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What is tubal ligation and what does it involve?

The whole idea for tubal ligation is to prevent the sperm from reaching the egg and fertilizing it. It is a surgical procedure that involves cutting, tying, clipping, cauterising or blocking the fallopian tubes in order to make a woman sterile. Although considered permanent, the process can be reversed.
 
Tubal ligation was once a major abdominal operation but it is now an outpatient procedure. Depending on which is best for you, the surgeon will give you a local, regional or general anesthetic. Your abdomen is then inflated with carbon dioxide gas, after which a small incision is made just below your navel, through which a laparoscope is inserted. This is a tiny tube with a light and a tiny magnifying glass attached, to allow the surgeon to find your tubes. Another incision will then be made, usually close to your pubic bone, through which to insert the instrument used to block the tubes. This is where you have a few options. You have a choice of having the tubes cauterised, cut and stitched closed, or pinched closed with either a rubber band or metal clip. Once this is done, the small incisions in your abdomen will be stitched closed. Tubal ligation only takes about 30 minutes to perform.
 
The procedure can also be done directly after giving birth - either vaginally or by C-section. The uterus is still high enough in the abdomen directly after delivery and the surgeon can see the tubes very easily without having to inflate the abdomen.
 
Regardless of when and how you have the operation done, you will be mobile within about eight hours. You will probably feel some pain for a few days afterwards, but should the pain or swelling become worse instead of better, then do see your doctor. It is also recommended that you give yourself at least a week to recover properly before resuming exercise or having intercourse.
 
Tubal ligation has no effect whatsoever on either your libido or hormone production. Although you will still ovulate every month, the egg will never reach your uterus, but will rather be re-absorbed by your body. You will also menstruate as usual.
With tubal ligation there is no guarantee that an egg will not slip through. There is a ratio of about one in 400 women getting pregnant in the first ten years after the operation. There is less chance of this happening if you have had your tubes cauterised or burned.
 
Should you become pregnant after tubal litigation, it is highly recommended that you visit your doctor immediately, as there is an increased risk of you having an ectopic pregnancy. This is where the egg plants itself outside the uterus, normally in one of the fallopian tubes.
 
It is possible for tubal ligation to be reversed, but women should not rely on this. This procedure is very expensive. Also, this operation is a lot more complicated than tubal litigation and the chances of you falling pregnant cannot be guaranteed. Of the many women who choose to reverse the procedure, only 20 to 40 percent of them fall pregnant and give birth successfully. Also, the risk of an ectopic pregnancy increases after the reversal procedure. It is not possible to reverse a tubular ligation done by cauterisation though, due to damage to the delicate tissue by the heat that is involved.
 
Once you are absolutely sure that you do not want to have any more children, and have tubular ligation directly after the birth of your last child, the benefits are great. No more worrying about taking your birth control pill and nothing to insert just before having intercourse. Another bonus is that tubal ligation will not interfere at all while you are breastfeeding your baby - unlike some contraceptives.
 
The other side of the coin though, as with any medical procedure, tubal ligation does have some risks attached, though few and far between, such as excess bleeding and infection. If you have had the procedure done directly after giving birth and experience any of these side effects, your recovery after the birth of your baby could last a lot longer. Tubal ligation could also increase the risk of you developing ovarian cysts.

More questions

There are some very good reasons that you would want to avoid sexual intercourse.
Your vagina will naturally shrink after delivery, as your body heals, but whether it returns to its original size, depends on a number of factors.
Your menstrual cycle usually starts towards the end of your breastfeeding phase, but how regular it is once it is back varies from woman to woman.
It is not uncommon for women to experience pain and discomfort during sex, for the first couple of months after having a baby.
The delaying effect that breastfeeding has on the return of normal menstruation has an effect on fertility and can be considered as a method of contraception – although it is not a very reliable one.
The Intrauterine System, or IUS, is an effective method of birth control that is safe to use while breastfeeding.
It is true that some women experience a drop in their sex drive while breastfeeding, however, this isn’t always the case.
The return to your normal cycle is not a hard and fast rule and it can take anything from a month to a year before your first post baby period happens.
It is entirely up to you and your husband as to when you want to start having sex after the birth of your baby. The best thing to do is to have patience and wait until your body is ready for sex after your baby is born.
As very often happens, if you are just too tired to have sex after a long day, then tell your husband. If he is understanding and clever, he will help you as much as he can. After all, you will both benefit from this.

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