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Sterilization, Here's What You Need to Know

Sterilization is a method of permanent contraception, which aims to prevent someone from having children. This procedure can be done on men or women. In men, sterilization is done by vasectomy. Whereas in women, sterilization can be done by tubal ligation or tubal occlusion. Vasectomy is a sterilization procedure by cutting the ducts that carry sperm to the penis. This action makes sperm not mixed with semen, so that semen cannot fertilize an egg. Whereas in women, sterilization is done by preventing sperm from meeting and fertilizing the egg. The process can be done by tubal ligation (binding or blocking the fallopian tubes) or by tubal occlusion (placing implants in the fallopian tubes). Sterilization does not affect hormone levels, sex drive, and a person's ability to have sex. Before discussing further, please note, this article will only discuss the types of sterilization in women, namely tubal ligation and tubal occlusion.

Sterilization Indications

Sterilization is carried out on women who decide not to want or stop having children. Before deciding to run a sterilization, consulting with a doctor is very important to do, considering the effects of sterilization are permanent. Generally, doctors only carry out sterilization when women are 30 years old and already have children. In patients outside of these two conditions, the doctor will suggest other types of contraception. This is done so that patients do not regret later on.

Sterilization Warning

Sterilization, either by tubal ligation or tubal occlusion, cannot prevent sexually transmitted diseases, such as chlamydia or HIV / AIDS. Although considered permanent, returns from tubal ligation can still be done. However, the success rate is very small. Women who have allergic reactions to anesthetics are not advised to undergo tubal ligation. Especially for tubal occlusion, it is recommended not to be done on women with the following conditions:
  • Feel free to want to get pregnant or not later on.
  • Allergy to metals and contrasting liquids.
  • Suffered from autoimmune disease. This condition can trigger inflammation in the area around the implant.
  • Giving birth or having a miscarriage in the last 6 weeks.
  • Suffering from pelvic inflammation.
  • The patient has undergone a tubal ligation procedure.
  • Only has one fallopian tube.
  • Fallopian tubes are blocked or closed, either one or both.
  • Recover surgery cannot be performed on patients undergoing tubal occlusion.
  • Patients who have undergone tubal occlusion cannot undergo pelvic surgery, such as electrosurgery, and endometrial ablation.
  • Abnormalities in the fallopian tubes.

Preparation of the Sterilization Procedure

For patients who want to undergo a sterilization procedure, consult with your doctor whether sterilization is the right choice to live, given the effect can be permanent. At the consultation session, the doctor will ask the patient's reasons, to ensure that there are no regrets in the future. The doctor will also explain a number of things, including the benefits and risks of sterilization, the stages of the sterilization procedure, the possibility of failure, how to prevent sexually transmitted infections, and the right time to undergo surgery. Talk with your partner about plans to undergo sterilization, because many other contraceptive options are available. Also consider complications that may arise after sterilization. A pregnancy test will be performed before undergoing sterilization, to ensure the patient is not pregnant. This is important to do, because obstruction of the fallopian tubes is at high risk of causing ectopic pregnancy, and can cause death if bleeding occurs. Patients will be asked to use contraception, until the day the sterilization is performed. Specifically for tubal ligation, patients will be told to do the following in preparation:
  • Stop eating, drinking and smoking the night before surgery.
  • Do not wear high heels on the day of surgery. Anesthetic effects can cause dizziness when walking.
  • Remove the jewelry worn before the operation.
  • Wear loose clothing to avoid post-operative discomfort.
  • Don't forget to bring pads. Vaginal bleeding may occur postoperatively.
  • Remove nail color before surgery.
Please note, tubal ligation can be done shortly after giving birth, or in conjunction with a caesarean section. In patients who do not undergo tubal ligation in these two conditions, contraceptive use should be done a month before undergoing tubal ligation, and continued until the tubal ligation procedure is completed.

Sterilization Procedure

Sterilization in women, both tubal ligation and tubal occlusion, aims to prevent sperm from fertilizing an egg. The following will describe the stages of each sterilization procedure.

  • Tubal ligation procedure

  • The patient will be anesthetized with general anesthesia to fall asleep, so that the patient does not feel anything during the operation.
  • The obstetrician will make a small incision around the navel, then the patient's stomach will be filled with carbon dioxide gas to make it bulge.
  • After the patient's stomach bulges, the doctor will insert a small device equipped with a camera and lamp (laparoscope) to reach the patient's reproductive organs.
  • The doctor will make another incision, to insert a special instrument such as a clip, which is used to close the fallopian tube.
  • Closing the fallopian tubes can be done by removing the fallopian tubes, cutting, folding, or clamping the fallopian tubes using a special ring or clamp.
  • Tubal ligation can also be performed shortly after a cesarean section. In this situation the incision will be in accordance with cesarean section.

  • Tubal occlusion procedure

  • The patient will be anesthetized prior to tubal occlusion. Anesthetized can be local or total anesthesia.
  • The doctor will insert a special device equipped with a small camera (hysteroscope) through the vagina to the cervix.
  • After the hysteroscope reaches the cervix, a small metal made from titanium (microinsert) is inserted into the fallopian tube. Microinsert will cause scarring and close the fallopian tubes, thus blocking the entry of sperm.
  • The whole procedure takes less than 30 minutes.

After the Sterilization Operation

After the sterilization is complete, the doctor will monitor the patient's condition every 15 minutes or one hour. If complications do not occur, the patient can go home a few hours later. The recovery process generally lasts between 2 to 5 days. The doctor will ask the patient for control, a week after surgery. In patients undergoing tubal ligation, contraceptive use is continued until the next menstrual cycle, whereas for patients undergoing tubal occlusion, contraceptive use is continued for up to 3 months after surgery. The doctor will give some advice to patients who have already undergone sterilization, which will help the recovery process, including:

  • After tubal ligation

  • Do not consume alcohol and drive a vehicle for up to 24 hours postoperatively.
  • Bandages may be removed the next day after surgery.
  • Bathing is allowed 2 days after surgery, but avoid scratching the incision area. Carefully dry the incision area after bathing.
  • Avoid lifting heavy objects and do not have sex until the doctor tells you when the right time to do it.
  • Continue normal activities gradually if conditions improve.
  • Contact your doctor if you feel that you have not fully recovered, or symptoms such as body temperature rise to 38 degrees Celsius or more, abdominal pain that continues to get worse after 12 hours, bleeding from the incision wound, or a bad odor from the incision wound.

  • After tubal occlusion

  • Contact your doctor if pelvic pain persists.
  • Use contraception in the doctor's recommended form, up to 3-6 months after surgery, or after the doctor makes sure the tube is closed.
  • Undergo X-rays, to make sure the implant stays in the right place, and the fallopian tubes are completely closed.
  • Tubal occlusion does not affect the menstrual cycle. See a doctor immediately if you don't have menstruation or there are signs of pregnancy.

Side Effects of Sterilization

The sterilization procedure, which is done imperfectly, can risk causing an ectopic pregnancy, which is a pregnancy outside the uterus, which can cause death. Sterilization can also cause some side effects, including allergic reactions due to drugs, and infections. Other side effects that may occur in each of the sterilization procedures are:

  • Side effects of tubal ligation

  • Damage to organs near the fallopian tube, such as the intestine or urethra.
  • Pelvic inflammation. This complication is very rare, and can be caused by clips used in surgery.
  • Heavy bleeding.

  • Tubal occlusion side effects

  • The formation of holes in the uterus and fallopian tubes.
  • Abdominal pain and cramps.
  • Nausea and vomiting.
  • The implant moves to another area in the stomach.

Success of sterilization

The success rate of sterilization is almost 100 percent. In one study, 2 to 10 women out of every 1000 women were found to be pregnant after undergoing tubal ligation. As for tubal occlusion, its effectiveness is not as great as tubal ligation. It is known, 96 women out of every 1000 women, become pregnant after undergoing this procedure. Cases of pregnancy after tubal occlusion, usually occurs because of the following things:
  • The implant was not installed properly.
  • Only one fallopian tube is closed.
  • Pregnancy occurs before tubal occlusion.
  • Supporting contraception is not used until 3-6 weeks after surgery, or until the doctor makes sure the fallopian tubes are closed.

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