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" Is sterilisation still popular?  In 2014, a leading family planning charity claimed that &amp;#039;sterilisation is now the most popular form of contraception in the world&amp;#039;. However, there are now signs that it is becoming a little less popular in Britain.  Recently, sterilisation rates in the UK have dropped markedly. There were only about 8,000 health service female sterilisations last year in England, as compared with 10,000 five years ago.  Partly this is due to the fact that sterilisation has become rather more difficult to obtain under the NHS. In addition, it seems that some women are turning to other ways of limiting their families, such as the Mirena &amp;#039;coil&amp;#039;, also known as the intra-uterine system (IUS).  Also, the sociological changes of recent years, with more and more people forming new relationships or deciding on a second or even third marriage, seem to have made some women feel that &amp;amp;#8211; instead of getting sterilised &amp;amp;#8211; they should keep alive their options of having another child.    What is female sterilisation? &amp;#039;Sterilisation&amp;#039; means preventing the woman from becoming pregnant by means of one of various different operations in which her Fallopian tubes are blocked or cut through &amp;amp;#8211; thus making it very difficult for her eggs to reach her womb.  Please note that after the &amp;#039;op&amp;#039;, it&amp;#039;s not totally impossible for those eggs to get through. There is in fact a small &amp;#039;failure rate&amp;#039; for this operation, generally estimated at between one in 200 and one in 500. (However, it varies with the method used.) You should ask your surgeon to tell you what he or she estimates the success rate of her method to be. Please be aware that if a pregnancy does occur after a sterilisation, there is a risk that it might be an ectopic one.  The old way of performing a sterilisation is to make a small cut (several inches long) in the lower part of the woman&amp;#039;s abdomen, and to work through it in order to get at the Fallopian tubes, which are then cut through, clipped, or blocked in some other way.  However, these days the most common procedure is a &amp;#039;keyhole&amp;#039; operation, also known as &amp;#039;laparoscopic sterilisation&amp;#039;.  What happens here is that the gynaecologist makes a small &amp;#039;nick&amp;#039; next to your navel. Through this opening, she pushes a slim, telescope-like device, which gives her a view of your Fallopian tubes. Then she makes another tiny cut, lower down your tummy. And through that, she inserts an instrument which she uses in order to put a clip on each tube.  The advantages of the keyhole operation are that the cuts in your tummy are very small, so that there should be less risk of pain, bleeding and infection.  The operation is also cheaper and faster, which makes it popular with Health Service administrators. The minor &amp;#039;downside&amp;#039; is that the surgeon may not have quite such a good view of your tubes.  The above operations are normally carried out under general anaesthetic, which means that you&amp;#039;d be unconscious for 20 to 30 minutes. I have seen keyhole sterilisation carried out under &amp;#039;local&amp;#039;. But the women definitely suffered quite a lot of discomfort.  hysterectomy   Hysteroscopic sterilisation (HS) In 2014, an increasing number of gynaecologists are offering a newer type of sterilisation operation, in which they do not make any cut at all in your abdomen.  Instead, they work through your vagina, inserting an instrument into your womb and using it to place a blocking device into each Fallopian tube. This is called a &amp;#039;hysteroscopic&amp;#039; sterilisation&amp;#039;, or &amp;#039;HS&amp;#039;.   Essure Nowadays, the blocking device is almost certain to be the Essure. This is a coil-like structure, about the length of a small matchstick. It contains metal, and also some polyethylene fibres, which are intended to cause a fibrous reaction in your tube, thus helping to block it.  Essure can be inserted without a general anaesthetic. The insertion generally causes only mild to moderate pain.  Essure takes some time to block the tube properly, so you need to use another form of contraception for at least three months. At the end of that time, it&amp;#039;s usual to have a special X-ray, called a &amp;#039;hysterosalpingogram&amp;#039; or &amp;#039;HSG&amp;#039;, to see if the tubes are fully blocked. Alternatively, you could have an ultrasound scan.  Essure is said to be 99.7 per cent effective. But as with any other operative procedure, there can be problems. For instance, the devices can be expelled, and they may occasionally perforate the wall of the Fallopian tube.  Indeed, since 2013 there has been some controversy about the use of Essure, particularly in the USA. The famous American campaigner Erin Brockovich has now established a website for women who claim that they have been harmed by the device, or who have become pregnant, with what are referred to as &amp;#039;e-babies&amp;#039;.  Essure is not regarded as a reversible method of contraception..    Other operations There are other operations that can cause sterility &amp;amp;#8211; for instance hysterectomy (which is removal of the womb), and oophorectomy ( which is removal of the ovaries).  But when a gynaecologist offers you a sterilisation &amp;#039;op&amp;#039;, she&amp;#039;s talking about an operation on your tubes &amp;amp;#8211; not your womb or ovaries.     Who can be sterilised?  Almost any woman can be sterilised &amp;amp;#8211; and even today many British couples choose this as their method of contraception &amp;amp;#8211; having the procedure done either on the NHS or privately. It&amp;#039;s estimated that about 12 per cent of all UK females who are of reproductive age have had the operation.  Although surgeons are generally much more willing to perform it for women who are over 30 and who have had children, some younger women who have never had a baby do opt for sterilisation.  However, if you are young and childless, you should think very carefully before agreeing to be sterilised. Do bear in mind that you might change your mind later on in life &amp;amp;#8211; and that reversal of the operation would be very difficult indeed.  Before having a sterilisation, you must be absolutely sure that you are not pregnant. The gynaecologist may ask you to do a pregnancy test.   Are there ever any medical reasons for not having the op?  Yes: surgery could be a bit difficult &amp;amp;#8211; but not impossible &amp;amp;#8211; if you&amp;#039;ve ever had one of these conditions:  ectopic pregnancy  prolapse fibroids  cysts on the ovary pelvic inflammatory disease (PID), including chlamydia infections and salpingitis.  And if you have had a Caesarean section, that might slightly increase the difficulty of the operation. If you are seriously overweight, it can be quite tricky for the surgeon to get at your tubes by the keyhole operation. Also, if your general health is poor, you might not be an ideal candidate for surgery.  You need to take the advice of the surgeon or anaesthetist on this and all matters connected with the operation.    How do you go about getting sterilised?  Personally, I think that in most cases you should begin by contacting your GP. Most good family doctors will want to discuss sterilisation with you in depth because it&amp;#039;s something that should be considered very carefully indeed.  The doctor should tell you about the operation, and about its associated risks.  Also, most importantly, she should make it clear that &amp;amp;#8211; as we have stated above &amp;amp;#8211; sterilisation is not 100 per cent effective against pregnancy. Also, she will advise you about the risk that a pregnancy might be ectopic (&amp;#039;out of place&amp;#039;).  Your GP will then refer you to a gynaecologist, either privately, or under the NHS.  Some clinics in the family planning field offer a sterilisation service. These include the British Pregnancy Advisory Service (Tel: 08457 30 40 30) and Marie Stopes clinics (Tel: 0845 300 0212). They do &amp;#039;contract sterilisations&amp;#039; for the NHS and also private ones.  You can if you wish go directly to a reputable sterilisation clinic, such as Marie Stopes or BPAS, without involving your own doctor and pay them privately. Currently (2014), Marie Stopes charges \u00A31,527, including the cost of the anaesthetic.  The clinic or surgeon will usually want to write to your doctor after the operation, to tell him it&amp;#039;s been done &amp;amp;#8211; but this isn&amp;#039;t compulsory and a few women don&amp;#039;t actually want to inform their GPs.    Do women regret being sterilised?  You have to accept that once you are sterilised, you will almost certainly not be able to have any more children, since reversal of the operation is very difficult. Nowadays, many women have more than one long-term relationship or marriage, and it has become quite common for a sterilised woman to have regrets because she wants a baby by the new man in her life. For the sake of completeness I should add that a woman who has been sterilised, but is then desperate to have a baby, does nowadays have the opportunity of &amp;#039;in vitro fertilisation&amp;#039; (IVF) treatment.  Indeed, one of the world&amp;amp;#8217;s first &amp;#039;test tube babies&amp;#039; was born to a mother who had had her tubes removed. However, IVF is extremely expensive &amp;amp;#8211; and only works in a minority of cases.    What happens after the operation?   You can usually go home the same day, though you shouldn&amp;#039;t attempt to drive yourself. Please bear in mind that you&amp;#039;ll undoubtedly have some pain and soreness in your tummy for a couple of weeks. You&amp;#039;ll probably have to take some aspirin, paracetamol or ibuprofen. If you get any severe pain, contact your GP. There shouldn&amp;#039;t be any vaginal bleeding. Your menstruation should not be affected by the operation though it is sometimes claimed that post-sterilisation periods are heavier in some women.  It&amp;#039;s recently been shown that this belief was due to a statistical mistake in a medical journal, many years ago. However, women who were on the Pill before being sterilised may be surprised by the heaviness of their menses. This is because they no longer have the benefit of the &amp;#039;period-shortening&amp;#039; effect of the Pill. Your hormone production and libido (sex drive) should remain the same &amp;amp;#8211; unless the operation has somehow affected you psychologically.  As a rule, you can resume sex within about a month of the operation, but it might be a little uncomfortable, so take it gently. If in doubt, ask your doctor or gynaecologist how soon you can start again.    Does sterilisation work immediately? Sterilisation of women should work immediately, but it&amp;#039;s vitally important that you&amp;#039;re not already pregnant when the op is done. After the operation, you should continue using your current method of contraception till the next period. This is because of the slight risk that an ovum (egg) might already have been in your womb or tube when the surgery was done.   What is the risk of pregnancy after sterilisation? Please note that as we have said above, every now and then a woman who has been sterilised does get pregnant.  The approximate risk is often quoted as 1 in 200 patients, but it might be higher with certain newer &amp;#039;quick sterilisation&amp;#039; methods.  If pregnancy does occur, let me repeat that it could be an ectopic one &amp;amp;#8211; that is, one which develops outside the womb, probably in the remains of the Fallopian tube.  So if you ever miss a period, you should get a pregnancy test done. Pain is often a warning sign of an ectopic pregnancy. If in doubt, ring your doctor.   Are there any other health risks from sterilisation? Any type of surgery can occasionally go wrong, and this is particularly true of keyhole surgery. Very occasionally, a gynaecologist may damage the bowel or womb, or the urinary apparatus. In general, the more experienced the surgeon, the less likely it is that any of these complications happens. Also, it is possible to get a deep vein thrombosis (DVT) after any surgical operation. Please follow the anti-thrombosis precautions recommended by the surgeon or her staff. General anaesthetics carry a small risk to health (greater than that of &amp;#039;locals&amp;#039;).  If in doubt, ask your gynaecologist or GP about the risks to your health. However, the vast majority of women come through the sterilisation operation with no significant problems at all.    Other people also read: Sterilisation of men (vasectomy): what is vasectomy? Sex and neurological disorders: what is a neurological disorder?  Sexually transmitted diseases (STDs): what sort of diseases are we talking about?  Female sexual arousal disorder: all in the mind?  Last updated 21.05.2014 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/procedures/surgical/a2218/sterilisation-for-women/>