Female sterilization permanently prevents women from becoming pregnant. There are two different procedures to achieve this goal, tubal ligation and tubal implants. They both work by blocking the fallopian tubes (tubes that lead from women’s ovaries into the uterus or womb) so that sperm cannot meet with and fertilize an egg.

Because these methods cannot be undone, they are only recommended for women who are sure they never want to have a baby or who do not want to have more children.

• Tubal ligation: The fallopian tubes are cut, sealed, or tied. With this method, very tiny cuts (called incisions) are made in the abdomen or belly. This is also known as having “tubes tied.” Surgical sterilization works to prevent pregnancy right away.

• Tubal implant: A very small spring-like coil is placed into each fallopian tube. The coils cause scar tissue to form in the tubes, thereby blocking the tubes. This method does not involve cuts or incisions. Instead, a health care provider uses a thin tube to thread the small coils through the vagina and uterus into the fallopian tubes, where the coils will stay.

With the tubal implant, it will take up to three months for the scar tissue to fully block the tubes. So, it is important to use a back-up type of birth control (like a condom or the birth control shot) until your health care provider says it is not needed. You will go back to the health center or office for an exam and be checked to make sure the coils are in the right place and the tubes are blocked. This may require a special type x-ray where dye is placed into the uterus to make sure the tubes are blocked.

Out of 100 women who have a sterilization procedure each year, less than one may become pregnant.

• Safe and highly effective approach to preventing pregnancy

• Lasts a lifetime, so no need to worry about birth control again

• Quick recovery

• No significant long-term side effects

• Your male partner doesn’t have to know about it or do anything different

• Does not protect against sexually transmitted infections (STIs), including HIV

• Some risk of infection, pain, or bleeding

• Very rarely, the tubes can grow back together. When this happens there is a risk for pregnancy. In some cases, this leads to tubal or ectopic pregnancy-- when the pregnancy happens in the fallopian tubes, which is a life-threatening condition.

• Some women later change their mind and wish they could have a child or additional children.

No. Most research finds no major changes in bleeding patterns after female sterilization. If a woman was using a hormonal method or IUD before sterilization, her bleeding pattern will return to the way it was before she used these methods. For example, women switching from combined oral contraceptives to female sterilization may notice heavier bleeding as their monthly bleeding returns to usual patterns. Note, however, that a woman’s monthly bleeding usually becomes less regular as she approaches menopause.

No. After sterilization a woman will look and feel the same as before. She can have sex the same as before. She may find that she enjoys sex more because she does not have to worry about getting pregnant. She will not gain weight because of the sterilization procedure.

No. There is no justification for denying sterilization to a woman just because of her age, the number or sex of her living children, or her marital status. Health care providers must not impose rigid rules about age, number of children, age of last child, or marital status. Each woman must be allowed to decide for herself whether or not she will want more children and whether or not to have sterilization.

Local anesthesia is safer. General anesthesia is more risky than the sterilization procedure itself. Correct use of local anesthesia removes the single greatest source of risk in female sterilization procedures—general anesthesia. Also, after general anesthesia, women usually feel nauseous. This does not happen as often after local anesthesia.

When using local anesthesia with sedation and analgesia, however, providers must take care not to overdose the woman with the sedative. They also must handle the woman gently and talk with her throughout the procedure. This helps her to stay calm. With many clients, sedatives can be avoided, especially with good counseling and a skilled provider.

Generally, no. Female sterilization is very effective at preventing pregnancy and is intended to be permanent. It is not 100% effective, however. Women who have been sterilized have a slight risk of becoming pregnant: About 5 of every 1,000 women become pregnant within a year after the procedure. The small risk of pregnancy remains beyond the first year and until the woman reaches menopause.

Most often it is because the woman was already pregnant at the time of sterilization. In some cases an opening in the fallopian tube develops. Pregnancy also can occur if the provider makes a cut in the wrong place instead of the fallopian tubes.

Generally, no. Sterilization is intended to be permanent. People who may want more children should choose a different family planning method. Surgery to reverse sterilization is possible for only some women—those who have enough fallopian tube left. Even among these women, reversal often does not lead to pregnancy. The procedure is difficult and expensive, and providers who are able to perform such surgery are hard to find. When pregnancy does occur after reversal, the risk that the pregnancy will be ectopic is greater than usual. Thus, sterilization should be considered irreversible.

Each couple must decide for themselves which method is best for them. Both are very effective, safe, permanent methods for couples who know that they will not want more children. Ideally, a couple should consider both methods. If both are acceptable to the couple, vasectomy would be preferable because it is simpler, safer, easier, and less expensive than female sterilization.

Yes, a little. Women receive local anesthetic to stop pain, and, except in special cases, they remain awake. A woman can feel the health care provider moving her uterus and fallopian tubes. This can be uncomfortable. If a trained anesthetist or anesthesiologist and suitable equipment are available, general anesthesia may be chosen for women who are very frightened of pain. A woman may feel sore and weak for several days or even a few weeks after surgery, but she will soon regain her strength.

Provide clear, balanced information about female sterilization and other family planning methods, and help a woman think through her decision fully. Thoroughly discuss her feelings about having children and ending her fertility. For example, a provider can help a woman think how she would feel about possible life changes such as a change of partner or a child’s death.

No. On the contrary, female sterilization greatly reduces the risk of ectopic pregnancy. Ectopic pregnancies are very rare among women who have had a sterilization procedure. The rate of ectopic pregnancy among women after female sterilization is 6 per 10,000 women per year. The rate of ectopic pregnancy among women in the United States using no contraceptive method is 65 per 10,000 women per year.

On the rare occasions that sterilization fails and pregnancy occurs, 33 of every 100 (1 of every 3) of these pregnancies are ectopic. Thus, most pregnancies after sterilization failure are not ectopic. Still, ectopic pregnancy can be life-threatening, so a provider should be aware that ectopic pregnancy is possible if sterilization fails.

If no pre-existing medical conditions require special arrangements:

• Minilaparotomy can be provided in maternity centers and basic health facilities where surgery can be done. These include both permanent and temporary facilities that can refer the woman to a higher level of care in case of emergency.

• Laparoscopy requires a better-equipped center, where the procedure is performed regularly and an anesthetist is available.