What to Expect — Sterilization for Women

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  What Are the Types and Risks of Sterilization?

  There are a few different ways to be sterilized. One method does not require an incision — a cut. It is called Essure. All the other methods require an incision.

  • NO-INCISION METHOD — ESSURE
  • INCISION METHODS — LAPAROSCOPY, MINI-LAPAROTOMY, LAPAROTOMY
  • HIGH-RISK METHOD — HYSTERECTOMY

  Your health care provider will help you decide which kind of sterilization might be right for you. Your medical history, including your weight and previous surgeries, may influence which kind will be best and safest for you.

  

  NO-INCISION METHOD — ESSURE

  To use Essure, a health care provider inserts two small coils called microinserts through the vagina, cervix, and uterus into the fallopian tubes. Once in place, the coils cause scar tissue to grow, blocking the tubes.

  During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. A small, rigid, tube-like instrument called a scope is inserted into the vagina and through the cervix. The coils are placed in the opening of the tubes.

  Like vasectomy, Essure is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant.

  Essure offers some advantages over other methods of sterilization:

  • The procedure is safer.
  • General anesthesia is not needed.
  • A surgical setting is not needed.
  • Recovery is faster.

  With Essure, no incisions are necessary. So you won't have any visible scars.

  Risks with No-Incision Methods

  Studies have shown that Essure is safe, but there are still some possible risks:

  • One or both of the coils may not be put in place correctly the first time. It may be necessary to have a second procedure.
  • The coils may move out of place.
  • The uterus may be injured during the insertion. This rare complication may require surgery.
  • The coils may be damaged during other medical procedures.

  Other rare complications include over-absorption of the saline fluid that is used to place the coils, a broken coil, changes in the menstrual cycle, infection, and pelvic or back pain.

  Talk with your health care provider about the benefits and risks of Essure to help you decide if it may be right for you.

  INCISION METHODS

  Laparoscopy

  Laparoscopy is one of the two most common types of sterilization.

  First you will get either general, regional, or local anesthesia.  Then, your abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows your health care provider to see your organs clearly. Then the provider makes a small cut near your navel and inserts a laparoscope (a rod-like instrument with a light and a viewing lens) to locate the fallopian tubes. The health care provider also may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only one incision and one instrument are used.

  The procedure can be performed in outpatient surgical clinics. It usually takes 20–30 minutes. Very little scarring occurs. Women often go home the same day.

  Mini-Laparotomy

  Mini-laparotomy is another common type of sterilization. It is often performed after childbirth. No gas or laparoscope is used. Usually, local anesthesia is used. A small cut is made in the lower abdomen, just above the pubic hair or just below the navel. The health care provider locates the tubes, then ties, clips, or uses a probe with an electrical current to block them off. Women usually recover in a few days.

  Laparotomy

  Laparotomy is major surgery. It is less commonly used than the other incision methods.

  The health care provider makes a two-to-five-inch cut in the abdomen. The provider locates and closes off the tubes. The operation requires general or regional anesthesia. You may need to be hospitalized for 2–4 days. It may take several weeks at home to completely recover. If the procedure is done after delivery, your hospital stay may be extended by 1–2 days.

  Risks with Incision Methods

  Complications can occur with any kind of surgery. These incision methods are considered low-risk surgeries. The complications that can occur during or after these them include

  • bleeding
  • infection
  • reaction to the anesthetic

  Infection is rare. It is treated with antibiotics. Very rarely, the bowel, bladder, uterus, or blood vessels are injured. You may need additional surgery to repair this.

  Complications may develop in 1–4 out of every 100 sterilizations that are performed through the abdomen. Death resulting from sterilization is extremely rare and is usually caused by a reaction to general anesthesia.

  HIGH-RISK SURGERY

  Hysterectomy

  Hysterectomy is the removal of the uterus. It is major surgery and is not usually used for sterilization. It is used to correct serious medical conditions.

  If you have a hysterectomy, you will no longer have your period. Usually, it will not affect your fallopian tubes. However, some medical conditions also call for the removal of a tube and/or ovary, on one side or both.

  Hysterectomy is performed through the abdomen and/or vagina. Women need to spend several days in the hospital. They usually spend several weeks at home recovering. They should abstain from sexual intercourse for 4–6 weeks, until the health care provider says it is safe to have sex.

  Risks with Hysterectomy

  Complications after hysterectomy, such as infection or blood loss, occur in 10–20 out of every 100 cases. Because hysterectomy is usually performed as a result of a serious medical problem, the risk of death is much greater than it is for more common sterilization methods.

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  Does Sterilization Hurt?

  Your health care provider will give you medicine to make sterilization as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local and regional anesthesia block the feeling of pain in certain areas of your body. These are much safer than general anesthesia.

  General anesthesia is entirely painless. It allows you to sleep through the procedure.

  When you get local or regional anesthesia, you may feel brief discomfort. The pain is relieved with medications and, sometimes, sedatives. Most likely, you will feel little or no discomfort during the procedure.

  Some women who use Essure for sterilization report mild to moderate pain during the placement of the coils.

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  How Will I Feel After Sterilization?

  The discomfort you feel after the procedure depends on your general health, the type of procedure, and how well you deal with pain. You may feel tired and have slight pain in your abdomen. You may occasionally feel dizzy, nauseous, bloated, or gassy, or have shoulder pain or abdominal cramping. Women who use Essure may have vaginal discharge, like a light menstrual period. Most symptoms will last 1–3 days.

  Contact your health care provider immediately if you

  • bleed from an incision
  • develop a rash or fever
  • have difficulty breathing
  • have fainting spells
  • have severe, continuous abdominal pain
  • have unusual discharge or odor from your vagina

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  How Long Does It Take to Recover from Sterilization?

  It depends on your general health, lifestyle, and the method of sterilization that you use. With mini-laparotomy and laparoscopy, recovery is usually complete in a day or two. You may want to take it easy for the next week or so. In any case, you should avoid heavy lifting for about one week. Recovery from sterilization with Essure is faster — some women return to normal activities the same day as the procedure. Others take a day or two.

  Talk with your health care provider about when it's safe to start having sex again. Remember, if you've had Essure, you need to use another birth control method until your health care provider confirms that your tubes are blocked.