When choosing birth control, modern women have a variety of options, ranging from the pill to the patch to the IUD. But tubal ligation — also known as sterilization or having your tubes tied — is one of the few birth control procedures that’s permanent. Although the popularity of tubal ligation has declined in recent years, the CDC reports that approximately 15 percent of women still opt for this procedure.

To find out what you need to know if you’re considering tubal ligation, we called Dr. Kelly Culwell, an OB-GYN and former medical officer at the World Health Organization. Here’s what she told us.

What is tubal ligation?
Tubal ligation is a procedure in which doctors obstruct the fallopian tubes through a surgical procedure so that sperm can’t fertilize eggs. Women still get their periods after tubal ligation, but they can no longer get pregnant. “We actually physically cut the tubes, burn the tubes, or put clips on the tubes, so it’s immediately effective,” Culwell says. “But the only way that we can do that is to actually do a surgery through your abdomen.”

Why do some women opt for tubal ligation?
Since tubal ligation is one of the few forms of permanent birth control, it’s reserved for women who are certain they never (or no longer) want to get pregnant. Unlike the pill or an IUD, tubal ligation doesn’t involve any hormones. “Some women really want to avoid hormones, which is one of the reasons that they want a permanent sterilization — because they can stop taking pills,” Culwell says. According to the American Cancer Society, tubal ligation may also ” rel=”noopener” target=”_blank”>reduce the chance of ovarian cancer but advise this should be done for valid medical reasons not simply reducing cancer risk.

How common is tubal ligation?

The popularity of tubal ligation has declined in recent years, but Culwell says that many women still opt for it. “It’s definitely still common, but with the increase in the use of long-acting reversible contraception like IUDs, I would say less women are choosing permanent contraception. Those methods are just as effective as permanent contraception or sterilization, and they don’t require a surgical procedure.”

What are the risks?
Tubal ligation is a major surgical procedure, so it comes with the risks inherent in any major surgery, bowel damage, infection, prolonged pelvic pain and complications from anesthesia. In rare cases, the fallopian tubes can become unblocked after sterilization, and the patient could be at risk for what’s known as an ectopic pregnancy, which is very dangerous. It’s also very difficult to reverse a tubal ligation. “If there’s any chance that a woman might not want permanent contraception, an IUD is a much better choice, because it’s just as effective and even for women who are absolutely certain they do not want children, they can avoid a surgical procedure.”

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