Tubal ligation

Infobox Birth control
name = Tubal ligation


width =
caption =
bc_type = Sterilization
date_first_use = 1930
rate_type = Failure
perfect_failure% = 0.5
typical_failure% = 0.5
duration_effect = Permanent
reversibility = Sometimes
user_reminders = None
clinic_interval = None
STD_protection_YesNo = No
periods =
benefits =
weight_gain_loss =
risks =
medical_notes =

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. [ [http://tubal.org/symptoms_of_pts.htm Post Tubal Ligation Syndrome] ]

Procedure

A tubal ligation 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 witha 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 as the fallopian tubes can, in some cases, reform or reconnect which can cause unwanted pregnancy. If this pregnancy does occur it carries a 33% chance of being an ectopic pregnancy or a tubal pregnancy.

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.Fact|date=July 2008

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, [cite paper |title=Family Planning Worldwide: 2008 Data Sheet |publisher=Population Reference Bureau |date=2008 |url=http://www.prb.org/pdf08/fpds08.pdf |format=PDF |accessdate=2008-06-27 Data from surveys 1997-2007.] making it the most common contraceptive method.cite journal |author=World Health Organization |year=2002 |title=The intrauterine device (IUD)-worth singing about |url=http://www.who.int/reproductive-health/hrp/progress/60/news60.html |journal=Progress in Reproductive Health Research |issue=60 |pages=1–8]

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. [cite journal |author=Campbell M, Sahin-Hodoglugil NN, Potts M |title=Barriers to fertility regulation: a review of the literature |journal=Studies in family planning |volume=37 |issue=2 |pages=87–98 |year=2006 |pmid=16832983| doi = 10.1111/j.1728-4465.2006.00088.x] Faith-based medical institutions in developed countries will sometimes refuse to perform tubal ligations [cite news |title=Woman given settlement after being denied tubal ligation |work=CBC news website |publisher=CBC news | date =September 13, 2007 | url =http://www.cbc.ca/canada/saskatchewan/story/2007/09/13/tubal-ligation.html |accessdate=2007-10-18 ] , and where long waiting times persist, there is a worrying risk of pregnancy or complications due to alternative contraception. [cite journal |author=Penava D, Daskalopoulos R, Nisker J, Hammond JA |title=Lack of timely access to tubal ligation increases risks of unintended pregnancy |journal=Women's health issues : official publication of the Jacobs Institute of Women's Health |volume=16 |issue=1 |pages=1–3 |year=2006 |pmid=16487918 |doi=10.1016/j.whi.2005.08.002] Because of the permanent nature of the operation, women under 40 without children are often denied access to tubal ligation, even if they express a determined desire not to have children. [cite news |last=Z. |first=Bonnie |title=Tubal ligation procedures denied to young women who don’t want children |work=American Sexuality magazine |publisher=nsrc.sfsu.edu | date =July 19, 2007 | url =http://nsrc.sfsu.edu/MagArticle.cfm?&Article=759 |accessdate=2007-10-18]

References

External links

* [http://www.surgery-sugery.com/tubal-ligation.php Video taking you through the one hour outpatient procedure]
* [http://nursinggazette.blogspot.com/2007/11/laparoscopic-tubal-ligation.html See Actual Laparoscopic Tubal Ligation]