Let’s talk about long-term contraception
In several of my previous articles, I wrote about the various family planning methods that couples can use to plan their pregnancies. Family planning is important as it helps couples to plan the right time to have children, so that they can be emotionally and financially secure.
For some women who have decided that they no longer want to have children, they may opt for sterilisation. This is a permanent method of contraception, and women should consider the factors very carefully before deciding to undergo such a procedure.
Blocking the tubes
Sterilisation involves blocking the fallopian tubes with rings or clips, through surgical procedures called tubal occlusion or tubal ligation, so that the sperm is unable to reach the eggs that are released from the ovaries. The operation is usually performed under general anaesthetic using a technique called laparoscopy.
One to three small cuts are made around the belly button. A telescopic device called a laparoscope is inserted through one of the incisions and a small camera at the tip of the laparoscope transmits an image to a screen so the surgeon can see the internal organs. The surgeon works through these small holes and places clips on the fallopian tubes. After the procedure, you have to wait until your next period for the sterilisation to be effective. In the meantime, you should continue to use other forms of contraception. A sterilisation procedure is more than 99% effective. However, it is not completely fail-proof.
About one in 200 women will become pregnant after sterilisation, because the tubes can come back together again after being cut or blocked. If pregnancy does occur, be aware that it could develop outside the womb and become an ectopic pregnancy. Although this is a very rare occurrence, it is a risk and you should see your gynaecologist immediately if you miss a period after the procedure.
Surgical risks
There is a risk that the surgical instruments used during the procedure may cause injury to organs or structures near the tubes. Operations involving general anaesthesia do carry a small risk, along with the risks of undergoing any form of surgery.
Sterilisation procedures may be difficult if you have certain conditions such as prolapse, fibroids, cysts on the ovary, or pelvic inflammatory disease (PID), including chlamydia and salpingitis. Additionally, the surgery can be tricky if you are seriously overweight or are in poor health.
A long-term decision
The advantage of tubal ligation is that a woman and her partner will not have to think about using contraception again. This may actually make sex more enjoyable! However, do be aware that this is a permanent procedure that cannot be reversed. Think carefully about why you want this procedure and whether it’s the best option for you at this time in your life.
There are several considerations here. Firstly, are you and your partner sure that you do not want children? You should not only think about the present, but the future as well, because your needs and desires may change a few years down the road. If you have a partner or husband, this is a decision that the both of you must make together. However, don’t let anyone force you into your final decision. Secondly, ask yourself why you are choosing this option. Is it because of a current crisis or change in your life, such as a new baby, a miscarriage or relationship problems? If you do this as a means to solve your problems, you may regret it later. Finally, have you considered other methods of contraception which are not only reversible, but also more effective?
These include intrauterine systems such as Mirena, contraceptive implants, and injections. If you choose these, you can have them removed or stopped and you will be able to have a baby again. You and your partner may also want to consider male sterilisation (vasectomy) instead, as it is easier to do and more effective. Nonetheless, it is still a decision to be weighed carefully, as reversal of vasectomy is also difficult. When it comes to the issue of children, there is never an easy answer.
The decision to have a child is a life-changing one, and so is the decision not to have one. Science only has part of the answer, the rest lies within you.
By DR NOR ASHIKIN MOKHTAR
The Star Newspaper, 20 september, 2009
