Tubal ligation is a permanent method of contraception for women who do not want or no longer wish to have children. Is it irreversible? How is the operation going? Are there any risks? A minimum age to respect? Details of Dr Philippe Deruelle, gynecologist.
Tubal ligation is an irreversible sterilization method For the women majors. The woman who wishes to have this intervention can no longer have children. This requires surgery. For which women is tubal ligation indicated? How’s it going ? What are the risks ? THE contraindications ? minimum age to do it? What effects on the body ? The rules ? Sexuality? Insight from Dr Philippe Deruelle, gynecologist and general secretary of the National College of French Gynecologists and Obstetricians (CNGOF).
Fallopian tube ligation or sometimes called tubal ligation is a surgical procedure for (adult) women who do not or no longer wish to conceive a baby. The purpose of this method of sterilization? Prevent mechanically – by cutting or coagulating the fallopian tube, by applying a clip or a ring – the spermatozoa from accessing the oocyte. The contraceptive effect is therefore immediate.
This permanent contraceptive method is indicated whether :
- You are certain that you will not or no longer have any children: there is no age requirement, no requirement for the number of children, or consent of the spouse to be given
- You do not want or can no longer use other contraceptives (smokers, problems with venous circulation, etc.)
► The gynecological consultation
During a gynecological consultation, the patient can request tubal ligation. It is at this time that the gynecologist takes great care to explain to his patient all the details of the intervention and the possible complications. He explains to him the alternatives in terms of contraception, provides clear and complete information on the consequences of this act and clearly insists on the fact that it is a question ofa permanent sterilization method.
► The reflection period
In France, the law imposes a reflection period of 4 months between the patient’s request and the operation. If at the end of this period, the patient has decided to use this method and she is perfectly aware that she will no longer be able to have children naturally after this act, she must confirm her consent in writing during the a second visit medical.
► Surgical intervention
“Tubal ligation is usually done by laparoscopic route“, explains Dr. Deruelle. This consists of making a small incision on the navel, which allows the introduction of a mini camera and one or two trocars (small cylindrical rods intended for punctures and biopsies) at the level of the part lower belly (one at the level of the appendix and the other in symmetry).Then there are several methods to block the fallopian tubes:
- either we apply a clip on the fallopian tube
- either we coagulate the fallopian tube
- either we cut the fallopian tube and the ligature
“This last method remains rare, but can be practiced in patients who know in advance that they will give birth by caesarean section and who wish to take advantage of this intervention to have recourse to a tubal ligation.“, he adds. Generally, the intervention is carried out on an outpatient basis (in a health establishment) under general anesthesia and the act itself lasts about 15 minutes.
Tubal ligation is not not very painful, even if there can be feelings of discomfort: the introduction of the trocars can tug and the air in the diaphragm (used during the operation to inflate the belly) can hurt a little bit. Finally, the scar at the level of the navel is painless and almost invisible (it measures 2 to 3 mm).
“It is a method whose risk of complications is low, but it’s still surgery of the abdomen with general anesthesia“, warns the gynecologist. Complications during the operation remain very rare, but at the time of the introduction of the trocars, a blood vessel, a neighboring nerve or part of the intestine can be injured, or be severed , the fallopian tube can start to bleed. However, these are the risks of any surgical intervention. In addition, awakening from anesthesia can be difficult and small pains in the abdomen – which fortunately disappear a few days later. – can occur Finally, as with any surgery, there is a risk of infection.
| It happens that some women regret their decision, a few years later. Psychological support is therefore necessary. |
This is the most effective method of contraception although you should know that it can, even if it is very rare, fail. Indeed, there have already been cases of ectopic pregnancy after tubal ligation (in less than 1% of cases). But tubal ligation is contraception permanent and totally definitive. “This is why ethically, this technique still poses problems, all the more so when we know the current number of couples who separate, divorce or remarry and whose life projects can quickly change. This is why gynecologists tend to be very cautious and insistent that tubal ligation is an irreversible practice.“, reminds Dr. Deruelle. “There is also a big difference between the Anglo-Saxon countries for which the practice of tubal ligation is more common and the Latin countries like France where we are always a little more reluctant to perform sterilization in a young woman, who has never had children and who has no contraindications to using other means of contraception“.
“Theoretically, tubal ligation has no contraindications. It is also important to remember that age cannot be a ban to perform voluntary female sterilization. It is sufficient that the patient is of legal age and consenting. Since 2001, the law on termination of pregnancy and contraception has been clear on this point.“, specifies the expert. And to add “a woman who has never had children should, if she wishes, be able to benefit from them without any problem“. On the other hand, tubal ligation is contraindicated in women for whom general anesthesia or laparoscopy are contraindicated. Finally, women with a gynecological or recent infection (less than 6 weeks) cannot have recourse to this method.
“There is no impact on the rules”
Tubal ligation does not influence the hormonal mechanism. “There is no impact on menstruation, since menstruation comes from the secretion of the ovaries and the uterus. However, tubal ligation does not affect the ovaries or the uterus. The woman continues to ovulate“, confirms the specialist. Similarly, this technique does not cause an early menopause. On the other hand, in the event of repeated delays in menstruation or vaginal bleeding, it is better to consult a doctor quickly. No impact on libido either since it does not modify the hormonal system: neither the pleasure nor the sexual desire of the woman are modified.
Tubal ligation is a fully covered by Social Security.
On the health forum: discussions about tubal ligation
To remember
► Tubal ligation is intended for adult women who do not or no longer wish to conceive a baby
► The contraceptive effect is immediate and irreversible.
► Tubal ligation is done in the majority of cases laparoscopically.
► Tubal ligation does not stop periods.
► Tubal ligation does not cause early menopause
Thanks to Dr Philippe Deruelle, gynecologist and secretary general of the National College of French Gynecologists and Obstetricians (CNGOF).