The ligature of the tubes is a method of permanent contraception which concerns women who do not want or no longer have children. Is it irreversible? How is the operation going? Are there risks? A minimum age to be respected? Dr. Philippe Deruelle Dr. Gynecologist.
The ligature of the tubes is an irreversible sterilization method For women major. The woman who wishes to use this intervention will therefore no longer have children. This requires surgery. For which women is the ligature of the tubes indicated? How is it going? What are the risks ? THE contraindication ? Minimum age To do it? What Body consequences ? Rules? Sexuality? Lighting by Dr. Philippe Deruelle, gynecologist and secretary general of the National College of French Gynecologists and Obstetricians (CNGOF).
The ligature of fallopian tubes or sometimes called a tubal ligature is a surgery intended for women (major) who do not want to conceive of a baby. The purpose of this sterilization method? Mechanically prevent – by cutting or coagulating the trunk, applying a clip or a ring – the sperm of accessing the oocyte. The contraceptive effect is therefore immediate.
This method of permanent contraception is indicated if :
- You are sure not to have or no longer have any children: there is no condition of age, neither condition of the number of children, nor agreement of the spouse to give
- You wishes or can no longer use other contraceptions (smokers, venous traffic problems …)
► Gynecological consultation
During a gynecological consultation, the patient can apply for the ligature of the tubes. It is at this point that the gynecologist takes care to explain to his patient all the details of the intervention and the possible complications. He explains the alternatives to him in terms of contraception, provides clear and complete information on the consequences of this act and of course insists that it is‘A permanent sterilization method.
► The reflection period
In France, the law imposes a period of reflection of 4 months Between the patient’s demand and the operation. If at the end of this period, the patient is determined to use this method and that she is fully aware that she will no longer have children naturally after this act, she must confirm her consent in writing during a second consultation medical.
► Surgical intervention
“”The ligature of the tubes is done in the majority of cases by Celioscopic track“, Explains Dr. Deruelle. This consists in making a small incision on the navel, which makes it possible to introduce a mini camera and one or two trocarts (small cylindrical stems intended to make punctures and biopsies) at the level of the lower part of the belly (one at the level of the appendix and the other in symmetry). Then, it exists several methods To obstruct the tubes:
- either we apply a clip on the trunk
- Either we coagulate the trunk
- Either we cut the trompe and the ligature
“”This last method remains rare, but can be practiced in patients who know in advance that they will give birth by cesarean and who wish to take advantage of this intervention to use a ligature of the tubes“, He adds. Generally, the intervention takes place on an outpatient basis (in a health establishment) under general anesthesia and the act itself lasts about 15 minutes.
The ligature of the tubes is not not very painfuleven if there can be sensations of discomfort: the introduction of trocarts can tread and air in the diaphragm (used during the operation to inflate the belly) can be a little bad. Finally, the scar at the navel is painless and almost invisible (it measures 2 to 3 mm).
“”It is a method whose risk of complications is low, But this remains an abdomen surgery with general anesthesia“, prevents the gynecologist. The complications during the operation remain very rare, but at the time of the introduction of the trocarts, a blood vessel, a neighboring nerve or part of the intestine may be injured, or by being cut, the trunk can be bleeding. These are the risks of any surgical intervention. In addition, the alarm of the anesthesia can be difficult and small Pain in the abdomen – which fortunately disappear a few days later – can occur.
| Some women are able to regret their decision a few years later. Psychological support is then necessary. |
This is the most effective method of contraception although you should know that it can, even if it is very rare, fail. Indeed, there have already been cases of extrautterin pregnancy after a ligature of the tubes (in less than 1% of cases). But the ligature of the tubes is a contraception permanent and completely final. “”This is why ethically, this technique still poses problems all the more when you know the current number of couples who separate, divorce or remarry and whose life projects can quickly evolve. This is why gynecologists tend to be very cautious and insistent that the ligature of tubes is an irreversible practice“, wishes to recall Dr. Deruelle.”There is also a big difference between the Anglo-Saxon countries for which the practice of the ligature of the tubes is more common and the Latin countries like France where we are always a little more reluctant to sterilize in a young woman, who has never had children and who has no contraindications to use other means of contraception“.
“”Theoretically, the ligature of tubes has no contraindications. It is also important to remember that age cannot be a ban to perform voluntary female sterilization. It is simply enough that the patient is major and consenting. Since 2001, the law relating to the interruption of pregnancy and contraception is clear on this point“, Specifies the expert. And add”A woman who has never had children should, if she wishes, be able to benefit without problem“. On the other hand, the ligature of the tubes is contraindicated to women whose general anesthesia or laparoscopy are contraindicated. Finally, women with a gynecological or recent infection (less than 6 weeks) cannot use this method.
“There is no impact on the rules”
The ligature of the tubes does not influence the hormonal mechanism. “”There is no impact on menstruation, since the rules come from ovarian secretion and the uterus. However, the ligature of the tubes does not affect the ovaries or the uterus. The woman continues to ovulate“, Confirms the specialist. Likewise, this technique does not cause an early menopause. On the other hand, in the event of delays in repeated rules or vaginal bleeding, it is quickly better to consult a doctor. No impact either on libido Since it does not modify the hormonal system: neither the pleasure and nor the sexual desire of women are modified.
The ligature of the tubes is a Intervention fully covered by Social Security.
On the Health Forum: discussions about the ligature of the tubes
Retain
► The ligature of tubes is intended for adult women who do not want to conceive a baby
► The contraceptive effect is immediate and irreversible.
► The ligature of the tubes is done in the majority of cases by laparoscopic route.
► The ligature of the tubes does not stop the rules.
► The ligature of the tubes does not cause an early menopause
Thank you to Dr. Philippe Deruelle, gynecologist and secretary general of the National College of French Gynecologists and Obstetricians (CNGOF).
