Contraception and Safer Sex

Birth Control Pills
Depo Provera
Emergency Contraception Pill
Female Condom (Reality Condom)
Fertility Awareness Methods
Hormonal Contraceptive Patch (Evra Patch)
Hormonal Contraceptive Ring (Nuva Ring)
Intrauterine Device (IUD)
Intrauterine System (IUS)
Male Condom
Tubal Ligation

Tubal Ligation

What is tubal ligation?
Tubal ligation is a permanent method of contraception for women achieved through surgery.  During a tubal ligation procedure, fallopian tubes are cut, burned, or blocked with rings, bands or clips. 

Tubal Ligation may be done with a method called laparoscopy or another one called minilaparotomy.  It can also be done at the time of a caesarean section or after the delivery of a baby.  Both methods have similar success rates and risks and both can be done as outpatient procedures (i.e. the patient can go home the same day). 

How does tubal ligation work?
Tubal ligation works by closing the fallopian tubes which: 
Stops the egg from traveling to the uterus from the ovary
Prevents sperm from reaching the fallopian tube to fertilize an egg

How effective is tubal ligation?
Tubal ligation is approximately 99% effective in preventing pregnancy. While it is intended to be a permanent birth control method, it is possible to become pregnant following tubal ligation. The failure rate is low at 2-10 per 1,000 women.  There is no 100% guarantee for any form of tubal ligation. 

* Tubal ligation does not protect against sexually transmitted infections*

How is a tubal ligation performed?
The patient is usually put to sleep with a general anaesthetic but local freezing is sometimes used. During a laparoscopy, the doctor uses a lighted telescope (called a laparoscope) to look at the uterus, fallopian tubes and ovaries. The laparoscope is placed through an incision made under the belly button. A second instrument is placed through a cut above the pubic bone. The tubes are blocked by clips or rings or burned with an electrical current. It is sometimes necessary to make a larger incision in the lower abdomen to block the tubes with clips, burning or cutting and tying. The procedure takes about 30 minutes. The surgery has few side effects and the patient can usually go home the day of the surgery. The patient cannot drive a car and will need to go home with someone. Recovery usually takes two to five days but can take longer.

After the surgery, speed of recovery depends on the patient’s pain tolerance, the type of anaesthesia used and the patient’s overall healing ability. The patient may have slight abdominal pain and/or fatigue. Less often, the patient may feel dizzy or nauseous or have shoulder pain, abdominal cramps or a gassy or bloated feeling. If the patient has a general anaesthetic, she may have a sore throat. The patient should not drive a car for 24 hours after the general anaesthetic. There are no other restrictions.

Most or all of these symptoms usually go away within two to five days and most women can return to their usual routines a couple of days after surgery. After that time, a woman may feel tired later in the day, have slight soreness over the incision, and have minor changes in bowel movements. This discomfort can usually be relieved with mild pain medication.

The procedure does not affect the menstrual cycle or the ability to enjoy sex.  The woman will still have periods after surgery. Tubal ligation will not cause hormonal changes.

How do I use tubal ligation as a method of contraception?
Tubal ligation is a permanent way to prevent pregnancy. It does not require any maintenance or monitoring.  After the procedure is completed, tubal ligation is effective immediately.

What are the advantages of tubal ligation?
No monitoring required
Effective immediately
Allows sexual spontaneity 
Covered by some provincial health insurance plans (e.g. Ontario Health Insurance Plan)

What are the disadvantages of tubal ligation?
Does not protect against sexually transmitted infections (STIs)
Requires surgery and recovery days
Reversal is expensive and sometimes impossible
Regret is possible if a woman decides later on that she wants to have more kids

How can I get a tubal ligation?
Tubal ligation requires surgery in a hospital. Your family doctor will refer you to a gynaecologist. There is usually a six-week to three-month waiting list for hospital space and the cost of hospitalization is covered by the Ontario Health Insurance Program (OHIP). Tubal ligation does not require your partner’s consent. 

Please note that some people may find it difficult to find a doctor who will perform a tubal ligation, depending on some factors. Many people who are younger or without children may find it difficult to access this service.

A tubal ligation may also be performed shortly after delivery or along with a therapeutic abortion. This is an option to be discussed with your doctor.

How much does tubal ligation cost?
Tubal ligation costs vary by province. For example, this procedure is free in Ontario if you are covered under OHIP (reversal is NOT covered by OHIP).