Female Sterilisation

What is female sterilisation?
Female sterilisation is the only permanent method of female contraception. Female sterilisation is either performed abdominally, through a mini laparatomy or by laparoscopic sterilisation, or through the vagina by culdoscopy. It can be performed as a day-care procedure under a general or local anaesthetic.

How does female sterilisation work?
Female sterilisation involves excising or blocking the Fallopian tubes which carry the ovum from the ovary to the uterus. This prevents the ovum from being fertilised by sperm in the Fallopian tube.

How effective is female sterilisation?
Female sterilisation is a highly effective form of contraception with an efficacy of 99.4 - 99.8% per 100-woman years. The effectiveness varies depending on which method of tubal ligation is used.

How is female sterilisation carried out?
Female sterilisation is done by a trained gynaecologist. There are two ways female sterilisation can be carried out.

  1. Tubal occlusion procedure:
    • Small cut near your belly button (laparoscopy) or just above your pubic hair line (a mini-laparatomy).
    • Mini-laparatomy is recommended for women who are obese, have had recent abdominal or pelvic surgeries, or have history of pelvic inflammatory disease or any other bacterial infections that affected the Fallopian tubes and the uterus.
    • The Fallopian tubes are located with a long, thin instrument that has a camera and a light. The tubes are then blocked by applying clips (plastic or titanium clamps) or ring (silicone ring) or by tying, cutting and removing a small piece of the tube.
    • Usually a same-day procedure.
  2. Removing the tubes (salpingectomy):
    • The tubes may be completely removed.


Is female sterilisation reversible?
Female sterilisation should be considered irreversible. Successful reversal will depend on the type of procedure used when the woman was initially sterilised and the number of years since the procedure was performed. The success in achieving pregnancy following reversal can be between 50% and 90%. However, following reversal a woman is at a higher risk of ectopic pregnancy, with 3-5% of pregnancies being ectopic.

Before the operation
Counselling prior to the procedure is very important as it is considered a permanent method. This will also reduce post-operative grief over the loss of fertility which some women experience. Often, a pregnancy scare precipitates a request for sterilisation. Hence, during counselling, a number of issues have to be considered with the couple, such as how would they feel if something happens to the present partner - whether they would want children with a new partner; and whether they are certain of not wanting any more children.

Anyone can be sterilised but there are several considerations before going into female sterilisation which include:

  • Relationship problems.
  • Indecision over the operation by either partner.
  • Psychiatric illness.
  • Ill health or disability which may increase the risk of the operation.
  • Request for sterilisation at young age, e.g. under 25.
  • Not having children yet.


After the operation

  • You have to recover from the anaesthetic and be able to eat and drink before leaving.
  • You should not drive yourself home, as anaesthetic may affect your driving abilities for 48 hours post operation.
  • The healthcare professionals will guide how you take care of your wound and when you can have a bath or a shower after the surgery.
  • A follow up appointment will be given in case stitches need to be removed.
  • Your sex life should not be affected and you may resume when you are ready to do so or as per medical practitioner guidance.


Any other consideration post-operation

  • You may feel a little bit of discomfort or some lower abdominal pain (period pains) after the operation.
  • Your medical practitioner will guide you when you can return to work. This is usually after 5 days.
  • You may have some vaginal bleeding. Sanitary towels are recommended to be used instead of tampons.
  • If you experience severe pain, high fever or excessive bleeding speak to your medical practitioner or call 112 (Emergency Department).


What are the advantages?

  • 99% effective at preventing pregnancy.
  • Immediate effect as a method of contraception (additional contraception should be used until your next menstrual period or 3 months, depending on the type of operation).
  • It is a permanent procedure.
  • Hormones will not be affected - you will continue to have periods.
  • Does not interfere with sex.


What are the disadvantages?

  • Involves a surgical procedure that requires anaesthetic.
  • Not easily reversed.


What are the risks?

  • Small risk of complications such as local infection, internal bleeding, or damage to other organs.
  • Increased risk of ectopic pregnancy, if you get pregnant after the operation.
  • Rarely, the operation can fail, and the Fallopian tubes re-join and make you fertile again.


Can I have female sterilisation after a miscarriage?
You can have the procedure immediately after a miscarriage.

Can I have the procedure after having a baby?
You can have the female sterilisation right after you have given birth. Postpartum sterilisation is done before the uterus returns to its normal location, usually a few hours or right after the baby is born. For someone who have had a caesarean delivery, sterilisation can be done from the same abdominal incision. As for vaginal delivery, a laparoscopic procedure can be done.

How often should I go for a check-up?
Your medical practitioner will tell you the date of your next appointment. However, do not wait for the next appointment if you:

  • Think you may be pregnant.
  • Could have an STI or HIV/AIDS.
  • Have severe pain in lower abdomen.
  • Excessive bleeding.


If I had female sterilisation, am I protected from Sexually Transmitted Infections?
No, only male and female condoms (when used correctly and consistently) protect you from STIs.