Female Sterilization

·         Cancer
·         General Procedure
·         Health Risks and Side Effects
·         Mechanism of Action
·         Menstrual Bleeding
·         Sexual Pleasure
·         Weight Changes
·         Who Can Use the Method
Myth: Cancer
Some clients incorrectly believe that female sterilization will cause women to develop cancer of the reproductive organs (uterus, cervix, or ovaries).
Female sterilization does not increase the risk of cancer of the reproductive organs which are defined below. In fact, several studies have reported a reduced risk of ovarian cancer after tubal occlusion. Very little research has been done to investigate the relationship between breast cancer and female sterilization, but so far there is no evidence of such a link.
Uterine Cancer: Cancer that forms in tissues of the uterus (womb). Two types of uterine cancer are endometrial cancer (cancer that begins in cells lining the uterus), and uterine sarcoma (a rare cancer that begins in muscle or other tissues in the uterus).
Cervical Cancer: Cancer that forms in tissues of the cervix (the lower end of the uterus). It is usually a slow-growing cancer that may not have symptoms, but can be found with regular screening.
Ovarian Cancer: Cancer that forms in tissues of the ovary. Most ovarian cancers are either ovarian epithelial carcinomas (cancer that begins in cells that line the ovary) or malignant germ cell tumors (cancer that begins in egg cells).
Counseling Messages:
Cancer is a disease that is commonly caused by smoking and other co-factors which are not related to female sterilization. (Cambodia)
Without any other health risks, no research confirms that female sterilization puts women at risk of uterine cancer. (Cambodia)
Cancer of the reproductive organs will not be present after female sterilization [Editor’s note: it cannot develop as a direct consequence of female sterilization]. Moreover, there is evidence that shows that female sterilization will help protect against ovarian cancer. (Indonesia)
All kinds of married women or any women who have sexual intercourse are at risk for cervical carcinoma. Therefore, all women need regular yearly Pap smear screenings. (Cambodia)
There is no scientific evidence proving this. (Mongolia)
Myth: General Procedure
Some clients incorrectly believe that female sterilization involves the removal of some or all of a woman’s reproductive organs, including the vagina.
During the sterilization procedure, the ovaries, uterus, and cervix are left in place. Only the fallopian tubes (the tubes which carry eggs from the ovaries to the uterus) are blocked or cut. The two most common surgical approaches are laparoscopy and minilaparotomy:
  • Minilaparotomy involves making a small incision in the abdomen (measuring 2-5 centimeters), and the fallopian tubes are brought to the incision to be tied and cut or else closed with a clip or ring. The doctor inserts a special instrument (uterine elevator) into the vagina, through the cervix, and into the uterus to raise each of the two fallopian tubes so they are closer to the incision.
  • Laparoscopy involves inserting a long thin tube with a lens in it (a laparoscope) into the abdomen through a small incision (measuring about 1 centimeter). This laparoscope enables the doctor to see and to close each tube with a clip, a ring, or block it by electric current.
Counseling Messages:
With the female sterilization the woman will undergo a minor operation where her fallopian tubes would be tied and cut, but her reproductive organs are not removed. Women who have their reproductive organs removed, such as having total abdominal hysterectomy, may be because of other health problems they're having and not because of their tubal ligation status. (Tuvalu)
It is only a process of tying both [fallopian] tubes to prevent fertilization between the ovum and spermatozoid. Other reproductive organs remain the same and you still have the normal monthly menstruation bleeding. (Cambodia)
You don’t have to worry that some parts of your reproductive organs will be removed when you have female sterilization. This procedure will only tie or block your tubes. (Indonesia)
Female sterilization is a surgical procedure where both fallopian tubes are cut and tied.
The genital organs include ovaries, uterus, and vagina and remain well functioning. (Cambodia)
Sterilization includes just the 'tying' of the tubes to prevent the egg from moving into the womb. The womb remains intact and you will continue to have your periods.(Ghana)
We tie and cut part of the tube on either side (this is “removal”) but the rest of the organs are not removed and that includes your vagina. Your sexual relationship will be as usual and that won't be affected. (Malaysia)
Female sterilization is not castration. Only the fallopian tubes are blocked to prevent the woman’s eggs from reaching the man’s sperm. (Republic of Benin)
For tubal ligation the surgeon just removes a small part of each [fallopian] tube and ligates it. This does not involve the uterus, or the vagina. There is not any additional procedure for tubal ligation. (Iran)
Myth: Health Risks and Side Effects
Some clients incorrectly believe that female sterilization leads to health risksor side effects such as hysterectomy, poor health, pain, or hormonal imbalances.
There are no documented medical side effects of female sterilization. The few complications that do occur during or following sterilization, such as infection or abscess of the wound, can generally be kept to a minimum if appropriate techniques are used and if the procedure if performed in an appropriate setting. Local anesthesia is best for female sterilization because it has lower risks of complications than use of general anesthesia. The risks are lowest when local anesthesia is used without sedatives. If sedatives are used, providers should closely monitor the woman’s vital signs, such as pulse rate and blood pressure throughout the procedure.
Some incorrectly believe that sterilization will cause a woman to need a hysterectomy. Recent research shows that sterilization does not appear to increase the need for a hysterectomy, however. Sterilization has no biologic relationship with hysterectomy. Hysterectomies are often done to treat menstrual disorders and women who are sterilized may be more likely to consider having hysterectomies to treat such disorders because they are not worried about losing their fertility.
Female sterilization does not cause lasting pain in the back, uterus, or abdomen. There is often some minor pain during the procedure. Women receive local anesthetic to stop pain during the procedure, and, except in special cases, women remain awake. A woman can feel the health care provider moving her uterus and 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. She can take ibuprofen (200–400 mg), paracetamol (325–1000 mg), or other pain reliever, but not aspirin. Stronger pain reliever is rarely needed.
Hormone Imbalances
Female hormones are not affected by female sterilization, and there will be neither a loss of femininity nor any change in sexual functioning.
Counseling Messages:
Sterilization is a simple surgical procedure that involves tying or severing the fallopian tubes so that the egg/ova and sperm are unable to meet and fertilize. The procedure does not cause ill health, backache, weakness or other illnesses or side effects. If you feel any of these symptoms, they are probably due to other medical conditions and must be investigated. Therefore, if you suffer from any of these symptoms following sterilization, please visit your general practitioner for an assessment. (Fiji)
Backaches and abdominal pain are due to many other reasons and can be corrected. Female sterilization does not cause such problems and the majority of women feel better after this procedure because they are permanently free from the repeated threat of pregnancy. (India)
Headaches, backaches, and even abdominal pain do happen to any women whether tubal ligation was done or not. Women who have tubal ligation are closely monitored and referred to the obstetrician for further assessment if needed. Tubal ligation does not increase the need for hysterectomy or cause women to become weaker. (Cook Islands)
Female sterilization does not cause any health problem apart from infertility. (Ghana)
In general, there is no complication after the procedure. It doesn’t cause health risks or side effects such as hysterectomy, poor health, pain or hormonal imbalances. A trained doctor will check your condition before conducting the procedure and will conduct it carefully, opening your abdomen through a small incision to get to the tubes. (Indonesia)
Female sterilization is only a minor procedure and the side effects are just minimal after the operation. [Editor’s note: Most of these side effects are related to anesthesia or post-operative infections.] (Malaysia)
You have to see a doctor to rule out if there are any other gynecological problems you may have. If you feel weaker after tubal ligation, it could be that you are not getting enough rest, have a poor diet, low hemoglobin levels or you could have worm infestation. Therefore, I strongly advise you to see the doctor for further investigation and treatment. (Tuvalu)
This is not true. The very [minor]operation involves blocking the passages that carry the female egg, thus preventing the male egg and female egg from joining together to become a pregnancy. (Nigeria)
The most common side effect is regret due to a poor decision made by the couple. Of course, a few days after the procedure women may experience pain at the incision site and may not feel well, but this will disappear later. Most women will be back to work as soon as usual. (Cambodia)
Female sterilization is a surgical procedure, not a hormonal contraceptive. Although the tubes are cut, there is no hormone produced or released from that part. It means your hormone function remains as usual. (Cambodia)
No, female sterilization does not cause the above.  (Show clients where the tubes are cut and tied.) (Vanuatu)
Myth: Mechanism of Action
Some people incorrectly believe that female sterilization prevents pregnancy either by stopping ovulation or by killing a woman’s egg.
Female sterilization does not stop ovulation or harm a woman’s egg in any way. An egg will still be released each month, but it will dissolve and be reabsorbed by the body.
Female sterilization prevents pregnancy by cutting or blocking the fallopian tubes (the tubes which carry eggs from the ovaries to the uterus) so that sperm cannot move up to meet the egg. There are several ways of blocking the fallopian tubes: tying them (ligation), removing a small piece of the tube (excision), sealing (cauterization), or applying clips or rings.
Counseling Messages:
Female sterilization, a permanent contraceptive method, is a procedure to help women who do not want to have more children. It does not stop ovulation or kill a woman’s eggs, but it will block the tubes which carry the egg from the ovaries to the uterus. Therefore, the egg can not meet the sperm. (Indonesia)
The fallopian tubes are ligated to prevent the sperm and ovum from meeting so that fertilization is not allowed. But, ovulation still takes place and does not kill the women’s egg. (Cook Islands)
During the procedure for female sterilization, the physician cuts or blocks the two [fallopian] tubes that carry the eggs to the uterus. Then, the eggs are no longer able to meet the spermatozoids that are introduced into the vagina during sex to make the woman pregnant. (Republic of Benin)
Pregnancy is caused by fertilization of the ovule by the spermatozoid. Female sterilization is a family planning method in which the two [fallopian] tubes are pierced, cut and tied to prevent pregnancy. (Cambodia)
Tubal ligation is just a minor operation in which the tubes (fallopian tubes) of a woman are tied and cut to prevent the ovum/egg from meeting the sperm. (Tuvalu)
There is no such effect.  (Show a model of the female organs and explain to them what happens.) (Mongolia)
Myth: Menstrual Bleeding
Some clients incorrectly believe that female sterilization will cause irregular or heavier menstrual bleeding or make monthly bleeding stop (amenorrhea).
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 (COCs) 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.
Counseling Messages:
For older women irregularities are more likely due to the normal aging process, not because of sterilization. For women who used COCs prior to sterilization, irregularities may be due to the transition from regulated to non-regulated cycles. Evidence, to date, does not support any biological explanation for an association between tubal ligation and subsequent menstrual or other gynecological problems. (South Africa)
Female sterilization applies to the fallopian tubes only, therefore you should menstruate monthly. Changes could be caused by obesity, menopause, or hormonal imbalances. (Cook Islands)
You will still have your period because this procedure does not remove the uterus and the ovaries. (Indonesia)
Female sterilization does not affect menstrual bleeding since the ovaries are still functional and the uterus produces normal monthly periods. Of course, the problems of menstrual bleeding are usually caused by a hormonal imbalance, which is the result of a change in a woman’s health and her psychological feelings. (Cambodia)
Women are concerned that their periods will get worse, which in turn will lead to a hysterectomy. If they have been using contraception that lightens their periods, such as COCs, Depo Provera or the Mirena IUD, this may well be the case. (New Zealand)
Menstrual period comes from the uterus. You will experience menopause only with a total hysterectomy. [Editor’s note: Menopause occurs as a result of age-related hormonal changes. Hysterectomy as such will not lead to menopause unless the procedure includes a bilateral oophorectomy.] (Vanuatu)
You will continue to have your periods. (Ghana)
Myth: Sexual Pleasure
Some clients incorrectly believe that female sterilization causes women to lose their sex drive or lose their sexual ability.
After sterilization a woman will look and feel the same as before. There is no loss of sexual drive or interest after female sterilization. She can have sex the same as before. She may find that sex is more enjoyable because she does not have to worry about getting pregnant.
Counseling Messages:
Female sterilization will not have any effect on your sexual feelings. You will continue to enjoy your husband as before. You may even enjoy sex better because you no longer entertain any fear of pregnancy during your sexual act. (Ghana)
This is not true. Understanding how your reproductive system works will prove this claim wrong. Sterilization will help to improve your sexual relationship, as the fear of unplanned pregnancy is eliminated. (Nigeria)
Because there won't be any intervention in the genital organs and sex hormones, there will not be any changes in your sex drive and sexual pleasure. (Iran)
Your sex hormones are not affected by female sterilization. You will still have your sex drive and you can enjoy your sexual activity because you do not have to worry about becoming pregnant. (Indonesia)
There is no evidence to prove that female sterilization affects one’s sexual desire. A comfortable intercourse is usually related to the environment and a person’s physical and mental health. (Cambodia)
The most common problem of sexual dysfunction is a psychological problem. For perimenopausal women, sexual function may be due to a disturbance or hormonal changes. (Cambodia)
Sexual desire is a mental process and is hormone dependent. When a woman has sterilization, her tubes are blocked and her other functions are perfectly all right. In some cases, sexual pleasure increases due to freedom from the anxiety of pregnancy.
Myth: Weight Changes
Some clients incorrectly believe that female sterilization will cause women to lose weight or to gain weight or that female sterilization will disfigure a woman’s body.
Sterilization does not cause any changes in weight, appetite, or appearance. However, older women are more likely to choose sterilization for contraception than younger women and most women gain weight as they age.
Counseling Messages:
Weight changes are related to diet. Many women gain weight or lose weight without having female sterilization. In general, some women may experience weight changes at an older age due to metabolism changes. (Cambodia)
Your weight changes depending on your nutrition and your lifestyle. Some people will have a large abdomen or disfigured body if they eat too much and do not exercise. Female sterilization will not influence your body shape. (Indonesia)
Female sterilization does not affect the hormonal systems of women. But, you can gain weight if you feel at ease and are no longer under the daily fear of pregnancy with your partner. (Republic of Benin)
Female sterilization does not cause weight change. In fact, these problems are usually caused by problems of their health or their economic situation. Actually, women that have not had female sterilization have these problems, too. (Cambodia)
Some women put on weight or loose weight. Female sterilization allows a woman to: 1. be flexible and contented and not worry about unwanted pregnancy; 2. enjoy sex more while knowing that she is safe. (Cook Islands)
Weight gain is mainly due to inactivity and food habit. Sterilization does not cause weight gain. Some women complain about weight loss due to repeated attacks of abdominal pain, backaches and gastric problems. Many of these symptoms are due to psychosomatic illness. More information on your family history and interpersonal relationships is required to determine the cause of these problems. After counseling you will be all right. (India)
Sterilization will have no effect on your body. (Ghana)
It has not been proved and there should not be any relation with female sterilization and weight gain. (Mongolia)
Myth: Who Can Use the Method
Some women avoid female sterilization because they incorrectly believe that only women of a certain age or who have a certain number of children can undergo female sterilization.
All women can undergo female sterilization safely with proper counseling and informed consent. There is no justification for denying sterilization to a woman because of her age, the number of her pregnancies or 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. If a specific woman’s situation suggests to a provider that she could have regrets later, the provider should help the woman think through her decision carefully. Ultimately, however, each woman must be allowed to decide for herself whether or not she will want more children and whether or not to have sterilization.
Counseling Messages:
Female sterilization is a voluntary family planning method. It is a safe procedure for most women, even if they are old or young, have just given birth, have only one or no children, and if they are still breastfeeding. Women must consider their choice before having female sterilization because it is a permanent contraceptive method, which means once she decides to have sterilization, she will never have a child in the future. (Indonesia)
The method can be used at any age, but be 100% sure that you don't want any more children before you choose sterilization because it is [generally not reversible]. (Ghana)
Female sterilization is a permanent method to prevent pregnancy. Any women who can bear a child can adopt this method. Reversing female sterilization is possible, but the chances are very low. If you have thought of having more children, then you are better off adopting another method of contraception.(India)
There is no rule or regulation for age or number of children. But, it is better that young people who may want to have more children avoid sterilization. Any person who is satisfied with the number of children they have can get tubal ligation. (Iran)
This is not true. Female sterilization is for women who do not want anymore children, have completed having the number of children they desire, and for health reasons [that is, for women where pregnancy is not recommended for medical reasons]. (Nigeria)
If you are sure your family is complete then anyone can have a tubal ligation. But, if you are under 30 years old [or any other age], you may change your mind about wanting children if you don’t already have any. (New Zealand)
Female sterilization is a matter of personal decision. It is up to the woman to choose the method. Any woman who meets the medically accepted conditions for this method can undergo it. [Editor’s note: According to WHO, there are no medical reasons that permanently restrict a person’s eligibility for sterilization.However, there are medical conditions that may limit when, where, or how the female sterilization procedure should be performed.] (Republic of Benin)
Female sterilization is available for all women who have the intention that they really do not want any more children and do not have contraindications to sterilization, or for women who cannot use birth spacing methods because they have a medical problem. [Editor’s note: According to the World Health Organization, there are no medical reasons that permanently restrict a person’s eligibility for sterilization.However, there are medical conditions that may limit when, where, or how the female sterilization procedure should be performed.] (Cambodia)
Female sterilization is one of the contraceptive methods that can be used by any woman who no longer wants to have children or has a serious medical condition. It is safe and there are no side effects related to age or the number of children a woman has. (Cambodia)
You can undergo sterilization when you decide that you now have the number of children you want. You need not wait until you reach a certain age. Sterilization can also be used in women who have medical or psychological reasons for not having children. (Fiji)
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