Female sterilization is a permanent procedure. A woman or anyone with female reproductive organs who undergoes sterilization will no longer have the ability to get pregnant. There are five types of female sterilization surgeries ranging from least to most invasive – Bilateral Tubal Ligation (BTL), Bilateral Salpingectomy (BS), Bilateral oophorectomy (BO), Bilateral salpingo-oophorectomy (BSO), and Hysterectomy. We will only cover the two least invasive procedures in this post.

All surgeries are done laparoscopically (minimally invasive surgery) or by laparotomy (open surgery).

Disclaimer: The author is not a reproductive health professional or a doctor. This post is made for educational purposes only. Consult a doctor for proper medical guidance.

For permanent contraception, the two most common procedures are Bilateral Tubal Ligation and Bilateral Salpingectomy.

Bilateral Tubal Ligation (BTL)/ Tubal Occlusion

Bilateral Tubal Ligation (BTL) is a safe surgical procedure that permanently closes, cuts, or removes pieces of your fallopian tube. BTL is also known as “having your tubes tied”, “tubal occlusion” or tubal sterilization. During a tubal ligation, your surgeon will either cut the fallopian tubes and tie them with a particular thread, cauterize (burn) the edges to seal them with scar tissue, or place clips (also known as Filshie clips) on the tubes to block them. While Tubal Ligation is primarily effective in preventing pregnancies, about 1 out of 200 women may still become pregnant after the procedure. Tubal ligation can also increase your risk of an ectopic pregnancy.

Bilateral Salpingectomy (BS)

Bilateral Salpingectomy (also known as the bisalp) is the complete removal of both fallopian tubes. Unlike the Tubal Ligation, your surgeon will remove both fallopian tubes entirely and leave no traces of it. Because its failure rate is close to zero, the bisalp is now the gold standard of female sterilization in the West.

The Bilateral Salpingectomy is recommended for those with a higher risk of ovarian cancer, such as those with a family history of breast, ovarian, pancreatic, or colon cancer. Removing the fallopian tubes can reduce the risk of ovarian cancer by approximately 80%.

When both ovaries are also removed (bilateral salpingo-oophorectomy or BSO), you will immediately go into menopause. Given the increased risk of heart disease, osteoporosis, and other conditions, BSO is not recommended in women under the age of 40.

Other types of female sterilization

Different types of female sterilisation other than bilateral salpingectomy and ligation may appeal to women for various reasons.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. Given it is one of the most invasive forms of permanent sterilization, hysterectomy is mostly recommended for those with underlying health reasons. Most women with advanced stages of endometriosis or a family/personal history of endometrial cancer will benefit from hysterectomy. After the removal of the uterus, any viable pregnancy will be impossible. 

Hysteroscopic Sterilization or Nonsurgical Sterilization

Not every permanent contraception involves surgery. There are nonsurgical sterilization procedures such as Tubal Implants that can block women’s eggs from traveling to meet the sperm during ovulation. Tubal implants require no general anesthesia or incisions, unlike other permanent forms of birth control. Tubal implant is also a hysteroscopic sterilization. It is performed through a hysteroscope, a type of endoscope that allows a doctor to see through the cervix into the uterus. 

Tubal Implant (ESSURE)

ESSURE is a tubal implant that was designed to be a nonsurgical permanent birth control. However it was recalled by BAYER in 2018 and is no longer offered in the United States for complications some patients experienced from it.

Female Sterilization and health in the Philippines

In the Philippines, the BTL (commonly known here as ligation) is the second most popular contraceptive method used by 8.6% of married Filipino women, according to the Philippine Statistical Authority (PSA). While Philippine law ensures universal and free access to modern contraceptive methods, it’s more complicated in practice. Given how family-oriented Filipino culture is and the litigious risks, it can be very challenging to get approved for sterilization in the Philippines. Filipino women requesting BTL or other procedures will more likely face pushback from doctors until they are over 35 -and- have at least three children. Some doctors may recommend vasectomy for their male partners over any female sterilization. Other doctors may not recommend any birth control to an unmarried patient due to religious beliefs. Medical tourism may be the only recourse for some Filipino women who want sterilization. Medical tourism is also an option for those seeking world-class care and healthcare professionals who are more open to sexual health matters. With more Filipinos opting out of parenthood, more legal protections for healthcare providers, and better patient education, Filipino doctors may become more open to female sterilization in the future.

Before talking to your doctor, make sure you fully understand the risks and benefits of any sterilization techniques you may consider. Doctors fully appreciate patients who do their research well. Any permanent female sterilization is permanent and irreversible. Proceed with sterilization only when you are sure there’s no chance you’ll want to get pregnant in the future. Sterilization also does not protect you from sexually transmitted diseases, so use condoms to protect yourself from STDs.

It’s safe for most people to get sterilized. As long as you become fully aware of the risks and benefits, you can find the care you need.

Sources:

https://www.plannedparenthood.org/learn/birth-control/sterilization

https://www.mayoclinic.org/tests-procedures/tubal-ligation/about/pac-20388360

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation