Since the June 2022 Supreme Court decision that allowed states to restrict or deny abortion access, permanent birth control options are becoming more popular, according to healthcare providers across the country.
For women, that option is tubal ligation, which is also known as having your tubes tied. It's a form of permanent sterilization for women: A woman’s fallopian tubes, through which an egg would normally travel to the uterus each month, are blocked or closed through surgery. This prevents the egg from ever being fertilized by sperm, and therefore prevents pregnancy. The procedure is for women who know and choose, with certainty, that they do not ever want to get pregnant?or bear children. Per Planned Parenthood, costs can range from $0 to $6,000 depending on insurance and other factors.
Myths and Misunderstandings About Tubal Ligation (Female Sterilization)
“I make sure that each patient understands that tubal ligation is a permanent procedure,” says?Kristyn Brandi MD, MPH, an ob-gyn and abortion provider at New Jersey Medical School in New Brunswick and the board chair of Physicians for Reproductive Health.?“It's a misnomer that a patient’s ‘tubes get tied,’ which leads?people?to think we can untie them. In reality, the procedure involves?cutting, cauterizing, or removing?the tubes altogether.”
Tubal Ligation vs. Vasectomy: What Is the Difference?
In men, a?vasectomy is when the vas deferens, or the tubes in the scrotum that carry sperm, are blocked or cut. This prevents sperm from joining semen as it leaves the body during ejaculation. Without sperm in semen, an egg cannot be fertilized during coitus to cause pregnancy.
Sterilization for women and men is the most common?method of birth control?in the United States, according to?a study published in March 2019 in?Obstetrics & Gynecology, used by nearly half (47.3 percent) of all married couples, with 30.2 percent having tubal ligation and 17.1 percent having a vasectomy.
Pros and Cons of Tubal Ligation or Getting Your ‘Tubes Tied’
The pros of having tubal ligation include never having to think about birth control again, though it does not protect against?sexually transmitted diseases. It is considered more than 99 percent effective. The cons of having your tubes tied are that it is very difficult, if not impossible, to reverse the procedure if you change your mind about wanting to have children in the future, and it is also a more extensive surgery than vasectomy. For long-term committed couples who know they do not want to have any children or more children together, vasectomy may be an option. Vasectomies are also easier to reverse if the couple decides later on that they do want to have children together.
A tubal ligation is just one form of long-term contraception, says Dr. Brandi. “There are other?forms of birth control that are more effective than tubal ligation, like the [hormone] implant?or the?IUD. Many people are surprised to learn that these are more effective than tubal ligation but are not permanent.”
Why Female Sterilization Is a Sensitive Issue
Female sterilization has a troubling history. In the past, women of color, women with low incomes, women who were incarcerated, and women with certain health histories were either encouraged to undergo sterilization or were sterilized without their knowledge or consent. “There is an important balance medical professionals should have between helping patients access care and making sure we do not coerce a patient into choices that may not be in their best interest despite our best intentions,” says Brandi.
Different Messages Behind Female and Male Fertility, Sterilization
In addition, a paternalistic culture has often encouraged women to put off sterilization either until they were older or had had children, even if a woman herself sought out sterilization because she knew she didn’t ever want children.
In a study published in March 2019 in?Rhetoric of Health & Medicine, Sara Davis and Abby Dubisar found that women on online forums and social media sites such as Reddit and Twitter wanted tubal ligation but were dissuaded from it or denied it by their doctors. At the same time, patient brochures on sterilization featured happy couples and families in the vasectomy pamphlets but unhappy or confused solo women in the tubal ligation ones, they found.
Finding the Right Physician for Birth Control Guidance
If you are interested in learning more about tubal ligation, speak with your obstetrician-gynecologist to find out if you are a good candidate.
“When I have a patient who wants permanent contraception, I make sure they know about all?options of contraception in general, and when it comes to permanent contraception, we talk about methods for people with uteruses and people with penises,” says Holly Bullock, MD, MPH, an assistant professor of obstetrics and gynecology at the University of Arizona College of Medicine in Tucson. The American College of Obstetricians and Gynecologists recommends that providers incorporate vasectomy counseling as an option for people asking about tubal ligation, because the failure rate is slightly lower at 0.15 percent for a vasectomy versus tubal ligation at 0.5 percent; Dr. Bullock notes that rate may not apply to every patient.
The Risks of Permanent Contraception for Women
“I know that seems likes splitting hairs, but for people to have a failed tubal ligation, it is more likely to be an?ectopic pregnancy, which is a medical emergency where the pregnancy grows outside of the uterus,” Bullock says. “With a failure of a vasectomy, it is more likely to be an intrauterine pregnancy, which then allows for options. A person may choose to continue the pregnancy, choosing parenting or adoption, or to end the pregnancy with abortion care. It is worth acknowledging that access to abortion has become extremely limited in our country in the past month. A vasectomy is also less risky, because it is done under local anesthesia in an office setting, while a tubal is done under general anesthesia, and there is a bigger risk of more problems.”
As a comparison,?failure rates for the IUD and implant?are 0.1 to 0.8 percent for various forms of the IUD and 0.01 percent for the implant, according to the Centers for Disease Control and Prevention.
People who have had tubal ligation have a lower risk of developing?ovarian cancer, too. Bullock says that with patients who express an interest she discusses every aspect of the procedure, such as whether it will be done following a vaginal or cesarean delivery or not related to pregnancy.
The Reality of Female Sterilization
Also, “if someone were to change their mind, I talk about whether adoption or?in vitro fertilization (IVF) could be an option, or a tubal reversal procedure, where tubes can be reattached, and the rates of success with that.” Success rates for a tubal reversal vary and may not result in a pregnancy — and insurance often doesn’t cover the reversal procedure or IVF, Bullock notes.
Since tubal ligation is permanent and regret can surface during or after the procedure, Bullock says she speaks with her patients frequently about whether they are sure they want to move forward. “I always make sure that someone, before the procedure of taking the tubes, has a chance to say they've had a change of mind. I let them know we can revisit their decision up until the day of the procedure, and sometimes people change their minds. I want to help them achieve their unique family size goals.”
There’s a History of Forced Female Sterilization
Even if a person is sure in their decision, they will likely still be asked by multiple healthcare providers about the choice. “It may seem judgmental, but we live in a society with a past medical history of making this decision, especially Black and brown people or those of different abilities, without their consent. We want to make sure that a person is not being coerced,” says Bullock. “There are rules that have come from an ugly history in our country of forced sterilization, to protect patients, especially those with state or federal health insurance like Medicaid, that require a 30-day waiting period before having the permanent birth control method of their choice.” Once the paperwork for it is signed, it is not binding, but it starts the waiting process, she says.
Permanent Sterilization Regrets: A Look at Statistics
In research published in?Clinical Obstetrics and Gynecology that compared female and male sterilization, the lead author, Grace Shih, MD, found that more women in their twenties were likely to express regret about having their tubes tied (20 percent), than were women in their thirties (6 percent). About 6 percent of men who had vasectomies expressed regret and sought reversals.
Ultimately, if you think a tubal ligation is right for you, find a physician who will work with you and listen to you and won’t tell you that permanent contraception requires you to be a certain age or have had a certain number of children, Bullock says. “It is painful to shop for a doctor who will listen to you, and I definitely feel for those patients,” she says.