Tubal ligation, often referred to as
"having your tubes tied," is a surgical procedure in which a woman's
fallopian tubes are blocked, tied, or cut.
Tubal implants, such as Essure, are small metal springs that are placed in each fallopian tube
in a nonsurgical procedure (no cutting is involved). Over time, scar tissue
grows around each implant and permanently blocks the tubes. Either procedure
stops eggs from traveling from the ovaries into the fallopian tubes, where the
egg is normally fertilized by a sperm.
A diaphragm is a round piece of flexible rubber with a rigid rim. Before intercourse, the diaphragm is placed in the vagina against the cervix. The diaphragm prevents semen from entering the uterus. Spermicide should always be used with a diaphragm for it to be most effective.
There are several different
ways of closing the
fallopian tubes, including clipping or banding them
shut or cutting and stitching or burning them closed. Your surgeon will
probably prefer one of the following methods. See a picture of
tubal ligation methods.
A tubal ligation can be done in the
tubal ligation is usually done as a mini-laparotomy after childbirth. The
fallopian tubes are higher in the abdomen right after pregnancy, so the
incision is made below the belly button (navel). The procedure is often done
within 24 to 36 hours after the baby is delivered. See a picture of a
postpartum tubal ligation.
An open tubal ligation (laparotomy) is done through a
larger incision in the abdomen. It may be recommended if you need abdominal
surgery for other reasons (such as a
cesarean section) or have had
pelvic inflammatory disease (PID),
endometriosis, or previous abdominal or pelvic
surgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen.
Scarring or adhesions can make one of the other types of tubal ligation more
difficult and risky.
Reversing a tubal ligation is possible, but it is not
highly successful. This is why tubal ligation is considered a permanent method
of birth control.
Tubal implant method
Implants, such as Essure, are inserted in
the fallopian tubes without surgery or general anesthesia. The procedure is
done in a doctor's office, an outpatient surgery center, or hospital and does
not require an overnight stay. The implant procedure usually takes about 30
Before the procedure, your
cervix is first opened (dilated) to reduce the risk of
injury to the cervix. Your doctor will use a
speculum and a dilating instrument to gradually open
the cervix just before the procedure.
For the procedure, you are
positioned as you would be for a pelvic exam. Your doctor passes a
thin tube (catheter) through your vagina and cervix, into the uterus, and then
into a fallopian tube. The catheter is used to place an implant into a
fallopian tube. An implant is then placed in the other fallopian tube the same
way. You may have some menstrual-like cramps afterwards.
After the procedure, an
X-ray is taken to make sure the implants are in place
and the tubes are closed.
In some cases, a tubal implant can be
difficult to insert. Should this happen, a second procedure is needed to
completely block both tubes.
For the first 3 months after
insertion, you must use another method of birth control. At 3 months, dye is
injected into your uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants
are in place and the tubes are fully blocked by scar tissue. If they are, you
will no longer have to use another method of birth control.
What To Expect After Surgery
After a tubal ligation, you will
most likely go home the same day. Your surgeon will give you instructions on
what to expect and when to call after the surgery.
You may have some slight vaginal bleeding
caused by the movement of your uterus during the surgery.
had a laparoscopy, your stomach may be swollen (distended) from the gas that
was used to lift your skin and muscles away from your abdominal organs so the
surgeon could see them better. This should go away within a day or so but may
last longer. You may also have some back or shoulder pain from the gas in your
abdomen. This will go away as your body absorbs the gas.
shower 24 hours after the surgery, but avoid rubbing or pulling on your
incision for at least a week.
You can have sexual intercourse as
soon as you feel like it and it does not cause pain, which is usually 1 week
Be sure to rest for a few days (or at least 24
hours) before beginning to resume your normal activities. You should be able to
resume all activities within a week.
No backup method of birth
control is needed after the surgery.
A follow-up exam in 2 weeks is usually scheduled.
Most women can return to normal activities
the same day as the procedure.
Be sure to use another method of
birth control for 3 months, until an X-ray confirms that the fallopian tubes
Why It Is Done
A tubal ligation or tubal implant
placement is a permanent method of birth control. Only
consider this method when you are sure that you will not want to become
pregnant in the future.
Permanent birth control is a reasonable
option when you:
Do not want to have children in the future, no
matter how your life may change.
Have a partner who also does not
want children in the future but does not want to have a
Have also considered other methods of birth
control and do not want the side effects, risks, or costs of those
Have health problems that would be made worse by
Have a hereditary condition that you do not want to pass
Do not have any medical conditions that would make having
How Well It Works
Tubal ligation and tubal implants are
not 100% effective at preventing pregnancy.
There is a slight risk of becoming pregnant
after tubal ligation. This happens to about 5 out of 1,000 women after 1 year.
After a total of 5 years following tubal ligation, about 13 out of 1,000 women
will have become pregnant.1
may occur if:
The tubes grow back together or a new
passage forms (recanalization) that allows an egg to be fertilized by sperm.
Your doctor can discuss which method of ligation is more effective
for preventing tubes from growing back together.
The surgery was not done correctly.
pregnant at the time of surgery.
Sterilization implants are a newer birth
control technology, so there are no long-term statistics. Studies so far show
that over 2 years, fewer than 1 out of 100 women got pregnant with
A tubal implant can be
difficult to insert. Some women have to have a repeat procedure before both
tubal implants are properly placed.
Call your doctor immediately if you have had tubal ligation or tubal implants and you
Tubal ligation. Major
complications of tubal ligation are not common.
Minor complications include infection and wound
complications include heavy blood loss,
general anesthesia problems, organ injury during
surgery, and need for a larger laparotomy incision during surgery.
Although fewer complications occur with laparoscopy than
with other kinds of tubal ligation surgery, these complications can be more
serious. For example, in rare cases, the bowel or bladder is injured when
the laparoscope is inserted.
Tubal implants. There are rare
reports of implants causing pelvic pain that doesn't go away. In these cases,
the implants were removed 6 weeks after they were placed in the fallopian
tubes.2 The risk of pelvic infection is greater with
tubal implants. Before you receive implants, you will be tested to make sure
that you don't have a vaginal infection or a
sexually transmitted disease (STD).
Ectopic pregnancy risk
If a tubal ligation or
implant fails and you become pregnant, you have an increased risk of having an
ectopic pregnancy. Ectopic pregnancies can occur years
after the tubal ligation and are most likely 3 or more years after the
procedure.3 For more information, see the topic
What To Think About
Tubal ligation and tubal implants
do not change your monthly
menstrual cycle. You will still release an egg each
month (ovulate) and have menstrual periods. You will go through
menopause at the same time that you would have if you
had not had the surgery. Your sexual desires will not change, although you may
feel more relaxed about having sex because you don't have to worry about
Tubal ligation and tubal implants are
permanent methods of birth control and allow you to be sexually active without
worrying about becoming pregnant.
Although tubal ligation and
tubal implants are expensive, it is a one-time cost. These procedures are
usually covered by medical insurance, and there are no costs after the surgery
is done. The cost of other birth control methods, such as pills or condoms and
spermicide, may be greater over time.
You must use another form of birth control for 3
months after receiving tubal implants.
Other things to think about
Reversing tubal ligation
requires reconnecting the fallopian tubes, and success rates for reconnecting
are very low. If you are considering tubal ligation, be absolutely certain you
will never want to have a biological child in the future.
Health insurance coverage may require a
waiting period from 48 hours to 30 days under most
Some doctors advise a waiting period
between the time a woman requests a tubal ligation and the time the surgery is
performed. This waiting period allows you to be certain about your decision.
Pollack AE, et al. (2007). Female and male
sterilization. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 361-401. New York: Ardent Media.
Lannon BV, et al. (2007). Techniques for
removal of the Essure* hysteroscopic tubal occlusion device. Fertility and Sterility. Published online August 2007. 88(2):
Speroff L, Darney PD (2005). Sterilization. In
A Clinical Guide for Contraception, pp. 359-386.
Philadelphia: Lippincott Williams and Wilkins.
Primary Medical Reviewer
Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
Kirtly Jones, MD - Obstetrics and Gynecology
May 13, 2010
WebMD Medical Reference from Healthwise
May 13, 2010
This information is not intended to replace the advice of a doctor.
Healthwise disclaims any liability for the decisions you make based on this