Tubal Ligation

What is tubal ligation?

Tubal ligation, commonly referred to as “getting your tubes tied,” is a surgical procedure that’s very effective in preventing pregnancy. It involves cutting, blocking or sealing off your fallopian tubes to prevent your eggs from being fertilized by sperm. The term “tubal” refers to the fallopian tubes. “Ligation” means to tie. Your fallopian tubes are cut and tied with a special thread (suture) or blocked during this procedure using a clamp, clip or band.

Your reproductive system includes your vagina, uterus, fallopian tubes and ovaries. The fallopian tubes are on either side of your uterus and extend toward your ovaries. They receive eggs from your ovaries and transport them to your uterus. Sperm can no longer reach the egg and an egg can’t reach sperm when the fallopian tubes are closed. This prevents you from becoming pregnant.

This procedure is also called tubal sterilization or female sterilization. It’s performed after vaginal childbirth or a Cesarean delivery (C-section), during another abdominal surgery or on its own. Tubal ligation can be difficult and expensive to reverse and doesn’t protect against sexually transmitted infections (STIs).

Why do people get their tubes tied?

Tubal ligation is considered permanent birth control. It’s about 99% effective in preventing pregnancy. If you’re sure you don’t want to be pregnant or be pregnant ever again, getting your tubes tied is a safe and convenient form of contraception. It allows you to enjoy sex without worrying about pregnancy.

In some cases, removal of your fallopian tubes is recommended for treating certain conditions. Your healthcare provider may also recommend it if you have a high chance of being a carrier of a specific gene mutation (BRCA) that’s associated with ovarian cancer.

How do I know I am ready to get my tubes tied?

You should carefully weigh your decision to undergo sterilization. Though tubal ligation has been successfully reversed in some people, the procedure is meant to be permanent.

People who are unsure if they still want children should choose a reversible form of contraception, such as birth control pills, an intrauterine device (IUD) or a barrier method (such as a diaphragm).

Your partner may also consider having a vasectomy, a method of sterilization that involves cutting and tying the vas deferens, a tube that transports sperm.

How do I get ready for tubal ligation surgery?

Before the procedure, you should discuss your decision for tubal ligation with your healthcare provider. Make sure you understand the risks of sterilization, how the procedure will be performed and any special instructions.

How is tubal ligation performed?

Your fallopian tubes are cut and tied with special thread, closed shut with bands or clips, or sealed with an electric current during tubal ligation. It can be performed in three ways:

Laparoscopic tubal ligation

Laparoscopy enables your healthcare provider to complete tubal ligation by making two small incisions — one at your navel and one just above your public bone.

First, an intravenous line (IV) will be inserted into a vein in your hand or arm. You’ll be given a general anesthetic in the IV to relax your muscles and prevent pain during surgery.

A small incision is then made near your navel. A laparoscope, a thin viewing tube about the width of a pencil, is passed through this incision, and your abdomen is inflated with carbon dioxide to make your organs easier to view.

Then, they insert a surgical instrument through a second small incision made at your pubic hairline. Your fallopian tubes are located and then sealed with a band, ring or clip. Sometimes, your healthcare provider will use an electric current, called electrocoagulation, to seal your fallopian tubes.

After your provider seals your fallopian tubes, they remove the laparoscope and use dissolvable stitches to close the incisions.

Laparoscopic sterilization is typically done as an outpatient procedure and can be performed at any time. The smaller incisions reduce recovery time after surgery and the risk of complications. In most cases, you can leave the surgery facility within four hours after laparoscopy.

Laparotomy

A laparotomy is a more extensive surgery that requires a larger abdominal incision and sometimes a day or two of recovery in the hospital. Your healthcare provider will make a two- to five-inch incision in your abdomen, then bring your fallopian tubes up through the incision. Next, the tubes are cut and closed off using bands, rings or clamps. Finally, your provider closes your abdomen with stitches.

As this is an open abdominal surgery, the recovery time can take several weeks. Generally, this form of tubal ligation is considered outdated and invasive compared to more modern practices, except when it occurs after a C-section delivery. In that case, your provider uses the same incision to deliver your baby and perform tubal ligation.

Mini-laparotomy tubal ligation (mini-lap)

Unlike a laparotomy, a mini-laparotomy uses a smaller incision — this is why it’s given the name “mini” laparotomy. This type of tubal ligation is typically done within 24 hours of a vaginal childbirth, when you’re already under epidural anesthesia. However, it can also be done under spinal anesthesia if you didn’t receive an epidural during labor.

After you give birth, your provider locates your fallopian tubes and uterus just below your navel. If a provider performs a mini-lap outside of childbirth, they make the incision just above your public bone.

Your healthcare provider locates your fallopian tubes, lifts them to the incision and closes them off using a special thread (suture). If the procedure isn’t related to childbirth, your provider may use bands, rings or clamps. The incision will be closed with stitches that dissolve.

Is getting my tubes tied a major surgery?

It depends on how your surgeon performs a tubal ligation. Your healthcare provider will determine the best way to proceed with surgery based on your medical history or if you’re having a tubal ligation immediately after childbirth.

A laparoscopic tubal ligation is less invasive because it leaves a smaller incision and has a shorter recovery time. A mini-laparotomy is slightly more invasive than laparoscopy and typically performed just after giving birth. The most major tubal ligation surgery is a laparotomy because it involves making a large incision across your abdomen.

What should I expect after getting my tubes tied?

After your tubal ligation, you’re taken to a recovery area for monitoring. If you’ve had a laparoscopic tubal ligation, you may be allowed to go home within a few hours. If you’ve had a mini-laparotomy or laparotomy, you may need to stay in the hospital overnight. If you get your tubes tied after giving birth, you’ll already have planned a hospital stay.

Some common restrictions you can expect after a tubal ligation are:

• Avoid lifting anything heavy for at least one or two weeks. If you gave birth just before your tubal ligation, it’s usually recommended to wait at least four weeks to lift anything heavier than your baby.
• Don’t drink alcohol or drive for at least 24 hours.
• You can resume showers as usual. Don’t swim or take baths for at least two weeks after surgery to allow for the incision site to heal.
• Gas in your abdomen may cause discomfort in your neck, shoulders and chest for 24 to 72 hours after surgery. Try taking a warm shower, using a heating pad or walking.
• You may have mild nausea. Try eating a light evening meal on the day of surgery. Tea, soup, toast or crackers may help relieve nausea.
• Your abdomen may be swollen for several days after the surgery. You can take over-the-counter pain medication or prescription pain reliever as directed by your healthcare provider.
• Vaginal bleeding up to one month after surgery is typical. Many people don’t have their next normal menstrual cycle for four to six weeks after surgery. When your normal cycle returns, you may notice heavier bleeding and more discomfort than usual.

What are the side effects of having a tubal ligation?

You’ll have some pain in your abdomen and feel tired after the procedure. The type of anesthesia used and how the surgery was performed can also affect your symptoms. The most common side effects of tubal ligation are:

• Shoulder pain.
• Bloating.
• Abdominal cramps.
• Nausea.
• Sore throat (from the breathing tube).
• Dizziness.

If you have pelvic pain that doesn’t go away after a few days, or if you have a fever, contact your healthcare provider right away.

What are the advantages of getting tubal ligation?

• Highly effective and convenient: Tubal ligation is about 99% effective. It protects you for the rest of your life against pregnancy. You never have to remember to take birth control pills or change it, and you don’t have to visit your pharmacy or gynecologist for birth control.
• Nonhormonal form of birth control: Some people prefer nonhormonal forms of birth control. Tubal ligation doesn’t change your hormones. It also doesn’t affect your period or cause menopause.
• Reduces risk of diseases or cancer: Studies have shown that tubal sterilization can reduce your risk for ovarian cancer by about 40%.

What are the disadvantages of getting tubal ligation?

• Regret: Studies have shown around 12% of people regret choosing sterilization and may benefit from waiting until age 30 to have the procedure. Make sure you’ve carefully weighed all pros and cons of getting your tubes tied.
• Permanent: Getting tubal ligation reversal surgery is expensive and not highly effective. Tubal ligation is meant to be permanent.
• Risks of surgery: Tubal ligation is a safe surgery and most people don’t have issues. But there are risks associated with all medical procedures.

What are the possible complications of getting your tubes tied?

Tubal ligation is a safe procedure with few complications. However, there are some complications associated with the procedure:

• Foul-smelling vaginal discharge.
• Pus or blood from the incision.
• Irregular bleeding from your vagina.
• Feeling like you’re going to faint.
• Fever.
• Pelvic or abdominal pain.
• Swelling or rash in the area of the incision.
• Allergic reaction to anesthesia.
• Injury to other organs during surgery (like your bladder or uterus).

In rare cases, your fallopian tubes can reconnect after tubal ligation or the clamp can fail. This can lead to ectopic pregnancy, a dangerous condition where a pregnancy develops in your fallopian tube.

Certain conditions like diabetes or endometriosis, having obesity and a history of abdominal surgery can increase your risk for complications.

What is post-tubal ligation syndrome?

Not everyone has signs of post-tubal ligation syndrome (PTLS). Some of the common symptoms of PTLS are:

• Pain in your pelvis or back.
• Painful sex.
• Headaches.
• Cramping during your period.
• Abnormal bleeding or missed periods.
• Symptoms of PMS or menopause.

Talk to your healthcare provider if you've had tubal ligation and experience uncomfortable or painful symptoms in the months or years afterward. They can help treat your symptoms and rule out any serious complications.

How long does it take to recover from a tubal ligation?

Your recovery depends on your health and the type of surgery you had. You should be able to resume normal activities within a few days if you’ve had a laparoscopic tubal ligation. If you had a tubal ligation after childbirth, the recovery will last a few weeks, as you’re also recovering from giving birth. If you had another abdominal surgery or C-section along with tubal ligation, your recovery might be extended up to eight weeks.

It’s important to follow all post-operative instructions you’re given. Your healthcare provider will schedule a follow-up appointment to make sure you’ve healed and that there weren’t any complications.

Do you get your period after you get your tubes tied?

Getting your tubes tied doesn’t impact your menstrual cycle. You’ll still get your period. It won’t cause menopause either. If you had irregular periods before the tubal ligation, you’ll likely have irregular periods again after sterilization.

Can you get pregnant after you get your tubes tied?

The chances of getting pregnant after a tubal ligation are low. Depending on how the fallopian tubes are closed, pregnancy rates within 10 years of having the procedure range from .4% to 1%.

When should I call my doctor after a tubal ligation?

Contact your healthcare provider immediately if you experience any of the following:

• Persistent nausea and vomiting for more than 24 hours.
• Temperature over 100 degrees Fahrenheit (37.33 degrees Celsius) for more than 24 hours.
• Redness, swelling, drainage or bleeding around the incision.
• Heavy bleeding with clots or soaking a pad within two hours.

Where do my eggs go after tubal ligation?

Your body will still go through the process of releasing an egg at ovulation even though the passage through the fallopian tubes is now closed off. The egg will become very small or break down and get absorbed by your body.

What is the difference between a salpingectomy and tubal ligation?

Salpingectomy is the removal of one or both of your fallopian tubes. Salpingectomy treats certain medical conditions of your fallopian tubes and prevents ovarian and breast cancers in people at a higher risk. Tubal ligation is when the fallopian tubes are permanently blocked to prevent pregnancy. Both procedures are forms of birth control that prevent pregnancy.

How soon can I have sex again after I get my tubes tied?

It’s generally recommended to wait about a week to resume sexual activity. If your tubes are tied after childbirth, you should follow the recommendations for resuming sex postpartum, which is usually around six weeks or after your healthcare provider clears you.

Can I still get an STD if I have my tubes tied?

Yes, you can still get sexually transmitted infections (STIs). Using condoms is the best way to lower your chance of getting or spreading infection.

A note from Cleveland Clinic

Tubal ligation is a safe, effective and permanent way to prevent pregnancy. Talk to your healthcare provider about the procedure to make sure you understand what to expect during and after the surgery.