There’s been a lot of talk about tubal ligations (aka getting your “tubes tied”) in the media lately. This method of contraception is a big no-no for the Catholic Church, so a lot of the media buzz is about Catholic hospitals, who refuse to perform the procedure. There are also more and more articles coming out, like this one in the Huffington Post, telling the stories of women who struggled for years to find a doctor who didn’t think they were too young to undergo the procedure.
Let me start by saying that both the religious and age reasons for denying a woman a tubal ligation are misinformed and misogynistic. The idea that a woman’s sexuality is only good for making babies, and the view that a young woman cannot possibly know her own mind and body enough to decide to never have children, are equally infuriating. The age reason is also incredibly paternalistic on the part of the medical community.
Despite all of the obstacles that may be in their way, many women still feel that tubal ligation is the best birth control option for them. Women who are done having children or who never want to have children at all may feel that a tubal ligation is the ideal contraception method. You don’t have to remember to take a pill, change a patch, or buy condoms, and you don’t have to ever have it removed like an IUD or an implant. It can be done in your doctor’s office and has a short recovery time. The appeal is obvious. But is there more to it?
Despite my disdain for the religious and age reasons to deny a woman a tubal ligation, I do have some concerns about the “simple” narrative of female sterilization that we are given. I am absolutely for women having choices and being the decision-makers about their bodies. I am also absolutely for full informed consent, which is often lacking in our health care system. Before addressing these concerns, I want to give a brief overview of what exactly tubal ligation is.
The purpose of a tubal ligation is to close off the fallopian tubes, which prevents an egg from making its way from the ovary to the uterus. There are several techniques that can be used to accomplish this, including cutting or burning the fallopian tubes, or blocking them with bands, clips, or rings. The procedure can be done through a variety of methods, although the most commonly used are laparoscopies and mini-laparotomies, which both require an abdominal incision (check out Planned Parenthood’s website for more details on the various methods used for performing tubal ligations).
Essure is also considered a method of tubal ligation. With Essure an insert is put into each fallopian tube, after which natural tissue grows and blocks the tubes. It takes about three months for the tubes to be fully blocked, during which time you need to use another contraception method. This method does not require an incision.
The side effects and risks of tubal ligation depend on what method is used. With the methods that require an incision there are the risks that come with any surgery, namely infection, bleeding, and reaction to anesthesia. There is also the rare possibility that a woman’s surrounding pelvic organs could be injured during surgery, the repair of which would require additional surgery. Planned Parenthood notes that: “Complications may develop in 1–4 out of every 100 sterilizations that are performed through the abdomen. Death resulting from sterilization is extremely rare and is usually caused by a reaction to general anesthesia.”
Essure has some more complex risks and side effects, including improper placement of the inserts and failure of the inserts to block the fallopian tubes after three months (either of which could mean a second procedure is needed). There is also the risk of injury to the fallopian tubes or uterus during the procedure (which could require surgery).
None of these potential complications seem very appealing but after being informed about them, some women may feel that they are worth the risk. But what about complications that women may not know about when considering this procedure?
The majority of women who undergo a tubal ligation are never informed about the risk of Post Tubal Ligation Syndrome (PTLS) also known as Post Sterilization Syndrome (PSS). Tubal ligations are not meant to affect hormone production or the healthy functioning of the ovaries, yet many women experience a variety of symptoms following the procedure that are consistent with hormone imbalances.
Symptoms can include hot flashes, fatigue, irregular menstrual cycles, loss of sex drive, and anxiety, just to name a few. PTLS has even been known to cause early menopause (check out the story of JoAnn Martinez, written as a guest post for PCOS Diva). There are a few theories about the causes of PTLS, but the majority of symptoms are likely the result of damage done to the blood supply to the ovaries during surgery.
Doctors are often dismissive of PTLS symptoms, which can make it very hard for women suffering from them to get the help that they need. Like JoAnn Martinez they may actually be told to take hormonal birth control pills. Yes, as strange as it sounds there are women who take the pill after having a tubal ligation, some of whom likely got the tubal ligation in order to avoid birth control methods like the pill. Many women see tubal ligation as the ultimate birth control, the method that will never mean an unplanned pregnancy. But how true is this?
Tubal ligation is meant to be nearly 100% effective at preventing pregnancy. However pregnancy can still occur with a chance of up to 3% depending on the tubal ligation method used. There are three basic ways that a tubal ligation can fail to prevent pregnancy: the procedure fails to successfully find and close the fallopian tubes (this may be due to the presence of scar tissue that makes it hard to locate the fallopian tubes), a tube may form a fistula creating a new opening, and recanalization (in which the tubes are not fully closed and so are able to reopen). If a woman becomes pregnant after a tubal ligation the pregnancy is considered high risk. This is because there is a 30-40% chance that it is an ectopic pregnancy (a pregnancy in which the fertilized egg implants somewhere other than the uterus, usually the fallopian tube).
One reason for this high rate of ectopic pregnancies in post-tubal ligation pregnancies is the fact that in cases of a fistula forming a new opening in a fallopian tube, there is enough room for a sperm to pass through but the fertilized egg may be too large. The egg then remains in the fallopian tube and begins to grow, which puts the mother at risk for severe complications if it is not addressed quickly.
So is tubal ligation the ultimate birth control method? It certainly is the right choice for some women, and it certainly isn’t for others. But in order to make that decision a woman should have access to ALL of the information about the options for the procedure, the potential risks and complications, and its rate of effectiveness. When we only give the “simple” narrative of tubal ligation (the one that says it’s all over in half-an-hour and then you never have to think about pregnancy again), we miss out on a lot of important information that is crucial for women to know in order to have full informed consent.