Birth Control Options for Women - Female Sterilization

Laparotomy. Laparotomy, a less common approach, requires an extensive two- to five-inch incision in the abdomen. It is considered major surgery and can require a hospital stay of a few days followed by recovery at home for several weeks. Resumption of intercourse depends on how quickly one is able to recover.

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Culdoscopy. Culdoscopy involves inserting a scope through the vagina and into the pelvic cavity. Although it is less invasive than laparoscopy, a major 2002 analysis reported that at this time it carries a higher complication rate than either laparoscopy or minilaparotomy.

Candidacy for Female Surgical Sterilization

Before undergoing sterilization, a woman must be sure that she no longer wants to bear children and will not want to bear children in the future, even if the circumstances of her life change drastically. She must also be aware of the many effective contraceptive choices available. Possible reasons for choosing female sterilization procedures over reversible forms of contraception include the following:

Not wanting children and being unable to use other methods of contraception.
Health problems that make pregnancy unsafe.
Genetic disorders.

If married, both partners should completely agree that they no longer want to have children and should also have ruled out vasectomy for the man. Vasectomy is a simple procedure that has a lower failure rate than female surgical sterilization, carries fewer risks, and is less expensive. [ SeeIn-Depth Report #27, Vasectomy.]

Even if all these factors are present, a woman must consider her options carefully before proceeding. Studies report that over time, between 14% and 25% of women eventually regret this choice. Studies suggest that women at highest risk for regretting sterilization are the following:

Women who are younger at the time of sterilization. In one long-term study, over 40% of women who had had tubal ligation between the ages of 18 and 24 regretted their choice. (Only about 4% of women over 35 had these regrets.)
Women who had the procedure immediately after a vaginal delivery.
Women who had the procedure within seven years of her youngest child.
Women in lower income groups.

If a woman changes her mind and wants to become pregnant, a reversal procedure is available, but it is very difficult to perform and requires an experienced surgeon. Subsequent pregnancy rates after reversal are between 20% and 84%, depending on the surgical skill, the age of the woman, and, to a lesser degree, her weight and the length of time between the tubal ligation and the reversal procedure. Not all insurance carriers cover the cost of reversal.