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Tubal ligation (informally known as getting one's "tubes tied") is a permanent form of female sterilization, in which the fallopian tubes are severed and sealed or "pinched shut", in order to prevent fertilization. Hormone production, libido, and the menstrual cycle can be affected by a tubal ligation.[1]


Assessment for the procedure

Factors affecting womens choice

Procedure

A tubal ligation surgery can be done in many forms; through a vaginal approach, through laparoscopy, a minilaparotomy ("minilap"), or through regular laparotomy. Also, a distinction is made between postpartum tubal ligation and interval tubal ligation, the latter not being done after a recent delivery. There are a variety of tubal ligation techniques; the most noteworthy are the Pomeroy type that was described by Ralph Pomeroy in 1930, the Falope ring that can easily be applied via laparoscopy, and tubal cauterization done usually via laparoscopy. In addition, a bilateral salpingectomy is effective as a tubal ligation procedure. A tubal ligation can be performed as a secondary procedure when a laparotomy is done; i.e. a cesarean section. Any of these procedures may be referred to as having one's "tubes tied."

Tubal ligation can be performed under either general anesthesia or local anesthesia (spinal or epidural, often supplemented with a tranquilizer to calm the patient during the procedure). The default in tubal ligations following on from cesarean birth is usually spinal/epidural, while the default in non-childbirth related situations may be general anesthesia as a matter of doctor preference. However, tubal ligations under local anesthesia, either inpatient or outpatient, may be performed under patient request.

Less commonly performed is the Essure procedure, in use since 2002. In this procedure micro-inserts are placed within the fallopian tubes by means of catheter and Hysteroscopy. The micro-inserts produce eventual occlusion of the fallopian tubes by causing the in-growth of tissue.

Effectiveness

A tubal ligation is approximately 99% effective in the first year following the procedure. In the following years the effectiveness may be reduced slightly since the fallopian tubes can, in some cases, reform or reconnect which can cause unwanted pregnancy. Method failure is difficult to detect, except by subsequent pregnancy, unlike with vasectomy or IUD. If pregnancy does occur it carries a 33% chance of being an ectopic pregnancy.[How to reference and link to summary or text]


Reversal

Generally tubal ligation procedures are done with the intention to be permanent, and most patients are satisfied with their sterilizations. Tubal reversal is microsurgery to repair the fallopian tube after a tubal ligation procedure.

Usually there are two remaining fallopian tube segments—the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called tubal reversal or microsurgical tubotubal anastomosis.

In a small percentage of cases, a tubal ligation procedure leaves only the distal portion of the fallopian tube and no proximal tubal opening into the uterus. This may occur when monopolar tubal coagulation has been applied to the isthmic segment of the fallopian tube as it emerges from the uterus. In this situation, a new opening can be created through the uterine muscle and the remaining tubal segment inserted into the uterine cavity. This microsurgical procedure is called tubal implantation, tubouterine implantation, or uterotubal implantation.

Tubal reversal, if done by a specialist microsurgeon, has a high success rate and few complications. Successful repair of the fallopian tubes is now possible in 98% of women who have had a tubal ligation, regardless of the type of sterilization procedure.[How to reference and link to summary or text]

IVF in vitro fertilization may overcome fertility problems in patients not suited to a tubal reversal.

Prevalence

Worldwide, female sterilization is used by 33% of married women using contraception,[2] making it the most common contraceptive method.[3]

Access

In developing countries, tubal ligation is generally a popular form of birth control, and is widely available, although some Muslim countries (e.g. Egypt and Indonesia) do not permit it.[4] Faith-based medical institutions in developed countries will sometimes refuse to perform tubal ligations,[5] and where long waiting times persist, there is a worrying risk of pregnancy or complications due to alternative contraception.[6] Because of the permanent nature of the operation, women under 30 without children are often denied access to tubal ligation, even if they express a determined desire not to have children.[7]

Advantages and disadvantages

Psychological benefits

Psychological negative consequences

Physical considerations

Tubal ligation is a more major surgery than vasectomy, and carries greater risks. Postoperative complications are more likely than with vasectomy, and more costly.[8] For instance, in industrialized nations, mortality is 4 per 100,000 tubal ligations, versus 0.1 per 100,000 vasectomies.[9]

Tubal ligation has a larger initial cost than other contraceptive methods. Typically vasectomies are more cost-effective than tubal ligation because they are less expensive. It may take more than a decade of use for tubal ligation to become as cost-effective as other highly effective, long term methods like IUD or implant. Continued method costs or costs from unintended pregnancies make many other methods as or more costly than tubal ligation if used for several years.[8] The cost of tubal ligation is reduced if it is performed during a cesarean section since the tubes are already exposed during the laparotomy.

In other animals

Main article: Neutering

See also

References

  1. Post Tubal Ligation Syndrome
  2. . "Family Planning Worldwide: 2008 Data Sheet" (PDF). Population Reference Bureau. Retrieved on 2008-06-27. Data from surveys 1997-2007.
  3. World Health Organization (2002). The intrauterine device (IUD)-worth singing about. Progress in Reproductive Health Research (60): 1–8.
  4. Campbell M, Sahin-Hodoglugil NN, Potts M (2006). Barriers to fertility regulation: a review of the literature. Studies in family planning 37 (2): 87–98.
  5. includeonly>"Woman given settlement after being denied tubal ligation", CBC news website, CBC news, September 13, 2007. Retrieved on 2007-10-18.
  6. Penava D, Daskalopoulos R, Nisker J, Hammond JA (2006). Lack of timely access to tubal ligation increases risks of unintended pregnancy. Women's health issues : official publication of the Jacobs Institute of Women's Health 16 (1): 1–3.
  7. includeonly>Z., Bonnie. "Tubal ligation procedures denied to young women who don’t want children", American Sexuality magazine, nsrc.sfsu.edu, July 19, 2007. Retrieved on 2007-10-18.
  8. 8.0 8.1 James Trusell, et al. (April 1995). Economic value of contraception. American Journal of Public Health 85 (4): 494–503.
  9. Ninaad S. Awsare, Jai Krishnan, Greg B. Boustead, Damian C. Hanbury, and Thomas A. McNicholas (2005). Complications of vasectomy.. Ann R Coll Surg Engl 87 (6): 406–410.

Further reading

Books

  • Davis, D. L. (1992). Gender and elective surgery in a Newfoundland fishing village. Champaign, IL: University of Illinois Press.

Papers

  • Abell, P. K. (1987). The decision to end childbearing by sterilization: Family Relations Vol 36(1) Jan 1987, 66-71.
  • Ammal, R. S. (1986). Effect of post-partum sterilization on extraversion, introversion and neuroticism: Indian Journal of Clinical Psychology Vol 13(1) Mar 1986, 51-54.
  • Ballou, J., & Bryson, J. (1983). The doing and undoing of surgical sterilization: A psychosocial profile of the tubal reimplantation patient: Psychiatry: Journal for the Study of Interpersonal Processes Vol 46(2) May 1983, 161-171.
  • Barichello, T., Martins, M. R., Reinke, A., Constantino, L. S., Machado, R. A., Valvassori, S. S., et al. (2007). Behavioral deficits in sepsis-surviving rats induced by cecal ligation and perforation: Brazilian Journal of Medical and Biological Research Vol 40(6) Jun 2007, 831-837.
  • Barragan, V. M., Gomez, F. J., & Crespo, G. S. (1997). Analysis of sexual response in the women who have undergone tubal sterilization: Psiquis: Revista de Psiquiatria, Psicologia y Psicosomatica Vol 18(7) Jul-Aug 1997, 42-54.
  • Bledin, K. D., Cooper, J. E., Brice, B., & MacKenzie, S. (1985). The effects on menstruation of elective tubal sterilization: A prospective controlled study: Journal of Biosocial Science Vol 17(1) Jan 1985, 19-30.
  • Bourgeois, M. (1982). Vasectomy and tubal ligation: Medicopsychological aspects of voluntary sterilization: Psychologie Medicale Vol 14(8) Jun 1982, 1195-1201.
  • Burnell, G. M., & Norfleet, M. A. (1986). Psychosocial factors influencing American men and women in their decision for sterilization: Journal of Psychology: Interdisciplinary and Applied Vol 120(2) Mar 1986, 113-119.
  • Cooper, J. E., Bledin, K. D., Brice, B., & Mackenzie, S. (1985). Effects of female sterilization: One year follow-up in a prospective controlled study of psychological and psychiatric outcome: Journal of Psychosomatic Research Vol 29(1) 1985, 13-22.
  • Cooper, P., Gath, D., Fieldsend, R., & Rose, N. (1981). Psychological and physical outcome after elective tubal sterilization: Journal of Psychosomatic Research Vol 25(5) 1981, 357-360.
  • Cooper, P. J., & Gath, D. H. (1983). Psychiatric case detection in gynaecological patients: Psychotherapy and Psychosomatics Vol 40(1-4) Nov 1983, 246-256.
  • Englert, Y., Marneffe, C., Soumenkoff, G., & Hubinont, P. O. (1985). Institutional abuse: Tubal sterilization in a population at risk of ill-treating their children: Child Abuse & Neglect Vol 9(1) 1985, 31-35.
  • Fraser, R. A., Hotz, S. B., Hurtig, J. B., Hodges, S. N., & et al. (1989). The prevalence and impact of pain after day-care tubal ligation surgery: Pain Vol 39(2) Nov 1989, 189-201.
  • Ganesan, V., & Palaniswamy, K. (1989). Tubectomy and anxiety: An experiment: Indian Journal of Applied Psychology Vol 26(2) Jul 1989, 44-49.
  • Hamersma, R. J., Miller, C., Anderegg, T., & Rudolph, B. (1975). Psychological dynamics and self-perceptions of vasectomy candidates: Perceptual and Motor Skills Vol 40(3) Jun 1975, 1004-1006.
  • Hentschel, H., Alberton, D. L., Sawdy, R. J., Capp, E., Goldim, J. R., & Passos, E. P. (2008). Sexual function in women from infertile couples and in women seeking surgical sterilization: Journal of Sex & Marital Therapy Vol 34(2) Mar-Apr 2008, 107-114.
  • Hunter, K. I., Linn, M. W., & Harris, R. (1981). Relationship between women's attitudes and choice of birth control: Psychological Reports Vol 49(2) Oct 1981, 372-374.
  • Joshi, V., & Saroja, K. (1988). The influence of son preference and joint family on adoption of tubectomy in rural areas: Indian Journal of Behaviour Vol 12(1) Jan 1988, 20-32.
  • Kaltreider, N. B., & Margolis, A. G. (1977). Childless by choice: A clinical study: American Journal of Psychiatry Vol 134(2) Feb 1977, 179-182.
  • Kopit, S., & Barnes, A. B. (1976). Patients' response to tubal division: JAMA: Journal of the American Medical Association Vol 236(24) Dec 1976, 2761-2763.
  • Mahajan, V., Yadava, A., & Sharma, N. R. (1999). Role of anxiety in the manifestation of psychosomatic complaints after tubectomy: Journal of Personality and Clinical Studies Vol 15(1-2) Mar-Sep 1999, 37-40.
  • Merino Barragan, V., Jimenez Gomez, F., & Sanchez Crespo, G. (1994). Analysis of mental health factors in women who have undergone tubal sterilization or reversible birth control: Revista de Psicologia Vol 12(1) 1994, 73-127.
  • Miller, W. B., & Shain, R. N. (1985). Married women and contraceptive sterilization: Factors that contribute to pre-surgical ambivalence: Journal of Biosocial Science Vol 17(4) Oct 1985, 471-479.
  • Miller, W. B., Shain, R. N., & Pasta, D. J. (1985). A model of the determinants in married women of sterilization method choice: Population & Environment: Behavioral & Social Issues Vol 8(3-4) Fal-Win 1985-1986, 223-239.
  • Miller, W. B., Shain, R. N., & Pasta, D. J. (1990). The nature and dynamics of post-sterilization regret in married women: Journal of Applied Social Psychology Vol 20(6, Pt 1) Apr 1990, 506-530.
  • Miller, W. B., Shain, R. N., & Pasta, D. J. (1991). The pre- and poststerilization predictors of poststerilization regret in husbands and wives: Journal of Nervous and Mental Disease Vol 179(10) Oct 1991, 602-608.
  • Miller, W. B., Shain, R. N., & Pasta, D. J. (1991). The predictors of post-sterilization regret in married women: Journal of Applied Social Psychology Vol 21(13) Jul 1991, 1083-1110.
  • Mistry, T. C. (1987). Impact of power and incentive in the process of decision-making for sterilization: Indian Psychological Review Vol 32(1) Jan 1987, 1-13.
  • Oliveira, F., Kerr, L., Frota, A., Nobrega, A., Bruno, Z., Leitao, T., et al. (2007). HIV-positive women in northeast Brazil: Tubal sterilization, medical recommendation and reproductive rights: AIDS Care Vol 19(10) 2007, 1258-1265.
  • Porter, C. W., & Hulka, J. F. (1974). Female sterilization in current clinical practice: Family Planning Perspectives Vol 6(1) Win 1974, 30-38.
  • Presser, H. B., & Bumpass, L. L. (1972). The acceptability of contraceptive sterilization among U.S. couples: 1970: Family Planning Perspectives Vol 4(4) Oct 1972, 18-26.
  • Richards, J. M., Kohler, C. L., Goldenberg, R. L., Jackson, J. R., & et al. (1991). Psychosocial impact of tubal ligation in Alabama women: Journal of Applied Social Psychology Vol 21(15) Aug 1991, 1248-1264.
  • Schwyhart, W. R., & Kutner, S. J. (1973). A reanalysis of female reactions to contraceptive sterilization: Journal of Nervous and Mental Disease Vol 156(5) May 1973, 354-370.
  • Shain, R. N., & Dickson, H. D. (1982). Tubal sterilization: Characteristics of women most affected by the option of reversibility: Social Science & Medicine Vol 16(10) 1982, 1067-1077.
  • Shain, R. N., Miller, W. P., & Holden, A. E. (1984). The decision to terminate childbearing: Differences in preoperative ambivalence between tubal ligation women and vasectomy wives: Social Biology Vol 31(1-2) Spr-Sum 1984, 40-58.
  • Smith, E. M., Friedrich, E., & Pribor, E. F. (1994). Psychosocial consequences of sterilization: A review of the literature and preliminary findings: Comprehensive Psychiatry Vol 35(2) Mar-Apr 1994, 157-163.
  • Song, M., Song, Z., Barve, S., Zhang, J., Chen, T., Liu, M., et al. (2008). Correction to "Tetrathiomolybdate protects against bile duct ligation-induced cholestatic liver injury and fibrosis." Journal of Pharmacology and Experimental Therapeutics Vol 325(3) Jun 2008, 1062.
  • Song, M., Song, Z., Barve, S., Zhang, J., Chen, T., Liu, M., et al. (2008). Tetrathiomolybdate protects against bile duct ligation-induced cholestatic liver injury and fibrosis: Journal of Pharmacology and Experimental Therapeutics Vol 325(2) May 2008, 409-416.
  • Tong, R., Pan, J., Tao, M., Kong, S., Hu, B., & Gong, H. (2002). Three years follow-up of female neurotics and sterilization in rural area: Chinese Mental Health Journal Vol 16(8) Aug 2002, 531-533.
  • Tsoi, M. M., & Ho, P. C. (1984). Psychological factors related to adjustment after tubal ligation: Journal of Reproductive and Infant Psychology Vol 2(1) Apr 1984, 1-6.
  • Turner-Bonk, M. F., Penfield, A. J., & Driscoll, D. L. (1978). Laparoscopic sterilization at an outpatient clinic: Public Health Reports Vol 93(1) Feb 1978, 55-59.
  • Wig, N. N., & et al. (1977). Usefulness of preoperative assessment in the prediction of psychiatric disturbances following tubal ligation: Indian Journal of Clinical Psychology Vol 4(1) Mar 1977, 39-43.


Dissertations

  • Abell, P. K. (1981). Voluntary sterilization and moral development of women: Dissertation Abstracts International.
  • Bryson, J. (1984). Reversal of sterilization in women: A study of social and psychological factors: Dissertation Abstracts International.
  • Cottrell, J. S. (1986). Sterilization effects on couples measured by MMPI, CPI, PVA and Leary ITP: Dissertation Abstracts International.
  • Schwyhart, W. R. (1975). Psychological adjustment of women using sterilization for contraception: Dissertation Abstracts International.

External links

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