• If the operation was done at the time of childbirth or abortion.

• If you strongly associate your identity as a woman with your fertility and have not worked out your feelings about this ahead of time.

How A Tubal Ligation Is Done

In the past, tubal ligation required major abdominal surgery, but this is almost never necessary now. These days, the operation most favoured is the laparoscopic sterilization. This operation has a relatively low complication rate, a short recovery period and two very small scars.

After you are under a general anesthetic, your bladder is emptied, and your abdomen and vagina are cleansed with an antiseptic soap. Two tiny incisions are made into the abdomen, one just above the pubic bone and the other just below the belly button. These incisions are 1/4 to 1/2 inch long. The abdomen is then inflated with gas so that the tubes may be more easily seen. Next the laparoscope (a slender light-containing telescope) is inserted into the upper incision, and the instruments for blocking the tubes into the lower incision.

While looking through the laparoscope, the doctor uses the instruments to block the tubes. He or she can use a variety of means including cautery, clips, rings or band, with or without a section of the tube being removed. Cautery means burning with an electric current. Clips, rings or bands block the tubes by squeezing them together. You should know ahead of time exactly what method your doctor is using and the chances for reversal.

After Surgery

After the surgery is completed, only one to two stitches are required to close each incision. The incisions can then be covered with a small dressing or bandaid (hence this type of tubal ligation is sometimes known as bandaid surgery). The operation lasts about 30 minutes.

After tubal ligation of this type, a woman can usually go home the same day and resume her normal activities within a week or even a few days. I usually suggest five to seven days to recover from the effects of the general anesthesia, even longer if necessary. You should allow some flex in your schedule post-operatively as women vary in the amount of recovery time their bodies require, and this is not always predictable ahead of time. It is also wise not to do any heavy lifting or strenuous physical work in the first week following surgery.

The ability to become pregnant ends immediately with the operation, and unlike vasectomy, there is no three-month waiting period during which birth control is still required.

The complications rate after laparoscopic sterilization is extremely low, about six in a 1,000 cases. The most common complication is that of bleeding into the abdomen, which can require hospitalization and further surgery.

Pregnancy, although rare, is a surprising complication of tubal ligation. Two to three women in a thousand operated on will become pregnant after tubal ligation.

If pregnancy does occur, it is more likely to occur in the tubes. A tubal pregnancy can bleed or rupture, which is a serious medical emergency requiring immediate surgery.

The nature of your menstrual periods may change, with heavier bleeding, or may stay the same. The usual cycle continues every month with an egg being produced. The difference now is that the egg is reabsorbed by the body and pregnancy cannot occur.

Women are usually told that tubal ligation does not affect other body functions. This may not always be true. In theory, your hormone secretions should also remain unchanged. However, some women may have their hormonal balance altered after tubal ligation. Premenstrual symptoms may intensify. Some women go into premature menopause immediately following surgery or within two to four years following surgery.

Some women become depressed after tubal ligation, especially if they were uncertain about their choice beforehand. However, most women experience a great deal of relief at the loss of their fertility. In one study, 50 percent of couples reported an enhanced sex life after tubal ligation, and 75 percent after vasectomy.