Tubal ligation: Difference between revisions

[[Tubal ligation]], also called getting one's tubes tied, and sometimes used to mean a bilateral salpingectomy (destroying both fallopian tubes), is a form of sterilization. Any method of tubal ligation works by stopping the path the egg cell would 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. There are several methods of tubal ligation, but bilateral salpingectomy has come to be the preferred standard of care, because it is the most effective.<ref name="ACOG774">ACOG Committee Opinion No. 774: Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention, Obstetrics & Gynecology: April 2019 - Volume 133 - Issue 4 - p e279-e284 doi: 10.1097/AOG.0000000000003164 Full text: https://journals.lww.com/greenjournal/Fulltext/2019/04000/ACOG_Committee_Opinion_No__774__Opportunistic.59.aspx [https://web.archive.org/web/20230507123319/https://journals.lww.com/greenjournal/fulltext/2019/04000/acog_committee_opinion_no__774__opportunistic.59.aspx Archived] on 17 July 2023</ref> 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> Because this is not Wikipedia, this article should focus on common questions that transgender and nonbinary people have about this procedure, and should be written in simple English, so that people who are not doctors can easily understand it.

Tubal ligation has no effect on the person's menstrual flow, menstrual cycle, hormone balance, the ability to orgasm, vulnerability to sexually transmitted infections,<ref name="planned parenthood">"Sterilization." ''Planned Parenthood.'' Retrieved July 9, 2020. https://www.plannedparenthood.org/learn/birth-control/sterilization [https://web.archive.org/web/20230306140201/https://www.plannedparenthood.org/learn/birth-control/sterilization Archived] on 17 July 2023</ref> or when or how the person will go through menopause.<ref>Deborah B. Nelson; Mary D. Sammel; Ellen W. Freeman; Clarisa R. Gracia; Li Liu; Elizabeth Langan (2005). "Tubal ligation does not affect hormonal changes during the early menopausal transition." ''Contraception'', 71(2), 0–110. doi:10.1016/j.contraception.2004.09.008 https://www.sciencedirect.com/science/article/abs/pii/S0010782404002756 [https://web.archive.org/web/20220323211639/https://www.sciencedirect.com/science/article/abs/pii/S0010782404002756 Archived] on 17 July 2023</ref> It does not elevate any cancer risks, and lowers ovarian cancer risk.<ref name="brinton cancer">Brinton LA, Gammon MD, Coates RJ, Hoover RN. “Tubal ligation and risk of breast cancer.” British Journal of Cancer 2000 May; 82(9), 1600–1604. doi:10.1054/bjoc.1999.1182 </ref><ref name="turney">Lyn Turney (1993). "Risk and contraception: What women are not told about tubal ligation." ''Women's Studies Int. Forum'', 16(5), 471–486. doi:10.1016/0277-5395(93)90097-s</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"> A.C. Donnadieu; X. Deffieux; A. Gervaise; E. Faivre; R. Frydman; H. Fernandez (2007). "Essure® sterilization associated with endometrial ablation." ''International Journal of Gynecology and Obstetrics'', 97(2), 0–142. doi:10.1016/j.ijgo.2007.02.009  

Anyone seeking sterilization will encounter sexist discrimination. Doctors, local laws, and health insurance companies put many more obstacles in the way of sterilization for people who they perceive as female, because of a widespread misconception that everyone who was born with a uterus will want to get pregnant someday. By comparison, doctors are much more willing and cooperative about giving the equivalent sterilization procedure to people who have testicles (a [[vasectomy]]). A doctor will only let a patient sign the consent forms for tubal ligation in the first place if the doctor is satisfied with how the patient answers a long series of intentionally offensive questions. Doctors intentionally try to lead people into giving the "wrong" answers, and then refuse to let the patient sign the consent forms. A survey found that male and female doctors are equally reluctant to let a "young" person (in their 20s or 30s) get a tubal ligation. Looking too youthful or whimsical can be enough for the doctor to decide you don't look like you can consider this decision, so dress maturely for this appointment.<ref name="misa">Misa, “How to get your tubes tied, even if you’re only 21.” ''Misa's Place'' (blog). Posted September 21, 2006. Accessed July 1, 2013. https://web.archive.org/web/20130701000000*/http://misasplace.blogspot.com/2006/09/how-to-get-your-tubes-tied-even-if.html</ref> See [[sterilization]] for more details on what the doctor wants to hear. There is also racist discrimination involved: doctors make sterilization relatively easy to get for people of color, or even push it on people of color who don't want it, but make sterilization almost impossible to get for people who are white. The motivation behind this racist discrimination is eugenics. After signing these consent forms, the patient may be required to wait a certain number of days before being allowed to have surgery. The wait is to give the patient time to make sure it's what they really want. This is also sexist discrimination, because people seeking a [[vasectomy]] are not forced to wait.<ref name="planned parenthood" /><ref name="jezebel">Erin Gloria Ryan, “Getting your tubes tied is a giant pain in the ass.” Published July 9, 2012. ''Jezebel'' (magazine). http://jezebel.com/5924414/getting-your-tubes-tied-is-a-giant-pain-in-the-ass [https://web.archive.org/web/20221109031044/https://jezebel.com/5924414/getting-your-tubes-tied-is-a-giant-pain-in-the-ass Archived] on 17 July 2023</ref><ref name="lowder">J. Lowder, “Sterilize me, please.” ''Slate'' (magazine). Posted July 9, 2012. Accessed May 4, 2012. http://www.slate.com/articles/double_x/doublex/2012/07/getting_your_tubes_tied_why_do_young_women_have_a_hard_time_getting_sterilized_.3.html [https://web.archive.org/web/20180918142117/http://www.slate.com:80/articles/double_x/doublex/2012/07/getting_your_tubes_tied_why_do_young_women_have_a_hard_time_getting_sterilized_.3.html Archived] on 17 July 2023</ref> Even after submitting the consent forms, the doctors usually continue to create obstacles, such as deciding that the consent forms need to be redone because the doctor didn't print their name below their signature, or canceling the surgery at the last minute because the patient didn't call to confirm that they still wanted it. Our wiki's article about [[sterilization]] tells more about how to navigate this form of sexist discrimination, find doctors who are willing to do it, and talk to them about it. As of this writing, some up-to-date resources for finding doctors who are willing to do a tubal ligation by the informed consent model include [https://np.reddit.com/r/childfree/wiki/doctors The Childfree Friendly Doctors List],<ref>"The Childfree Friendly Doctors List." ''Childfree'' (subreddit wiki). Updated May 3, 2022. Accessed May 4, 2022. https://np.reddit.com/r/childfree/wiki/doctors [https://web.archive.org/web/20210527154029/https://np.reddit.com/r/childfree/wiki/doctors Archived] on 17 July 2023</ref> and [https://www.facebook.com/groups/906558446831913 Facebook's Childfree and Sterile/Seeking Sterilization group].<ref>''Childfree and Sterile/Seeking Sterilization'' (Facebook group). Created March 3, 2021. Updated May 4, 2022. Accessed May 4, 2022. https://www.facebook.com/groups/906558446831913 [https://web.archive.org/web/20221028231829/https://www.facebook.com/groups/906558446831913 Archived] on 17 July 2023</ref>  

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 temporarily look enlarged (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 muscles inside the top of the abdomen (the diaphragm), and the nerves refer that sensation to the shoulders.<ref>"Diagnostic laparoscopy." ''MedLine Plus''. Accessed May 4, 2022. http://www.nlm.nih.gov/medlineplus/ency/article/003918.htm [https://web.archive.org/web/20230510201713/https://www.nlm.nih.gov/medlineplus/ency/article/003918.htm Archived] on 17 July 2023</ref> The gas slowly goes away by being absorbed into the body, so in a few days, the belly will no longer look distended.  

Most methods of tubal ligation are about 99% effective or greater in preventing pregnancy.<ref name="ACOG208">{{Cite journal|date=March 2019|title=ACOG Practice Bulletin No. 208: Benefits and Risks of Sterilization|journal=Obstetrics & Gynecology|language=en|volume=133|issue=3|pages=e194–e207|doi=10.1097/AOG.0000000000003111|issn=0029-7844|pmid=30640233|author1=American College of Obstetricians Gynecologists' Committee on Practice Bulletins—Gynecology|s2cid=58625472}}</ref> A pregnancy can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, or if the tubes later reconnected (recanalization), so that there was enough of an opening in the tube for an egg or sperm to pass through. If someone does get pregnant after a tubal ligation, then the embryo might implant somewhere wrong. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnancy) or in the fallopian tube (a tubal pregnancy), the embryo generally can't survive,<ref>{{cite journal | vauthors = Zhang J, Li F, Sheng Q | s2cid = 35923100 | title = Full-term abdominal pregnancy: a case report and review of the literature | journal = Gynecologic and Obstetric Investigation | volume = 65 | issue = 2 | pages = 139–41 | date = 2008 | pmid = 17957101 | doi = 10.1159/000110015 }}</ref> For the pregnant person, an ectopic pregnancy is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery.<ref name=kirk2013>{{cite journal | vauthors = Kirk E, Bottomley C, Bourne T | title = Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location | journal = Human Reproduction Update | volume = 20 | issue = 2 | pages = 250–61 | year = 2014 | pmid = 24101604 | doi = 10.1093/humupd/dmt047 | doi-access = free }}</ref> Worldwide, pregnancy happens after the cutting, tying, or blocking methods of tubal ligation in 1 in 200 cases; of those pregnancies, 1 in 10 of them were ectopic pregnancies.<ref name="Date">Date, Shilpa Vishwas et al. “Female sterilization failure: Review over a decade and its clinicopathological correlation.” International journal of applied & basic medical research vol. 4,2 (2014): 81-5. doi:10.4103/2229-516X.136781 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137647/ [https://web.archive.org/web/20220717185335/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137647/ Archived] on 17 July 2023</ref> However, the preferred method, salpingectomy, destroys the whole fallopian tubes, which makes it far safer for preventing pregnancies (ectopic or otherwise) than tubal ligation methods that only cut, tie, or block the tubes. There have only been two reported cases worldwide of any kind of pregnancy happening after bilateral salpingectomy.<ref name"Bollapragada">Bollapragada, Shrikant S et al. “Spontaneous pregnancy after bilateral salpingectomy.” ''Fertility and sterility'' vol. 83,3 (2005): 767-8. doi:10.1016/j.fertnstert.2004.07.970 Full text: https://www.fertstert.org/article/S0015-0282(04)02993-0/fulltext [https://web.archive.org/web/20191002050852/https://www.fertstert.org/article/S0015-0282(04)02993-0/fulltext Archived] on 17 July 2023</ref>