Sterilisation for women

You need to take the advixce of the surgeon or anaesthetist on this and all matters connected with the operation.

How do you go about getting sterilised?
Personally, I think that you should begin by contacting your GP. Most good family doctors will want to discuss sterilisation with you in depth, as it is something that should be considered very carefully indeed.

The doctor should tell you about the operation, and about its associated risks. Also, most importantly, he should make it clear that – as we have stated above - sterilisation is not 100 per cent effective against pregnancy. The failure rate is about 0.5 per cent - but is a little higher in younger women.

Your GP will then refer you to a gynaecologist, either privately, or under the NHS. Some clinics in the family planning field also offer a sterilisation service. These include the British Pregnancy Advisory Service (Tel: 08457 30 40 30) and Marie Stopes Clinics (Tel: 0845 300 0212).

You can if you wish go directly to a reputable sterilisation clinic such as Marie Stopes or BPAS, without involving your own doctor. They will usually want to write to him after the operation, to tell him it's been done – but this isn't compulsory, and a few women don't actually want to inform their GPs.

Do women regret being sterilised?
You have to accept that once you are sterilised, you will almost certainly not be able to have any more children. Nowadays, many women have more than one long-term relationship or marriage, and it has become quite common for a sterilised woman to later want another baby if she has a new man in her life.

For the sake of completeness I should add that a woman who has been sterilised, but then really wants to have a baby, does nowadays have the opportunity of 'in vitro fertilisation' (IVF treatment). Indeed, one of the world's first 'Test tube babies' was born to a mother who had had her tubes removed. However, IVF is extremely expensive – and only works in a minority of cases.

What is done in the operation?
If you are certain of your decision, the operation itself is fairly simple. The Fallopian tubes (where the egg is fertilised by the sperm) are blocked by the surgeon in one of several ways, thus making fertilisation unlikely – unless you have very bad luck!

Your periods should not be affected by the operation though it is sometimes claimed that post-sterilisation periods are heavier in some women.

Your hormone production and libido should remain the same – unless the operation has somehow affected you psychologically.

In the old days, most women were admitted to hospital for the operation – and stayed in for some days. Nowadays, most sterilisation operations are conducted as day-cases – in other words, you'll probably be able to go home that evening.

The traditional way of sterilising somebody was through a cut (a few inches long) in the lower part of the tummy. Alternatively, the cut could be made in the topmost part of the vagina. Both these procedures nearly always required a general anaesthetic.

However, in recent years it's become much more common to do the 'milder' and less upsetting laparoscopic operation. (It's sometimes referred to as 'the Band-Aid op' – because incisions can be covered by just a small piece of sticking-plaster.)

It is carried out through either one or two tiny 'nicks' in your lower abdomen. Generally, the surgeon makes the first little incision immediately below your navel – where a scar isn't likely to be very visible. Through this incision, she inserts a laparoscope.

A laparoscope is a thin metal 'telescope' that lets the surgeon see your two Fallopian tubes. With the laparoscope, she can 'seal off' the tubes, using rings or electrical coagulation. However, some surgeons prefer to put clips on your tubes. To do this, another instrument has to be inserted through a second small incision.

Although quite a few sterilisations are still carried out under general anaesthetic, recent years have seen an increasing tendency for the operation to be done under 'local' – which many women prefer. Also, local anaesthetic is safer for you than having a 'general'.

At the large charitable clinics, such as Marie Stopes, they tend to use 'twilight' techniques – which means combining a local anaesthetic with enough sedation to make you quite pleasantly 'woozy'.

Obviously, you must not drive yourself home on the day of the operation!

What is the cost of the operation?
In recent years, female sterilisation has become rather more difficult to obtain free – ie under the National Health – in many parts of the country. So, many people go to private gynaecologists, or to large charitable organisations like BPAS or Marie Stopes.

A private surgeon can charge whatever the 'market' can stand - currently up to £1,500. But the charitable clinics are at present charging an all-in fee of about £700.

Does sterilisation work immediately?
Sterilisation of women should work immediately, but it's important that you're not already pregnant when the op is done – or have active sperm inside you from love-making the night before !

Some women continue using their current method of contraception for a little while – for instance, till the next period. A few will keep a coil in for a short time.

What is the risk of pregnancy after sterilisation?
Please note that as we have said above, every now and then a woman who has been sterilised does get pregnant. The approximate risk is estimated at 1 in 200 patients.

If pregnancy does occur, you must appreciate that it could be an ectopic one – that is, one which develops outside the womb, probably in the remains of the Fallopian tube.

So if you ever miss a period, you should get a pregnancy test done. Pain is often a warning sign of an ectopic pregnancy. If in doubt, ring your doctor.

Are there any other health risks from sterilisation?
Any type of surgery can go wrong, and this is particularly true of laparoscopic surgery.

Very occasionally, a gynaecologist may damage the bowel or womb, or the urinary apparatus. In general, the more experienced the surgeon, the less likely it is that any of these complications happens.

General anaesthetics carry a small risk (greater than that of 'locals'), which is one reason why in 2005 there's an increasing tendency to opt for local anaesthesia.