Tubal ligation - sometimes referred to as having one's "tubes tied” or tubal sterilisation - is a form of permanent contraception in women, in which the fallopian tubes are blocked or cut. The fallopian tubes, approximately 10cm long and 0.5cm wide, connect the ovaries to the uterus. Each month, an egg released by an ovary travels along one of the fallopian tubes to the uterus. If the egg is met by a sperm, fertilisation can occur. Cutting or blocking the tube prevents the egg and sperm from meeting, thus preventing fertilisation.
Tubal ligation should not be undertaken if there is any doubt about wanting another pregnancy. Reversal of the procedure is possible but it is difficult and often unsuccessful. If there is any thought about reversal before a tubal ligation, another form of contraception is a better option.
As tubal ligation does not remove any organs or disrupt hormonal balance, it does not affect menstruation or menopause
and sex drive should not be affected. Tubal ligation does not provide protection from sexually transmitted infections.
Tubal ligation procedures
Tubal ligation can be performed in several ways: electro cautery (cauterising the tubes with a heated wire connected to an electrical device); cutting and tying; or placing a clip, ring or band around the tubes.
Laparoscopic Tubal Ligation
Tubal ligation is usually performed using a laparoscopic approach. This involves making two small incisions in the abdomen. A laparoscope (a long thin tube with a camera and light source at its tip) is inserted through one incision and surgical instruments are inserted through the other incision. The abdomen is inflated with carbon dioxide gas to help separate the organs and allow the area to be seen clearly on a television monitor. The fallopian tubes are then able to be located and the tubal ligation performed. The incisions in the abdomen are closed with steristrips (small paper tapes) or small stitches. Laparoscopic tubal ligation is usually performed under a general anaesthetic. The procedure takes approximately 30 minutes and does not normally require an overnight stay in hospital.
Occasionally an “open” surgical approach known as mini-laparotomy may be required if the laparoscopic approach is deemed inappropriate. This may be the case if there is scarring in the pelvis from previous surgery, or medical conditions such as endometriosis. With this approach a single incision, approximately 4-5 cm long, is made just above the pubic hair line. The fallopian tubes are located and the tubal ligation performed. The incision is closed with dissolvable stitches. This type of tubal ligation usually requires a hospital stay of one to two days.
After both types of surgery, some pain or discomfort may be experienced in the abdomen and at the incision sites. Whilst in hospital, pain relieving medications may be given through a drip in the back of the hand. After going home, pain-relieving medications such as ibuprofen and paracetamol should be adequate to relieve any pain or discomfort experienced.
There may also be some nausea and tiredness as a result of the anaesthesia. Rest is important in relieving this and in assisting with overall recovery. Recovery and activity guidelines will be given prior to being discharged from the hospital or clinic.
Sterility is achieved immediately after these tubal ligation methods. However, it is important to use contraception right up to the time of the operation.
Tubal ligation has a failure rate of approximately 1%. Failure can occur if the fallopian tubes were not cut or blocked properly, if the cut ends grow back together, or if the clips on the tubes slip. If pregnancy does occur after a tubal ligation, it is more likely to be ectopic (an abnormal pregnancy that occurs outside the uterus - usually in the fallopian tubes - in which the foetus will not survive). If pregnancy is suspected – ectopic or otherwise - after tubal ligation, seek immediate medical advice.
Hysteroscopic tubal occlusion
This procedure is similar to tubal ligation. It blocks the fallopian tubes but does not involve making any incisions in the abdomen. During this procedure a small telescope (a hysteroscope) is passed into the uterus via the vagina and cervix. The entrance to each tube is located and a small spring/coil like device is positioned inside them. Scar tissue grows into the coils, blocking the fallopian tubes. It takes approximately three months for complete blockage of the tubes to occur. This procedure takes around 10 minutes to perform and can be carried out without the need for anaesthetic.
American College of Obstetricians and Gynaecologists (2017). Hysteroscopic Sterilisation (Web Page). Washington, DC: American College of Obstetricians and Gynaecologists. https://www.acog.org/Patients/FAQs/Hysteroscopic-Sterilization [Accessed: 22/09/17]
Mayo Clinic (2014). Tubal Ligation (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/tests-procedures/tubal-ligation/basics/definition/prc-20020231 [Accessed: 22/09/17]
MedlinePlus (2015). Tubal ligation (Web Page). Bethesda, MD: US National Library of Medicine (NIH). https://medlineplus.gov/ency/article/002913.htm [Accessed: 22/09/17]
Last reviewed – September 2017