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What does the female sterilisation operation involve?
A female sterilisation operation involves operating on the fallopian
tubes, which carry a fertilised egg to the womb where it can develop
into a baby. These tubes are within the abdominal cavity, so this
operation involves the surgeon gaining access to them through
the abdominal wall.
This makes a female sterilisation operation more complicated
than a vasectomy, which only requires a small cut in the scrotum.
Sterilisations are occasionally done under local anaesthetic,
but it is usual to have a general anaesthetic. The operation is
usually done with the aid of a 'laparoscope', a kind of telescope
that allows the surgeon to see the tubes on a TV screen, and to
apply clips to the tubes, which block them off. You need to take
it easy for several days after a sterilisation operation.
How effective is laparoscopic sterilisation?
The usually quoted figure for failure (ie pregnancy) in the UK
is 1 in 200. (In the USA, many surgeons quote a failure rate of
1 in 50.) This is a low failure rate, but it does come as a surprise
to many women who thought this was (nearly) 100% effective.
Why does it fail?
Failures can occur immediately, due to a problem at the time
of operation, or after some years when the tubes manage to recanalise
(join up).
The failure rate after sterilisation seems to be higher in younger
women (aged under 30 years). This is one of the reasons that a
doctor might suggest that younger women use one of the very effective
reversible methods for a few years, and then reconsider sterilisation
in their 30s.
What are the risks with sterilisation?
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Any operation carries a small risk from the general anaesthetic,
from bleeding, or from infection in the wound.
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Sometimes, using 'keyhole surgery', it is very difficult (or
impossible) for the surgeon to reach the tubes to apply the
clips. In this case it might be necessary to make a longer incision
in the abdomen (a laparotomy), and this will mean the operation
takes longer to recover from.
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Even using a laparotomy, it can be impossible to apply the
clips in a few women.
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If a woman does become pregnant after a sterilisation, there
is a relatively high risk of the pregnancy being ectopic (in
the fallopian tube). This is a medical emergency. If any woman
who has been sterilised thinks she might be pregnant, it is
vital that she doesn't just dismiss the idea; she needs an immediate
pregnancy test and if this is positive an urgent scan to check
on the site of the pregnancy.
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The most important, although rare, risk of the laparoscopy
is that the laparoscope can perforate internal organs (usually
the bowel) as it is being inserted into the abdomen. This can
be a serious situation for the woman's health.
Are there any risks to the woman's general health?
Once the possible risks of the operation itself have passed,
then there are no further risks to your health from operations
that have used modern techniques. However, there are also no health
benefits.
Many of the alternatives to sterilisation do have positive benefits
to health for some people.
Women sometimes complain of heavy and/or painful periods after
the sterilisation operation. This is not due to the operation,
but because they have stopped using other methods of contraception
(eg the pill) that were previously controlling some of the symptoms
of their periods.
Can sterilisations affect sexual function?
The sterilisation operation itself doesn't affect sexual function.
If you were previously using a less effective method of contraception,
then you might find your sex life is improved because you no longer
worry about getting pregnant. A few women realise after having
the operation that part of their sexual arousal came from the
possibility that they could get pregnant, even if a pregnancy
was not wanted. They might find that having the operation has
had an adverse effect on their sex life.
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