who have a uterus, this procedure is meant to make it permanently virtually impossible for them to get pregnant. For some [[transgender]] and [[nonbinary]] people, if their only concern about their uterus is that a risk of pregnancy is a source of distress and body dissonance (called [[gender dysphoria]]), this is an alternative to removing the uterus (called [[hysterectomy]]).<ref>Laura Erickson-Schroth, ed. ''Trans Bodies, Trans Selves: A Resource for the Transgender Community.'' Oxford University Press, 2014. Pp. 236, 267-268.</ref> Tubal ligation has no effect on the person's menstrual flow, menstrual cycle, hormone balance, the ability to orgasm, cancer risk,<ref name="brinton cancer">Brinton, L. “Tubal ligation and risk of breast cancer.” 2000.</ref><ref name="turney">Turney, Lyn. “Risk and contraception: What women are not told about tubal ligation.” Women’s Studies International Forum 16:5 (1993).</ref> vulnerability to sexually transmitted infections,<ref name="planned parenthood">"Sterilization." ''Planned Parenthood.'' Retrieved July 9, 2020. https://www.plannedparenthood.org/learn/birth-control/sterilization</ref> or when or how the person will go through menopause.<ref>Nelson, D. “Tubal ligation does not affect hormonal changes during menopausal transition.” 2005.</ref> Sometimes a person can choose to have [[uterine ablation]] done at the same time as tubal ligation, which is supposed to stop menstrual flow. If someone chooses to get ablation, then they have to get a tubal ligation or some other kind of contraception too.<ref name="donnadieu 2007">Donnadieu, A., et al. “Essure sterilization associated with endometrial ablation.” 2007.</ref><ref>Donnadieu, A., and Fernandez. “The role of Essure stabilization performed simultaneously with endometrial ablation.” 2008. </ref> | |||
There are various methods for tubal ligation, which can be considered either a laparoscopic surgery (meaning it is done by cutting only a few tiny holes on the lower belly, and putting long thin laparoscope tools through them to do the work), or a procedure (meaning it can be done without cutting into the body). The fallopian tubes (which connect the ovary to the uterus) can be blocked off by a variety of different methods. The tubes can be tied and cut (ligation), clipped, pinched off in a loop with a band, burned (cauterization), blocked with scar tissue or an implant (tubal occlusion), or completely destroyed (salpingectomy). Any of these methods can be called tubal ligation on paperwork and health insurance. Cutting or tying the tubes has the most risk of still being able to get pregnant, whereas destroying the tubes is the most effective at preventing pregnancy. Blocking the tubes with an implant can be done by putting it in through the vagina, without cutting into the body, which is safer,<ref name="donnadieu 2007" /> but an implant has the risk of later traveling into parts of the body where it is not supposed to be, which can be harmful. | |||
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==Process== | |||
[[ | [[File:Uterine Horns Diagram (English).svg|thumb|A diagram of the parts of an adult person's uterus, before any surgery.]] | ||
[[File:Sterilizace ženy.jpg|thumb|A diagram of some-- but not all-- methods of tubal ligation.]] | |||
Some regions have laws that make it so that a person has to be certain age before they are allowed to get a tubal ligation. Tubal ligation is done by written informed consent from the patient, without needing a diagnosis of any health problem. | Some regions have laws that make it so that a person has to be certain age before they are allowed to get a tubal ligation. Tubal ligation is done by written informed consent from the patient, without needing a diagnosis of any health problem. | ||
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A tubal ligation is done by a gynecologist, family medicine doctor, or general surgeon in a medical office, hospital, or clinic.<ref name="planned parenthood" /> Tubal ligation is done in one stage. Although many sources refer to it being done under local or regional anesthesia,<ref>Hatasaka, et al. “Laparoscopic tubal ligation in a minimally invasive surgical unit under local anesthesia compared to a conventional operating room approach under general anesthesia.” 1997.</ref> typically it is done under general anesthesia. The patient goes home the same day. | A tubal ligation is done by a gynecologist, family medicine doctor, or general surgeon in a medical office, hospital, or clinic.<ref name="planned parenthood" /> Tubal ligation is done in one stage. Although many sources refer to it being done under local or regional anesthesia,<ref>Hatasaka, et al. “Laparoscopic tubal ligation in a minimally invasive surgical unit under local anesthesia compared to a conventional operating room approach under general anesthesia.” 1997.</ref> typically it is done under general anesthesia. The patient goes home the same day. | ||
During laparoscopic surgery, the surgeons put carbon dioxide gas into the abdominal cavity. This is to lift organs apart so that the surgeon can see what they're doing as they work. This is called insufflation of the abdomen. After surgery, the person's belly will still look distended. This is the only particularly uncomfortable part of tubal ligation. During recovery, the person may feel pain in their shoulders, because the distended abdomen puts pressure on the diaphragm, which the nerves refer to the shoulders.<ref>http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm</ref> The gas slowly goes away by being absorbed into the body, so in a few days, the belly will no longer look distended. | During laparoscopic surgery, the surgeons put carbon dioxide gas into the abdominal cavity. This is to lift organs apart so that the surgeon can see what they're doing as they work. This is called insufflation of the abdomen. After surgery, the person's belly will still look distended. This is the only particularly uncomfortable part of tubal ligation. | ||
During recovery, the person may feel pain in their shoulders, because the distended abdomen puts pressure on the diaphragm, which the nerves refer to the shoulders.<ref>http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm </ref> The gas slowly goes away by being absorbed into the body, so in a few days, the belly will no longer look distended. | |||
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==Costs and health insurance== | ==Costs and health insurance== | ||
A tubal ligation costs between USD$1,500 and USD$6,000.<ref name="planned parenthood" /> Most health insurance companies cover it, especially if they otherwise cover contraception. If cost is a obstacle, you may be able to lower it to suit your income level through a state program or a Planned Parenthood health center.<ref name="planned parenthood" /> If a complication happens, it could cost much more. See also: [[Saving up for transition expenses]]. | A tubal ligation costs between USD$1,500 and USD$6,000.<ref name="planned parenthood" /> Most health insurance companies cover it, especially if they otherwise cover contraception. If cost is a obstacle, you may be able to lower it to suit your income level through a state program or a Planned Parenthood health center.<ref name="planned parenthood" /> If a complication happens, it could cost much more. See also: [[Saving up for transition expenses]]. | ||
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==Complications and risks== | ==Complications and risks== | ||
[[File:Ectopic Pregnancy Diagram.jpg|thumb|A diagram of a non-viable type of pregnancy in which an embryo implants in a fallopian tube. This can happen after tubal ligation if the tube has not been successfully cut, tied, blocked, or destroyed.]] | [[File:Ectopic Pregnancy Diagram.jpg|thumb|A diagram of a non-viable type of pregnancy in which an embryo implants in a fallopian tube. This can happen after tubal ligation if the tube has not been successfully cut, tied, blocked, or destroyed.]] | ||
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Tubal ligation makes it virtually impossible to get a pregnancy of any kind. It is extremely rare for a pregnancy to happen afterward anyway, but it does happen. This can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, so that there was still enough of an opening in the tube for an egg or sperm to pass through. There is a tiny risk that if someone does get pregnant after a tubal ligation, then the embryo might implant in the wrong part of the uterus. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnacy) or in the fallopian tube (a tubal pregnancy), it can cause the pregnant person to suffer circulatory collapse and die.<ref>Raziel, et al. “Ovarian pregnancy—a 12-year experience of 19 cases in one institution.” 2003.</ref> If someone gets an ectopic pregnancy, it is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery. For every 1,000 women who have their tubes cut, about 5 will later get pregnant, and of those, about 1 in 3 gets an ectopic pregnancy,<ref name="planned parenthood" /> which is still much rarer than ectopic pregnancies in people who have not had a tubal ligation. For comparison, even if someone has had their uterus removed, but still has ovaries, there is still a chance that they could get an ectopic pregnancy. The only kind of surgery that makes it completely impossible to get pregnant is removal of the ovaries, but that means the person's body won't make hormones anymore. | Tubal ligation makes it virtually impossible to get a pregnancy of any kind. It is extremely rare for a pregnancy to happen afterward anyway, but it does happen. This can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, so that there was still enough of an opening in the tube for an egg or sperm to pass through. There is a tiny risk that if someone does get pregnant after a tubal ligation, then the embryo might implant in the wrong part of the uterus. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnacy) or in the fallopian tube (a tubal pregnancy), it can cause the pregnant person to suffer circulatory collapse and die.<ref>Raziel, et al. “Ovarian pregnancy—a 12-year experience of 19 cases in one institution.” 2003.</ref> If someone gets an ectopic pregnancy, it is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery. For every 1,000 women who have their tubes cut, about 5 will later get pregnant, and of those, about 1 in 3 gets an ectopic pregnancy,<ref name="planned parenthood" /> which is still much rarer than ectopic pregnancies in people who have not had a tubal ligation. For comparison, even if someone has had their uterus removed, but still has ovaries, there is still a chance that they could get an ectopic pregnancy. The only kind of surgery that makes it completely impossible to get pregnant is removal of the ovaries, but that means the person's body won't make hormones anymore. | ||
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==See also== | ==See also== | ||
*[[Bottom surgery]], meaning any of a variety of | *[[Bottom surgery]], meaning any of a variety of other surgeries that some nonbinary people may choose to get on their reproductive organs | ||
*[[Practical resources]] | *[[Practical resources]] | ||
*[[Saving up for transition expenses]] | *[[Saving up for transition expenses]] | ||