5 advantages and disadvantages of tubal ligation and how the surgery is done

Tubal ligation or tubal ligation is a surgical sterilization procedure for women who no longer wish to become pregnant. To talk about it, gynecologists Dr. Rogério Tabet (CRM 97801), from the Public Health System, and Dr. Mariana Rosário (CRM SP-127.087), from the Albert Einstein hospital, explained what it is, which types and answered the most common questions about the surgery.

What is ligation?

According to experts, tubal ligation is a method of sterilizing women when they choose not to have more children. “Surgical tubal ligation takes away the ability of the fallopian tube to carry the egg to the uterus. So the tube is cut so that the egg no longer takes this path,” explained Dr. Mariana. The Doctor. Rogério added that the surgery “is covered by health plans. In private clinics, it costs an average of 5 thousand reais”.

Types of tubal ligation explained by the gynecologist

The Doctor. Rogério informed that there are two types of tubal ligation: abdominal and vaginal. He understands the difference between the methods:

• Abdominal route: the doctor explained that, with the abdominal route, it is possible to perform two procedures: “the minilaparotomy, through a small cut at the cesarean site; and the videolaparoscopicintroducing a microcamera into the umbilical scar and cutting both tubes”.
• Vaginal route: “a stereoscope is introduced into the vagina up to the uterine cavity and at the entrance of the right and left tubes. So, a spring called essure is placed to obstruct and prevent the sperm from finding the egg,” said Dr. Rogerio.

Now that you know the main types of surgery, check out who can do the procedure!

Who can do the procedure?

On March 8, 2022, on International Women’s Day, the Chamber of Deputies voted and approved the bill that allows tubal ligation to be performed without the husband’s authorization. In addition, the minimum age to perform the procedure has increased from 25 to 21 years.

Dr. Mariana informed that, according to the WHO, the woman must have at least two children to have the surgery. Complementing, Dr. Rogério explained that tubal ligation can also be authorized when “there is a risk to life between operatives, for example: if there is a lot of adhesion or if the uterus is very thin with risk of rupture in a previous pregnancy”.

How ligation is done

The Doctor. Rogério explained that in tubal ligation, by minilaparotomy, “a mini cesarean section is performed at the cesarean section to cut both tubes”. Already “by videolaparoscopy, a microcamera is introduced in the region of the umbilical scar, thus, the cauterization of the cut of both tubes is performed”.

The tubal ligation can also be performed vaginally and, according to the doctor, “the steroscope is introduced through the vagina into the uterine cavity on each side of the tubal bone. Then, a spring is placed to prevent the sperm from meeting the egg.”

Advantages and disadvantages of surgery

All surgery is a bodily interference. Therefore, before making a decision, it is important to know the procedure. Next, gynecologists point out the advantages and disadvantages of tubal ligation. Look:

Benefits

• It is a definitive method with a failure rate of around 2% in 10 years;
• Does not introduce hormones into the body;
• It does not cause side effects in other organs;
• The woman does not need to remember to take the contraceptive;
• Does not interfere with libido.

Disadvantages

• If the woman repents, it is very difficult to reverse;
• Surgical procedure with anesthetic risks;
• Risks of postoperative infections;
• As with any surgical procedure, there can be complications, eg adhesions and internal infections;
• In some cases, a woman may experience changes in menstrual flow.

Dr. Mariana highlighted that if “the woman wants to get pregnant after the surgery, she will probably have to undergo the reversal procedure or in vitro fertilization”. However, depending on the type of surgery performed, it is not possible to reverse.

Recovery after tubal ligation

According with the doctor. Rogério, when the tubal ligation is performed by abdominal laparotomy, the post-surgical and recovery have all the risks of a post-cesarean. For example, “there are risks of infection at the site and hematoma, in addition, the patient may have some internal bleeding. But generally the recovery time is 5 days on average.”

Already Dr. Mariana added that when the surgery is performed vaginally or laparoscopically, recovery is smoother. “Sometimes, in a week, the woman is already well and can go back to work”. Usually, the patient stays in the hospital for one to two days if there are no complications.

Common questions about tubal ligation answered by doctors

Is it possible to get pregnant after tubal ligation?

Rogério Tabert (RT): it is considered a definitive method, therefore, it is necessary to go through a multidisciplinary procedure with psychologists. In the past, the right and left horns were only bent and tied in a knot. However, currently, the tube is cut and cauterized, so the chances of reversal are very small.

Does tubal ligation make you fat?

Mariana Rosario (MR): tubal ligation does not make you fat. People confuse it with animal castration, for example, in which the ovary is removed. However, in tubal ligation, the tube is cut and the ovary is kept. So, it does not induce the person to have a menopause, which theoretically can cause weight gain.

How long after the procedure can I have sex?

RT: if it is an open surgery, such as abdominal menilaparotomy, you can usually have sex after surgery recovery, that is, on average 7 days.

Can it be done by SUS?

RT: SUS performs the procedure both by videolaparoscopy and minilaparotomy surgery. Now, by vaginal hysteroscope, it does not.

What are the main changes in a woman’s body after surgery?

MR: The main change can occur in menstrual flow, however, it does not occur in all women. The flow gets more intense and the patient has more colic because of it.

The Doctor. Rogério informed that “the syndrome described as post tubal ligation can cause menstrual irregularity, in addition to pain and discomfort due to adherence, but the incidence is not high. Therefore, after the surgery, the woman is able to have a normal life, as well as produce hormones.”

5 alternatives to tubal ligation

If you’re still not sure whether to have a tubal ligation, there are other ways to prevent pregnancy. Below are the main methods cited by gynecologists:

• Birth control pills: Dr. Mariana informed that there are “combined or single contraceptive pills. That is, only with progesterone or with progesterone and estradiol”. In addition, Dr. Rogério mentioned that there are pills for continuous or pause use. “The continuous use pill is used in specific cases where the woman cannot menstruate, for example, in cases of endometriosis where the woman feels constant pain or in PMS too”. As for the break pill, the woman stays from 4 to 7 days without taking it, depending on the hormone and type.
• IUD: According to the doctor, “the copper IUD is a device that releases copper ions and can increase menstrual flow and cramping”. Already “the hormone IUD releases the hormone progesterone, being indicated for women who do not want to menstruate”. In addition, the doctor mentioned that there is a copper-silver IUD that is not hormonal.
• Condom: as mentioned by Dr. Mariana, “the male and female condom are two barrier methods that can be an alternative to prevent pregnancy.” Furthermore, Dr. Rogério pointed out that it is an excellent method to avoid sexually transmitted diseases and stressed the importance of knowing how to use condoms correctly to be effective.
• Hormonal implant: According to the expert, “a hormonal implant is a device placed under the skin to prevent ovulation.” Dr Rogério explained that the implanon it is placed subcutaneously on the inside of the arm and lasts an average of 3 years, being an option for those who have a lot of blood leakage. He mentioned that “the SUS makes the method available in specific situations, especially when the patient is socially vulnerable”.
• Patch: applied to the skin to continuously release norelgestromin and ethinylestradiol. “Evra should be placed once a week, with the onset of menstruation, and changed weekly for three weeks. After that, it is necessary to take a break for a week and, on the eighth day, return again with adhesive”, explained the specialist.

As informed by professionals, tubal ligation is a surgery that can be irreversible. Therefore, the procedure is done in conjunction with the medical part, social assistance and psychological support. That way, the woman can make the best decision. Enjoy and learn more about in vitro fertilization, a possibility for women who want to reverse tubal ligation.

The information contained on this page is for informational purposes only. They do not replace the advice and follow-up of doctors, nutritionists, psychologists, physical education professionals and other specialists.