Female sterilisation

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is female sterilisation.

Female sterilisation blocks the fallopian tubes, which link the ovaries to the womb (uterus). This prevents the woman’s eggs from reaching sperm and becoming fertilised. Eggs will still be released from the ovaries as normal, but they'll be absorbed naturally into the woman's body.

Sterilisation is an operation. It's usually carried out under general anaesthetic.

At a glance: facts about female sterilisation

Female sterilisation is more than 99% effective, and only 1 woman in 200 will become pregnant in her lifetime after having it done.

You don't have to think about it every day, or every time you have sex, so it doesn't interrupt or affect your sex life.

You'll still have periods after being sterilised.

You'll need to use contraception until a week after the operation is done or until your next period, depending on which method you use.

As with any surgery, there's a small risk of complications. These include internal bleeding, infection or damage to other organs.

There's a small risk that the operation won't work. Blocked tubes can rejoin immediately or years later.

If the operation fails, this may increase the risk of ectopic pregnancy.

The sterilisation operation is difficult to reverse and isn't available on the NHS.

Female sterilisation doesn't protect against sexually transmitted infections (STIs). You should use condoms if you have a high risk of getting an STI – for example, if you have multiple sexual partners.

How female sterilisation works

Female sterilisation blocks the fallopian tubes. This means a woman's eggs cannot meet sperm, and fertilisation can't happen.

How female sterilisation is carried out

Female sterilisation is usually a minor operation, with most women returning home the same day.

Tubal occlusion

A laparoscopy (keyhole surgery) is the most common method of female sterilisation. The surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope. A laparoscope is a small telescope that contains a tiny light and camera. The camera allows the surgeon to see your fallopian tubes clearly.

A less common way to do female sterilisation is a mini-laparotomy. This is a small incision, usually less than 5cm (2 inches), just above the pubic hairline. Your surgeon can then access your fallopian tubes through this incision. A laparoscopy is usually the preferred option because it's faster. But a mini-laparotomy may be recommended in some cases.

Your surgeon will discuss what is best with you.

Blocking the tubes

The fallopian tubes can be blocked by either:

• applying clips – plastic or titanium clamps are closed over the fallopian tubes
• tying and cutting the tube – this destroys 3 to 4cm (1-1.5 inches) of the tube (usually only used when sterilisation is done at caesarean section)

Removing the tubes (salpingectomy)

If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.

Before the operation

If you decide to be sterilised, your GP will usually discuss it with you and refer you to a specialist for treatment. This will usually be a gynaecologist at your nearest NHS hospital. A gynaecologist is a specialist in the female reproductive system.

Your consultation will give you a chance to talk about the operation in detail. You can talk about any doubts, worries or questions that you might have.

Your GP shouldn't refuse to refer you for the procedure, even if they do not believe that it's in your best interest.

If you choose to have a sterilisation, you'll be asked to use contraception until the day of the operation. You'll be asked to continue using contraception until your next period if you're having your fallopian tubes blocked (tubal occlusion).

Sterilisation can be performed at any stage in your menstrual cycle.

Before you have the operation, you'll be given a pregnancy test to make sure that you're not pregnant.

Recovering after the operation

Once you've recovered from the anaesthetic, passed urine and had something to eat, you'll be allowed to go home. If you leave hospital within hours of the operation, ask a relative or friend to pick you up, or take a taxi.

The healthcare professionals treating you in hospital will tell you what to expect and how to care for yourself after surgery. They may give you a contact number to call if you have any problems or any questions.

If you've had a general anaesthetic, do not drive a car for 48 hours afterwards. This is because even if you feel fine, your reaction times and judgement may not be back to normal.

How you will feel

It's normal to feel unwell and a little uncomfortable for a few days if you've had a general anaesthetic. You may have to rest for a couple of days. Depending on your general health and your job, you can normally return to work 5 days after tubal occlusion. You should avoid heavy lifting for about a week.

You may have some slight vaginal bleeding. Use a sanitary towel rather than a tampon until this has gone. You may also feel some pain, similar to period pain. You may be prescribed painkillers for this. If the pain or bleeding gets worse, seek medical attention.

Caring for your wound

You'll have a wound with stitches where the surgeon made the incisions (cuts) into your tummy. Some stitches are dissolvable and disappear on their own, others will need to be removed. If your stitches need removing, you'll be given a follow-up appointment.

If there's a dressing over your wound, you can normally remove this the day after your operation. After this, you will be able to have a bath or shower as normal.

Having sex

Your sex drive and enjoyment of sex will not be affected. You can have sex as soon as it's comfortable to do so after the operation.

You'll need to use contraception until your first period to protect yourself from pregnancy.

Sterilisation will not protect you from STIs. So continue to use barrier contraception such as condoms if you have a high risk of getting an STI. For example, if you have multiple sexual partners or are unsure of your partner's sexual health.

Who can have it done?

Almost any woman can be sterilised, including women that have not had children. Sterilisation should only be considered by women who do not want any more children, or do not want children at all. Once you are sterilised it's very difficult to reverse the process. So it's important to consider the other options available before making your decision. Sterilisation reversal is not available on the NHS.

Research has shown that people who are sterilised before they're 30 are more likely to regret the operation. So women under the age of 30 are particularly advised to consider all other options and be sterilised only if they're sure it's right for them.

Advantages and disadvantages of female sterilisation

Advantages of female sterilisation are that:

• it can be more than 99% effective at preventing pregnancy
• tubal occlusion (blocking the fallopian tubes) and removal of the tubes (salpingectomy) should be effective immediately – you should continue to use contraception until your next period
• it will not affect your sex drive
• it will not affect the spontaneity of sexual intercourse or interfere with sex
• it will not affect your hormone levels

Disadvantages of female sterilisation are that it:

• does not protect you against STIs, so you should still use a condom if you are unsure about your partner's sexual health
• is very difficult to reverse a tubal occlusion and reversal operations are rarely funded by the NHS

Salpingectomy is not reversible. IVF may be an alternative way to get pregnant, but would have to be paid for privately.

Risks of female sterilisation

With tubal occlusion, there is a very small risk of complications. These include internal bleeding and infection or damage to other organs.

It's possible for sterilisation to fail. The fallopian tubes can rejoin and make you fertile again, although this is rare. About 1 in 200 women become pregnant in their lifetime after being sterilised.

If you do get pregnant after the operation, there's an increased risk that it will be an ectopic pregnancy.

If you miss a period, take a pregnancy test immediately. If the pregnancy test is positive, you must see your GP so that you can be referred for a scan to check if the pregnancy is inside or outside your womb.

The risk of complications are:

• the operation cannot be completed because of unexpected findings or difficulties, for example not being able to get into the abdomen (tummy) or not being able to find the fallopian tubes (the surgeon may make a larger cut in the abdomen to complete the operation) – 1 in 180
• perforation (making a hole) in the uterus by one of the instruments – 6 in 1000
• injuries to the bowel, bladder or blood vessels – 3 in 1000 (up to 15 in 100 injuries are not diagnosed at the time of the procedure)
• regret about being sterilised
• hernia at incision (this is a bulge in the skin where the operation was done and there may be bowel in the bulge) – 1 in 100 keyhole procedures
• shoulder tip pain due to the carbon dioxide put into the abdomen during the procedure to help see the fallopian tubes – up to 1 in 10
• death as a result of complications – 1 in 12,000

Where can you get contraception?

Most types of contraception are available free in the UK. Contraception is free to everyone through the NHS. You can get contraception, and information and advice about contraception, at:

• most GP practices – talk to your GP or practice nurse
• sexual health clinics – they also offer contraceptive and STI testing services
• some young people’s services

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer). They'll provide you with contraception as long as they believe you fully understand the information you're given and are able to use the contraception safely.

Doctors and nurses have a responsibility to make sure that you are safe and free from harm. They'll encourage you to consider telling your parents (or carer), but they won't make you. The only time that a professional will not be able to keep confidentiality is if they believe you're at risk of serious harm, such as abuse. If this was the case they would usually discuss it with you first.