How is the tubal ligation done?
The procedure is painless and can be done by gynecologists, with an average duration of 40 minutes. Initially, the patient is anesthetized through inhalation or injection. The doctor then makes incisions and then inserts a small device, which will help locate the tubes.
After tying, cutting or tightening the uterine tubes, the cut is closed with small stitches. Usually, the woman is released a few hours after surgery.
Types of ligation
There is more than one way to carry out the operation. However, all follow the basic principle of tubal ligation, which is to prevent the passage of the oocyte and sperm through the tubes, avoiding fertilization.
Basically, tubal ligations are classified according to the way the cut is made and its access routes, the main types being abdominal and vaginal. In addition, there are several ways to effectively break the tubes, including:
- Plastic rings;
- Titanium clips (surgical);
- Suture thread.
To choose the ideal procedure for each woman, it is necessary to take into account factors such as preference, adhesion and scar, in addition to the presence of endometriosis or fibroid.
Laparotomy ligation is the most common method used in SUS, in which a horizontal cut similar to a cesarean section is made in the belly. Due to the size of the cut, it is a more invasive operation, with a higher risk of infection and pain in the postoperative period.
As with laparotomy, ligation is done through an abdominal cut above the pubis. However, in the case of minilaparotomy, this cut is much smaller. This type of surgery is usually done within a maximum of two days after delivery, at which time there is an increase in the volume of the uterus, which facilitates the operation.
Normally, tubal ligation cannot be performed during or in the next 42 days after delivery or abortion, due to the emotional fragility in which the woman is. But when the need for the procedure is proven, the indicated surgery is the minilaparotomy.
This procedure is based on the insertion of a mini-camera in small holes made in the abdomen region. For the surgeon, this way of performing the ligation is better because the camera allows a more detailed view of the internal organs and tissues.
Because it is less invasive, it has less risk of infection, less apparent healing, greater chance of effectiveness and faster recovery in relation to laparotomy.
Like videolaparoscopy, it is less invasive and, therefore, presents less blood loss, less pain in the postoperative period and shorter hospital stay. It is made through an incision through the posterior cul-de-sac of the vagina (space around the cervix, in the posterior region), from where the tubes are reached. However, it presents a higher risk of infection.
Hysteroscopic ligation consists of inserting a hysteroscope (an endoscopic tube with an illumination system) into the vagina. In this procedure, no cut is performed and, among all the ways to perform the ligation, this is the only one that does not require an operating room.
During the process, the hysteroscope accesses the tubes through the endometrial cavity (mucosa that covers the inner face of the uterus). Upon reaching the tubes, the device inserts a small 4 cm stainless steel spring, called a tubal stent, which causes local inflammation. Thus, an immune system reaction occurs that leads to the growth of scar tissue, causing the tubes to close.
Depending on the healing process, this method takes about 3 months to complete. After this period, the woman undergoes an x-ray of the female reproductive system, in order to prove or not the complete obstruction of the uterine tube.
In February 2017, Anvisa determined the suspension of the import, distribution, sale and use of the Essure tubular stent, classifying it as a maximum risk. According to the agency, the implementation of the device can cause unwanted pregnancy, chronic pain, perforation, changes in menstrual bleeding, allergy and migration of the device.
Who can do the tubal ligation?
The method can be done by women who no longer wish to have children by their own choice, but as it is definitive, it is only allowed by law in women over the age of 25 or with at least two children alive, decreasing the chance of regret. Thus, a 30-year-old woman who does not have children can perform tubal ligation, and the same is possible for a 20-year-old woman who already has at least 2 children.
However, even when the woman is already a mother for the second time, there are other circumstances that can generate regret, such as when she loses a child, changes a partner or improves her financial condition.
Therefore, it is necessary to comply with the minimum period of 60 days between the manifestation of the desire to perform the sterilization and the completion of the surgical process, a period in which the woman must be offered fertility regulation services and counseling by a multidisciplinary team. , aiming to discourage early sterilization.
There is also the possibility of surgery being performed on women at risk of health and even death, in cases of conception. However, in these situations, sterilization can only be carried out by means of a report witnessed in a report and signed by two doctors.
How is the pre and postoperative?
The ligation surgery requires some care before and after being performed. Understand:
To perform the ligation, it is necessary initially to perform common exams for any surgery, such as blood count , coagulogram, electrocardiogram and transvaginal ultrasound. They are also made:
- Pregnancy test;
- Gynecological clinical examinations;
- Pap smear;
- Pelvic ultrasound.
With the exception of hysteroscopy , which dispenses anesthesia or uses only mild sedation, the other types of tubal ligation require hospitalization and at least local anesthesia. A specific diet or fast may also be requested.
The recovery time depends on the type of surgery chosen, but it is usually between 24 to 48 hours after the procedure. In general, it is necessary to have a degree of rest, leaving a time without physical activity and sexual intercourse, always taking the prescribed medication correctly (indicated for possible pain).
There may also be:
- Vaginal bleeding, caused by movement of the uterus during surgery;
- Swelling in the stomach area;
- Pains in the back and shoulders.
Are there any complications?
It is very rare that there is any complication in the postoperative period of the tubal ligation. When it occurs, the most common complication is injury to the wall of the uterus, a problem that should not cause any major disorder, since the patient no longer intended to become pregnant.
In addition, risks may include:
Even though it is considered a sterilization operation, there is a 0.1% to 0.3% chance of the woman becoming pregnant. The main problem in this situation is that in most cases where a woman becomes pregnant, the pregnancy ends up being ectopic (outside the womb). Therefore, every woman who has undergone the procedure should immediately seek her gynecologist in case of menstrual delay.
For many women, fertility is what makes them feminine. Therefore, this operation can affect their psychological balance and self-esteem , as it eliminates their reproductive role.
- Adverse reaction to anesthesia;
- Injury to the bladder, intestines or arteries;
- Early menopause.
What is the price of tubal ligation?
The tubal ligation costs from R $ 1,500 to R $ 5,000, depending on the region of the country, the chosen doctor and the hospital. However, the patient can perform the procedure through the Unified Health System (SUS) and some health plans, according to coverage. For this, there must be medical indication, in addition to compliance with the requirements of the law.
Hysteroscopy tubal ligation had become popular in the country and could be found as an option in Family Planning Programs in several public hospitals until the moment of the operation’s suspension by ANVISA.
Is it possible to reverse the method?
It is possible to reverse the tubal ligation using the laparoscopic method, but the process has many risks and is not performed by most gynecologists. Therefore, surgery is commonly considered irreversible.
However, when ligation was performed using clips or rings, reversion is possible in 80% of cases. In order for it to be performed, it is necessary that the end of the uterine tubes have been preserved and that there is no dilation. This process is called anastomosis , in which the cut tube is rewired and sutured again.
After 30 days of the reversal operation, when the complete menstrual cycle has elapsed, in addition to the complete healing of the tubes, the recovery of fertility is confirmed. Sexual abstinence is also indicated during this period to prevent genital infections. Within 12 months the patient is able to conceive, but the chances of pregnancy are reduced by up to 20%.
There is no time limit for reversing the sterilization, but it is important to bear in mind that female fertility gradually decreases after 35 years of age.
For women who have been sterilized and regretted, another way is to perform in vitro fertilization, a medically assisted reproduction technique that is based on the laboratory insertion of a significant number of sperm around each oocyte, in order to obtain pre- good quality embryos, which will later be transferred to the uterus.
Advantages and disadvantages
Before deciding to perform the surgery, it is important to know the advantages and disadvantages of ligation:
- Lower risk of pregnancy among contraceptive methods;
- It dispenses with the use of contraceptives, avoiding periodic spending and the need to use the medication regularly;
- It does not interfere with a woman’s libido;
- It has few complications in the postoperative period;
- It is ideal for women who are at risk for their health in the event of a possible pregnancy;
- Decreases the risk of ovarian cancer;
- Protects against pelvic infections;
- No review is required.
- It does not prevent the transmission of STDs, therefore it still requires the use of barrier contraceptive methods;
- It can interfere with blood supply to the ovaries, causing early menopause;
- High rates of regret;
- The reversal of the procedure is not possible in all cases and reduces the chance of becoming pregnant by at least 20%;
- Despite being a little invasive procedure, sterilization runs the same risks as any other surgery and is not indicated as a better alternative, considering the wide variety of contraceptive methods on the market.
Tubal ligation is a sterilization operation, not a contraceptive method. For this reason, it is important to note that the operation should be treated as the last possible alternative, because although it is reversible, it is an invasive surgery that can be avoided with the use of other methods.
So, before opting for tubal ligation, talk to your gynecologist about other effective and reversible options, such as:
- Condom: barrier method that prevents the arrival of sperm in the uterus. Made of latex or polyurethane.
- Diaphragm: flexible ring surrounded by a fine rubber, which prevents sperm from entering the uterus. It must be placed in the vagina 15 to 30 minutes before intercourse and must not be removed until 6 hours have elapsed since the last sexual act.
- IUD or IUS: the intrauterine device and intrauterine system, respectively, are inserted into the uterus, preventing the penetration and passage of sperm. In the copper IUD there is no hormone release, unlike the SIU, or Mirena, formulated based on Levonorgestrel .
- Hormonal implant: consists of a small rod inserted in the arm, under the patient’s skin, which releases progestogen.
- Spermicide: chemical substance that immobilizes and destroys sperm during sex. They can be in creams, gels, suppositories, sprays and foams.
- Birth control pill: oral pill composed of a combination of hormones.
- Contraceptive injection : hormonal intramuscular injections applied to the arm or buttocks.
- Contraceptive implant: small capsule containing etonogestrel that is inserted under the skin, using a disposable applicator.
- Contraceptive patch: adherent material that must be attached to the woman’s skin and remain in the same position for a week.
- Vaginal ring : flexible ring with etonogestrel and ethinyl estradiol that is placed in the vagina on the 5th day of menstruation, remaining for 21 days.
- Table: based on the calculation made from a calendar, counting the days of the beginning and end of the fertile period.
- Withdrawal : withdrawal of the penis from the vagina before ejaculation.
- The morning after pill: emergency contraception, has the function of preventing ovulation and creating an unfavorable environment for sperm. It must be taken within 72 hours after intercourse.
- Cervical mucus method: based on the observation of the presence of cervical mucus, which can indicate fertility. During that time, there should be no sexual intercourse.
- Vasectomy: closure of the male vas deferens, the channel that conducts sperm to the urethra.
Read more: Vasectomy: how much does it cost? Is it possible to do it through SUS?
These mechanisms have different degrees of efficiency and it is important to note that no method with the exception of sexual abstinence provides 100% safety in preventing pregnancy. Consult your doctor before deciding to use methods that involve hormones or any other chemicals.
Having adequate family planning also helps to prevent unwanted pregnancies. If there is any kind of doubt or insecurity, tubal ligation should not be performed.
Does tubal ligation change the menstrual cycle?
Normally, tubal ligation does not cause changes in menstruation or female hormone levels. Variations in menstrual flow and pain in the pelvic region may appear, symptoms that characterize the post-ligation syndrome, but it is not common.
Does sterilization affect a woman’s sexuality?
Tubal ligation does not interfere with libido (sexual desire or pleasure) or sexual intercourse.
I did a tubal ligation. Am I free of STDs?
Despite preventing pregnancy, the method does not protect against sexually transmitted diseases. Therefore, the use of condoms remains necessary. For this reason, it is best suited for women who are in a stable and lasting relationship.
Does tubal ligation affect breastfeeding?
The procedure does not interrupt milk production if the woman is breastfeeding.
Does sterilization fatten?
As it does not directly affect any endocrine organ, the operation does not affect the patient’s weight.
Tubal ligation is a sterilization operation that, despite presenting a reversal method, is considered definitive. Therefore, knowing the consequences of making such a significant decision is very important.