Overview

Tubal ligation — also known as having your tubes tied or tubal sterilization — is a type of permanent birth control. During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy.

Tubal ligation prevents an egg from traveling from the ovaries through the fallopian tubes and blocks sperm from traveling up the fallopian tubes to the egg. The procedure doesn't affect your menstrual cycle.

Tubal ligation can be done at any time, including after childbirth or in combination with another abdominal surgery, such as a C-section. Most tubal ligation procedures cannot be reversed. If reversal is attempted, it requires major surgery and isn't always effective.

Why it's done

Tubal ligation is one of the most commonly used surgical sterilization procedures for women. Tubal ligation permanently prevents pregnancy, so you no longer need any type of birth control. However, it does not protect against sexually transmitted infections.

Tubal ligation may also decrease your risk of ovarian cancer, especially if the fallopian tubes are removed.

Tubal ligation isn't right for everyone, however. Your doctor or health care provider will make sure you fully understand the risks and benefits of the procedure.

Your doctor may also talk to you about other options, including long-acting reversible contraceptives such as an intrauterine device (IUD) or a birth control device that's implanted in your arm. An alternative permanent option is hysteroscopic sterilization, in which your doctor places a small coil or other insert into the fallopian tubes. The insert causes scar tissue to form and seal off the tubes.

Risks

Tubal ligation is an operation that involves making incisions in your abdomen. It requires anesthesia. Risks associated with tubal ligation include:

  • Damage to the bowel, bladder or major blood vessels
  • Reaction to anesthesia
  • Improper wound healing or infection
  • Continued pelvic or abdominal pain
  • Failure of the procedure, resulting in a future unwanted pregnancy

Things that make you more likely to have complications from tubal ligation include:

  • History of pelvic or abdominal surgery
  • Obesity
  • Diabetes

How you prepare

Before you have a tubal ligation, your health care provider will talk to you about your reasons for wanting sterilization. Together, you'll discuss factors that could make you regret the decision, such as a young age or change in marital status.

Your health care provider will also review the following with you:

  • Risks and benefits of reversible and permanent methods of contraception
  • Details of the procedure
  • Causes and probability of sterilization failure
  • Ways to prevent sexually transmitted infections
  • The best time to do the procedure — for instance, shortly after childbirth or in combination with another abdominal surgery, such as a C-section

If you're not having a tubal ligation shortly after childbirth or during a C-section, consider using contraception for at least one month before the procedure and continue using a reliable form of contraception until your tubal ligation procedure is performed.

What you can expect

Tubal ligation can be done:

  • Following a vaginal birth using a small incision under the belly button (mini-laparotomy)
  • During a C-section
  • Anytime as an outpatient procedure using a laparoscope and short-acting general anesthesia (interval tubal ligation)

Before the procedure

You may be asked to take a pregnancy test to make sure you're not pregnant.

During the procedure

If you have an interval tubal ligation as an outpatient procedure, either a needle is inserted or an incision is made through your belly button so your abdomen can be inflated with gas (carbon dioxide or nitrous oxide). Then a laparoscope is inserted into your abdomen.

In most cases, your doctor will make a second small incision to insert special instruments through the abdominal wall. Your doctor uses these instruments to seal the fallopian tubes by destroying parts of the tubes or blocking them with plastic rings or clips.

If you have a tubal ligation after vaginal childbirth, your doctor will likely make a small incision under your belly button, providing easy access to your uterus and fallopian tubes. If you have a tubal ligation during a C-section, your health care provider will use the incision that was made to deliver the baby.

After the procedure

If gas was used during tubal ligation, it will be removed when the procedure is done. You may be allowed to go home several hours after an interval tubal ligation. Having a tubal ligation immediately following childbirth doesn't usually involve a longer hospital stay.

You'll have some discomfort at the incision site. You might also have:

  • Abdominal pain or cramping
  • Fatigue
  • Dizziness
  • Gassiness or bloating
  • Shoulder pain

Your health care provider will discuss management of any post-procedure pain with you, before you go home from the hospital.

You may bathe 48 hours after the procedure, but avoid straining or rubbing the incision. Carefully dry the incision after bathing.

Avoid heavy lifting and sex until your health care provider informs you that it's safe to do so. Resume your normal activities gradually as you begin to feel better. Your stitches will dissolve and won't require removal. Check with your health care provider to see if you need a follow-up appointment.

If you have any concerns that you aren't healing properly, call your doctor. Call your health care provider immediately if you have:

  • Temperature of 100.4 F (38 C) or greater
  • Fainting spells
  • Severe abdominal pain that continues or gets worse after 12 hours
  • Bleeding from your wound through your bandage
  • Discharge from your wound that is foul smelling

Results

Tubal ligation is a safe and effective form of permanent birth control. But it doesn't work for everyone. Fewer than 1 out of 100 women will get pregnant in the first year after the procedure. The younger you are at the time it's done, the more likely it is to fail.

If you do conceive after having a tubal ligation, there's a risk of having an ectopic pregnancy. This means the fertilized egg implants outside the uterus, usually in a fallopian tube. An ectopic pregnancy requires immediate medical treatment. The pregnancy cannot continue to birth. If you think you're pregnant at any time after a tubal ligation, contact your health care provider immediately.

Keep in mind that although tubal ligation reversal is possible, the reversal procedure is complicated and may not work.

Dec. 21, 2017
References
  1. Hatcher RA, et al. Male and Female Sterilization. In: Contraceptive Technology. 20th ed. New York, NY: Ardent Media.
  2. Hatcher RA, et al. Female Sterilization: Tubal Ligation or Occlusion. In: Managing Contraception 2017-2018. 14th ed. Tiger, Georgia: Bridging the Gap Foundation.
  3. Frequently asked questions. Contraception FAQ035. Sterilization by laparoscopy. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Sterilization-by-Laparoscopy. Accessed Oct.6, 2017.
  4. Frequently asked questions. Contraception FAQ052. Postpartum sterilization. American College of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Postpartum-Sterilization. Accessed Oct.6, 2017.
  5. Butler Tobah YS (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 11, 2017.

Tubal ligation