Women and Children's
Directorate
STERILISATION FOR WOMEN
(TUBAL OCCLUSION)
Patient Information Leaflet
What is Sterilisation?
Sterilisation is a permanent way of preventing pregnancy once you have
decided that you do not want more children, or that you will never want
children. Sterilisation involves an operation.
• for women the operation is called Tubal Occlusion
• for men the operation is called Vasectomy
This information aims to help you and your health care team make
the best decisions for you.
What are Tubal Occlusion and Vasectomy?
Tubal Occlusion is an operation that blocks, seals or cuts the fallopian
tubes; this means that your eggs can no longer be fertilised by your
partner's sperm through sexual intercourse.
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Vasectomy is an operation that blocks, seals or cuts the tubes (known as
the vas deferens) which carries sperm from the testicles to the penis. The
man will still be able to ejaculate, the semen will no longer contain any
sperm and therefore cannot cause a pregnancy. The sperm in the
testicles are naturally reabsorbed back into the body and do not build
up.
What do you need to consider?
You should only choose Tubal Occlusion or a Vasectomy if you are sure
that you do not want more children or that you will never want children.
If you have a partner you should discuss and agree together which
option suits you best as a couple. Your doctor or nurse can talk to you
about your choices and help you come to a decision. Some couples, for
example, choose Vasectomy rather than Tubal Occlusion because the
operation is less risky and there is less chance of getting pregnant again.
Research has shown that you are more likely to have regrets about
sterilisation if you are under 30 or if you do not have children already.
You need to be very sure about your decision and that you fully
understand what it will mean.
Are there alternatives to Tubal Occlusion?
Alternative long-term methods of contraception that women can use to
avoid getting pregnant include:
• Copper IUDs (which used to be known as the coil) - the IUD
(intrauterine device) is put into your womb and can safely stay there
for up to eight years. If you are over 40 when it is fitted, it can be left in
until you reach the menopause.
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• A progestogen IUS (intrauterine system) - this is a hormone-releasing
IUD that lasts for five years. The Mirena system is as effective as
Vasectomy and more effective than Tubal Occlusion.
• Progestogen implants - this uses a small flexible tube inserted under
the skin of the arm to release the hormone progestogen. The implant
lasts for three years.
The main advantage of these alternative methods to sterilisation is that
they do not require surgery and can be reversed; your doctor or nurse
can tell you more about them.
If you are a couple you need to also consider Vasectomy.
Vasectomy is usually done under local anaesthetic. The surgeon will
usually make one or two small cuts in the skin of your scrotum to reach
the tubes (the vas deferens) which carry sperm. They will then block the
tubes and close the ends, either by cutting or using diathermy to heat
and seal them off. There is a small risk (about one in every 2000
vasectomies) that the tubes will reform some time after the operation. If
this happens, you could make your partner pregnant.
There is no evidence that having a Vasectomy affects your sex drive and
carries less risk than Tubal Occlusion does for women. Having a
Vasectomy does not increase the risk of getting testicular cancer or heart
disease.
Please see your GP for further information and referral for vasectomy.
Tubal Occlusion: What does it involve?
Tubal Occlusion can be done using a general or local anaesthetic. You
can have a Tubal Occlusion at any time in your menstrual cycle, as long
as you have been using effective contraception right up to the day of the
operation.
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You will be given a pregnancy test before the operation. However, it may
not show up a very early pregnancy.
To avoid getting pregnant you must keep using effective contraception
until your first period after the operation.
If you are not using any contraception before you come in for your
Tubal Occlusion it is advisable to do the procedure in the first 10
days of your cycle.
Tubal Occlusion under General Anaesthetic
This operation is usually done as a day case in hospital. The surgeon will
make a tiny opening in your abdomen to reach the fallopian tubes by
either laparoscopy or mini-laparotomy:
• laparoscopy -This involves two small cuts, one in or just below your
navel and another lower down, to one side, or just above the bikini
line.
• mini-laparotomy - This involves a slightly larger opening than for
laparoscopy. In the UK it is usually only used if a laparoscopy is not
successful.
Once the surgeon has access to the fallopian tubes, they will usually seal
them off with a clip known as a Filshie clip. Occasionally they may use
diathermy to close off the tubes, if clips have not been successful. This
destroys part of the tube by heating and sealing it and is harder to
reverse than clips.
If you have a Tubal Occlusion at the same time as a caesarean, or if you
have it done by mini-laparotomy after giving birth, the tubes will usually
be cut and tied instead of being closed with clips. This is because in these
circumstances ties give better results.
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Risks of Tubal Occlusion under General Anaesthetic
The surgical risks of Tubal Occlusion under General Anaesthetic are
damage to:
• internal organs (for example the bowel or bladder)
• blood vessels.
These risks occur in about 0.5% of all laparoscopies and may result in
further surgery, usually by laparotomy, in order to repair any damage.
Although a longer time in hospital and further time off work than initially
planned will be needed, the vast majority of women have no long-term
problems.
The risks of internal damage are increased if:
• you are overweight (greater than 80kg/12½ stone)
• have had previous abdominal or pelvic surgery
• you have had previous problems from laparoscopy.
Insertion of the laparoscope or additional probes may also damage
blood vessels in the abdominal wall, causing external bleeding and
sometimes severe bruising or haematomas. Haematomas heal by
themselves with time, although they can be painful and unsightly.
Prior to Surgery
Do not eat or drink for at least 6 hours prior to operation. It is advisable to
not smoke or drink alcohol on the day of your operation.
Recovery and Discharge
The surgeon or nurse will discuss the operation with you after you wake
up. Once you have passed urine, had something to eat and drink and
fully awake, you will be discharged home, about 4 hours after your
operation. Someone will need to collect you from hospital and to look
after you at home. You must arrange to have someone to stay with you
on your fist night at home while you recover from the operation.
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Following surgery you may experience pain including:
• shoulder pain. This is caused by the gas used during surgery. This will
soon subside once you are moving around.
• pain around the wound. Mild but effective pain relief such as
paracetamol can be taken.
The sutures will either dissolve in approximately 10-14 days or we
suggest you attend your GP's practice nurse 5-7 days to have them
removed.
Most women are able to return to work 3-5 days after the operation.
If the wound becomes red or itchy do not worry. If you are experiencing
a lot of discharge from the wound or persistent trouble, contact your GP
or practice nurse.
Some women experience a red/brown discharge soon after, this will
settle in about 3-5 days. DO NOT use tampons during this time.
You may resume sexual activity when you feel comfortable to do so and
when your vaginal bleeding has settled. However you must continue
using your usual contraceptive method until after your next period. You
may bathe or shower the following day but refrain from using scented
soaps or talc on your wound for 3 days as this may irritate the skin or
introduce infection. Pat your wound dry and don't rub the area.
Tubal Occlusion under Local Anaesthetic (Essure)
Tubal Occlusion under Local Anaesthetic (also known as hysteroscopic
sterilisation) does not involve making any cuts. In this hospital we use a
device called ESSURE.
This procedure is usually done as an out patient in the Gynaecology Day
Suite. During the procedure the surgeon will insert a tiny titanium coil
into the fallopian tubes through the vagina and womb. Body tissue will
then grow around the coil and block the fallopian tubes.
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Risks of Tubal Occlusion under Local Anaesthetic (hysteroscopic
ESSURE sterlisation)
There is a small risk (about one in every 2000 Essures) that the tubes will
reform some time after the operation. If this happens, you could get
pregnant. This type of Tubal Occlusion though is 10 times more reliable
than Tubal Occlusion under General Anaesthetic.
Tubal Occlusion by hysteroscopic Essure sterilisation is permanent and
cannot be reversed.
Prior to the Essure Appointment
You are advised to take some simple pain relief, for example
Paracetamol one hour before you come to the Gynaecology Day Suite for
your procedure.
Recovery and Follow Up after hysteroscopic Essure sterilisation.
Your appointment for Tubal Occlusion using Essure lasts about an hour
and you will be asked to stay in the Gynaecology Day Suite for a
minimum of 20 minutes after the procedure.
You are advised to bring someone with you to drive you home
afterwards.
You will be advised to rest for the remainder of the day.
If you have Essure Tubal Occlusion you must keep using contraception
for at least three months after the procedure. After this time you will
have a scan to check whether your tubes have been successfully blocked.
If the tubes have not been blocked the doctor or nurse will discuss other
options for contraception with you.
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How well does Tubal Occlusion work
Tubal Occlusion fails if the tubes that have been cut or blocked as part of
the operation join up later on. You can get pregnant immediately or at
any time (even several years) after a failed operation.
For laparoscopic Tubal Occlusion, there will be around one pregnancy in
every 200 procedures that are carried out. For hysteroscopic ESSURE
sterilisation, there will be around one pregnancy in every 10 procedures
that are carried out.
If you get pregnant after a Tubal Occlusion there is a chance that the
pregnancy will develop in the fallopian tube rather than in the womb.
This is called an ectopic pregnancy.
Can Tubal Occlusion be reversed?
Tubal Occlusion is meant to be permanent. It is best to give yourself time
to think about your decision to have Tubal Occlusion. Many women who
have a Tubal Occlusion at the same time as a caesarean, or immediately
after giving birth or having an abortion, have regrets later on . It also
seems to lessen the chances of success.
The chances of an operation to reverse Tubal Occlusion being successful
vary a great deal. There is no guarantee of success. The best chances of
successfully reversing a Tubal Occlusion seem to be when clips have
been used and when the reversal is done by microsurgery.
Tubal Occlusion is free through the NHS but you will have to pay to have
the operation reversed.
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Tubal Occlusion: What are the risks? • You should contact a doctor or nurse as soon as possible if:
• you think you might be pregnant; or
• you have sudden or unusual pain in your abdomen; or
• you have any unusual vaginal bleeding; or
• a light or delayed period. If you feel feverish or generally unwell or
have increasing pain in your abdomen tell your doctor immediately.
There is no evidence that having a Tubal Occlusion causes problems that
would mean you need a hysterectomy.
There is no evidence that having a Tubal Occlusion affects your sex drive.
If you were on the contraceptive pill before your Tubal Occlusion your
periods may become heavier again, compared to the withdrawal bleed
you had while taking the pill. This is quite normal.
Research shows that if you are over 30 years old when you have a Tubal
Occlusion, it is not linked to getting heavier or irregular periods. There is
little evidence about how having a Tubal Occlusion affects your periods if
you have the operation when you are under 30.
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When should you contact your doctor?
Following your Tubal Occlusion contact your GP or the hospital if you
experience:
• Increasing pain that is not resolved with simple painkillers.
• A raised temperature or fever (over 38°C).
• Increased bleeding that is heavier than a period.
• Offensive or smelly discharge.
• Bleeding or discharge from the incision sites.
Contacts
If you have any questions or are concerned about anything to do with
your operation contact the
Day Surgery Unit on 01253 655706
Gynaecology Day Suite on 01253 303995
or your GP/practice nurse.
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Useful contact details
Main Switchboard:
01253 300000
Patient Relations
Department
For information or advice please
contact the Patient Relations
Department via the following:
Tel: 01253 655588
email: [email protected]
You can also write to us at:
Patient Relations Department
Blackpool Victoria Hospital
Whinney Heys Road
Blackpool
FY3 8NR
Further information is available on
our website: www.bfwh.nhs.uk
References
This booklet is evidence based
wherever the appropriate evidence
is available, and represents an
accumulation of expert opinion
and professional interpretation.
Details of the references used
in writing this booklet are
available on request from:
Policy Co-ordinator/Archivist
01253 303397
Travelling to
our sites
For the best way to plan your
journey to any of the local sites
visit our travel website:
www.bfwhospitals.nhs.uk/
departments/travel/
Approved by:
Clinical Improvement Committee
Date of Publication:
12/06/2012
Reference No:
PL/743 V1
Author:
Lavinia Parkinson
Review Date:
01/06/2015