Tubal ligation - what is it, indications, contraindications, side effects

Tubal ligation is considered a safe medical procedure, the implementation of which should not threaten the health and life of a woman. The choice of this method is to free the woman from the risks associated with other contraceptives, such as side effects of oral hormones, manipulations that can lead to damage to the reproductive organ when inserting an IUD, vaginal rings, or the costs associated with frequent visits. writing prescriptions. Tubal ligation is a very popular procedure in highly developed countries.

1. What is tubal ligation?

Tubal ligation is the most effective way to prevent pregnancy. Tubal ligation is a surgical procedure in which the tubes are cut and tied. It distorts it patency of the fallopian tubesthrough which a fertilized egg can no longer pass into the uterus. Tubal ligation was successful - the Pearl index is 0,5. Sometimes the fallopian tubes open spontaneously, but these are isolated cases. The operation is performed by laparotomy or laparoscopy under local or general anesthesia.

Tubal ligation often occurs during a caesarean section. A woman can start sexual activity only after the wounds have healed, which takes about 3 months. About the application of this type contraceptive methods the woman must make the decision in consultation with her partner, and consent to the procedure must be given in writing. In most cases, this is an irreversible solution. this type contraception practiced in highly developed countries.

In Poland, such a procedure is illegal. Under the Criminal Code, depriving a person of the ability to bear children is punishable by imprisonment for a term of 1 to 10 years. This penalty is imposed on the doctor performing the procedure, not on the woman who chooses to perform it.

Tubal ligation is allowed if it is part of the treatment or if a subsequent pregnancy would seriously harm the woman's health or be life-threatening.

This is also acceptable in a situation where the next offspring will have a genetically severe disease. In other situations, the doctor cannot perform the procedure even at the direct request of the patient.

2. Sterilization then and now

Sterilization has a rather long history in the world. Unfortunately, these procedures were very often carried out illegally, violating the personal freedom of women, causing them harm.

Quite common was the sterilization of poor and black women, who, in case of opposition, were left without any medical assistance and material assistance. In the history of our civilization there are also cases of forced sterilization of the mentally ill, prisoners and representatives of racial minorities in order to eliminate them. They were a violation of human rights.

Currently, as stated above, such an operation in Poland is legally unacceptable, and its implementation is illegal and punishable by imprisonment. However, in the USA and many countries of Western Europe (Austria, Denmark, Finland, Norway, Sweden, Great Britain), this procedure is carried out at the request of the patient.

3. Decide if you should have a tubal ligation.

The decision to have surgery tubal ligation is one of the most difficult decisions in a woman's life. There are quite a few consequences, because a large percentage of the procedure is irreversible. A woman should calmly and fairly weigh all the pros and cons, be fully aware that in the future she will not be able to have children conceived naturally. She should take into account the various life situations in which she may find herself, such as a change of partner and the desire to have children from him, the death of a child. She should also consider alternatives, such as the use of other reversible contraceptives.

The most common reasons why women decide to undergo sterilization are:

• unwillingness to have more children when it is impossible to use other methods of contraception,
• health problems that can worsen during pregnancy and threaten the life of the mother,
• genetic anomalies.

Although women try to think things through before making a final decision about the procedure, approximately 14-25% regret their decision. This is especially true for women who decide to be sterilized at a very young age (18-24 years old) - about 40% regret their decision. Therefore, in some countries there are proposals for the possibility of sterilization after 30 years in women who already have children.

There are centers around the world that specialize in restoring the patency of the fallopian tubes, but these are very complex and expensive procedures, the success of which cannot be guaranteed. That is why it is so important to carefully inform a woman about all the possible consequences of tubal ligation.

4. Indications for tubal ligation surgery.

In addition to voluntary sterilization, there are also indications that determine which women should undergo this tubal ligation procedure. They can be divided into several main groups:

• medical indications - cover the entire spectrum of internal and oncological diseases that can lead to serious health complications or even life-threatening conditions when a woman becomes pregnant. At the time of the procedure, the disease must be in remission or well controlled, and the patient's condition must be stable,
• genetic indications - when a woman is a carrier of a genetic defect and the birth of a healthy child from her is medically impossible,
• according to psychosocial indications, this is a radical prevention of pregnancy in women who are in a difficult, impossible to improve financial situation.

It is extremely important that the patient is thoroughly informed about the process of tubal ligation, the benefits, indications, contraindications and possible complications after the procedure before it is performed during a visit to the doctor.

5. Effects of tubal ligation

Consequences of tubal ligation permanent infertility. Therefore, before a woman decides on this procedure, she should consider whether she is sure that she does not want to have children. Effectiveness of tubal ligation big. The procedure, which restores the patency of the fallopian tubes, is only 30% effective.

However, be aware that if you become pregnant before the procedure, there is a high risk of an ectopic pregnancy. It occurs statistically more often in younger women who have undergone the procedure, as well as in those who have undergone surgery using the method of electrocoagulation of the fallopian tubes. Before the procedure, you should use certain methods of contraception, with a high Pearl index (we advise you not to use the calendar method, it is better to use condoms or temporary sexual abstinence).

Some women also report more frequent bladder infections after surgery.

There are many unfounded myths about the side effects of salpingectomy. Women are afraid to lose "femininity" after the procedure, reduce libido, gain body weight. No observations have confirmed these theories, on the contrary, as many as 80% of women report improved contact with their partner.

6. Complications after tubal ligation

Tubal ligation is a safe method. As you can see, long-term side effects are no more of a threat. Most side effects occur in connection with the procedure itself. Between 4 and 12 women per 100 salpingectomies performed in developing countries die (bleeding, anesthesia complications).

The most common causes of complications are:

• causes of anesthesia: allergic reactions to injected drugs, circulatory and respiratory disorders (the use of regional anesthesia significantly reduced the risk of these complications),
• surgical causes: damage to large vessels and associated bleeding requiring re-opening of the abdominal cavity, damage to other organs, infections and wound abscesses.

The most dangerous complication associated with laparoscopy, a serious threat to life, is damage to large vessels:

• aorta,
• inferior vena cava,
• femoral or renal vessels.

6.1. Minilaparotomy

A mini parotomy is a procedure in which the doctor makes an incision in the abdominal wall just above the pubic symphysis. This procedure carries a greater risk of pain, bleeding, and bladder damage compared to laparoscopy.

After the operation and the anesthesia associated with it, each patient has the right to feel weakness, nausea and pain in the lower abdomen. However, these symptoms pass very quickly and complete recovery occurs in just a few days.

6.2. Complications after using the ESSURE method

The use of this modern method also entails certain risks. This may apply to the procedure itself - damage to the reproductive organ when inserting the insert into the fallopian tube, bleeding. Other complications after using the Essure method include:

• bleeding from the genital tract,
• pregnancy
• risk of ectopic pregnancy,
• pain,
• convulsions
• intermittently long periods, especially during the first 2 cycles,
• nausea,
• vomiting,
• fainting
• allergic reactions to the material.

7. Ligation of the ovaries and the law

of this type contraception practiced in highly developed countries. In Poland it is allowed when it is part of the treatment or if the subsequent pregnancy would seriously harm the woman's health or endanger her life.

In practice, tubal ligation is performed when another pregnancy poses a threat to the health or life of a woman, and also when it is known that the next offspring will have a genetically severe disease. In another situation, the doctor cannot perform the procedure even at the direct request of the patient.

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