If you have a partner and are considering sterilisation, this guide to tubal occlusion and our guide to vasectomy can help you think about which choice is right for you both.

Compared to tubal occlusion, vasectomy:

• is more effective at preventing pregnancy (see below)
• usually done with a quicker less invasive procedure
• has a lower chance of complications

But vasectomy may not be the most suitable choice in every case. It depends on your individual circumstances and preferences.

Once a tubal occlusion operation has been confirmed as successful, it’s more than 99% effective at preventing pregnancy.

Some tubal occlusion operations fail because the tubes that carry the eggs rejoin. This may occur soon after the procedure or some years later.

If the tubal occlusion fails, there’s a chance you could get pregnant:

• After a successful tubal occlusion procedure, there’s about a 1 in 200 chance of getting pregnant
• For comparison, after a partner has a successful vasectomy, there’s about a 1 in 2,000 chance of getting pregnant. So vasectomy is about 10 times more effective at preventing unplanned pregnancy than tubal occlusion

Before considering sterilisation, it’s worth thinking about whether a long-acting reversible contraception (LARC) method may suit you and a partner. LARC methods include:

• the implant
• a hormonal intrauterine device (also called a hormonal IUD or hormonal coil)
• a copper intrauterine device (also called a copper IUD or copper coil)

These methods are all more than 99% effective and can be more effective than female sterilisation at preventing pregnancy.

A copper coil fitted after the age of 40 and some types of hormonal coil fitted after the age of 45 can stay in place until after the menopause. For some people, this may be preferable to having a surgical procedure.

• It’s highly effective at preventing pregnancy

• After the sterilisation has worked, you don’t have to use contraception ever again

• You need a surgical procedure – also see below – Are there any serious risks or complications?

• If the sterilisation fails, you may get pregnant. A surprise pregnancy is uncommon after a successful tubal occlusion – also see above – How effective is tubal occlusion?

• Tubal occlusion doesn’t protect you from sexually transmitted infections, so you may want to use condoms as well

• Some people may regret being sterilised – also see below – Can anyone be sterilised?

• It’s not easy to reverse if you change your mind. Reversal procedures are not usually available on the NHS. This means you’d have to pay to see a private specialist. Reversal may be unsuccessful. Not everyone who has a reversal procedure will be able to get pregnant.

Sterilisation may not be the best choice for you if:

• there’s any chance you or a partner may want to get pregnant in the future
• you or a partner feel pressured to get sterilised
• you or a partner are pregnant or have a child under 1 year old
• you or a partner are under any stress, for example if you’re having family, relationship or health problems or have recently given birth or had a miscarriage or abortion

You’ll always be offered counselling before choosing sterilisation. Your healthcare professional will discuss the points above and talk to you about the chance of regretting the operation.

More people regret sterilisation if they were sterilised when they:

• were under 30 years old
• had no children
• weren’t in a relationship
• changed relationships
• had relationship problems

It’s important to consider the chance of regret before getting sterilised. Young or single people may be offered extra counselling. This is because sterilisation is meant to be permanent. It’s not always possible to reverse sterilisation if you regret it.

No, you don’t need a partner’s permission. It’s your decision whether or not to get sterilised.

If you have a partner, it’s usually best to talk about sterilisation with them and get information and counselling together, but you don’t have to.

If someone is pressuring you to get sterilised when you don’t want to, tell your healthcare professional.

Sterilisation by tubal occlusion is a permanent method of contraception.

If you change your mind, you may be able to have a procedure to try and reverse the sterilisation. Reversal procedures are very rarely available on the NHS, so you’ll need to pay to get one at a private clinic. This may be expensive.

Even after a reversal operation, there’s no guarantee that you’ll be able to get pregnant.

If there’s any chance you may want to be pregnant in the future, you may wish to consider long-acting reversible contraception instead of sterilisation. Also seee above – How effective is tubal occlusion?

Sterilisation will not affect your sex drive, your orgasms or your enjoyment of sex.

For some people, sex can be more enjoyable once they’re not worried about pregnancy.

Go to your GP surgery or a sexual health clinic. They’ll talk with you about what’s involved. If you decide to go ahead, they can refer you for the procedure.

Sterilisation is free on the NHS in most areas, but waiting lists can be long. It’s important to continue with a reliable method of contraception while you’re waiting for the procedure.

You can also pay to have a sterilisation done at a private clinic.

All treatment is confidential.

You can expect to get:

• information and counselling to help you make an informed decision
• a chance to discuss the procedure and any concerns you have
• a chance to ask any questions you have

You should be told about:

• highly effective long-acting reversible contraception (LARC)
• the chances of getting pregnant after a successful sterilisation
• possible risks and complications
• the risk of regret and the difficulty of reversing a sterilisation
• the need to use contraception until the sterilisation has been confirmed as effective

You’ll be asked about your medical history. Make sure you mention any conditions you have, any medicines you’re using, and any previous surgery.

You’ll get information about how to get ready for the sterilisation procedure and what to expect afterwards.

You’ll need to:

• Plan how to get home afterwards. You should not drive yourself home.
• Read and sign a consent form

You’ll need to use other contraception until you have the operation and for a short time afterwards.

Before the operation, you’ll have a general examination. This includes an internal examination, where your healthcare professional will gently feel your tummy and inside your vagina.

It’s done at a hospital. You’ll usually have a general anaesthetic so that you’re asleep during the operation.

There are different ways of reaching the fallopian tubes:

• Laparoscopy: This is the most common method. Your doctor makes a small cut just under your tummy button and another small cut below and to the side. The doctor inserts a laparoscope (a long thin tube with a light and camera on it), so they can see your fallopian tubes.

• Mini-laparotomy: Your doctor makes a small cut near your pubic hair line and inserts a laparoscope so they can see the tubes.

The doctor may:

• block the tubes – this is usually done by using clips
• tie the tubes, then cut and remove a small piece of each tube

Your doctor will discuss the different options with you.

The time you stay in hospital after the operation can vary, but most people will go home the same day.

If you had a laparoscopy, you’ll usually have 2 small scars where the doctor made cuts during your operation. They’ll be around 0.5 cm to 1 cm long.

If you had a mini-laparotomy, you’ll usually have 1 scar, usually less than 5 cm long.

You may feel unwell or uncomfortable and have some tummy pain for a few days. This is normal. You can take painkillers if you need to.

You may have to rest a lot in the first few days and take it easy for a week or so, avoiding strenuous activity. Gradually increase your daily activities and exercise as you start to feel better.

You may get slight bleeding from your vagina for the first few days.

Your doctor or nurse will give you information on wound care, stitches, activity following the procedure, pain relief, looking after yourself, and any situations where you should seek medical help.

They should confirm which method was used to block the tubes and tell you if there were any complications. If there were, you’ll usually be offered a follow-up appointment, and your GP will be told.

Get immediate medical advice if you have:

• severe tummy pain or pain that’s getting worse – especially if you feel generally unwell and/or have a fever, vomiting or loss of appetite. This could be due to internal bleeding or damage to your bowel or bladder. This is rare, but very serious and needs treatment straight away.

• pain in the chest – including any sharp pain which is worse when you breathe in, breathlessness, or coughing up blood, painful swelling in your leg(s) or it’s hard to put weight on your leg. These could be the signs of a blood clot.

You can have sex when you feel comfortable and ready. Use another method of contraception until the sterilisation is effective (see below).

You may be advised to use an additional method of contraception for 7 days after the sterilisation operation.

You do not need a follow-up test to check if the sterilisation has worked.

Tubal occlusion won’t help protect you from sexually transmitted infections, so you may want to use condoms as well.

You’ll still have periods. They’re unlikely to change unless you were using hormonal contraception before the sterilisation.

If you were using hormonal contraception, you may find that once you stop using it, periods become heavier or your bleeding pattern changes.

Sterilisation does not cause menopause. Your ovaries, uterus and cervix are left in place and your hormones aren’t affected.

You’ll still ovulate (release an egg each month), but the egg is broken down naturally by your body.

All surgical procedures have known risks and side effects. It’s important to have a discussion with your doctor about your personal risk before you get sterilised.

The chance of serious complications from tubal occlusion is low. Most people won’t have any complications.

Possible complications include:

• side effects from the general anaesthetic
• bleeding
• an infection
• blood clots
• damage to another part of your body, such as the bladder, bowel, or blood vessels.

If tubal occlusion fails and you get pregnant, there’s a small increased risk of ectopic pregnancy. An ectopic pregnancy develops outside your uterus (womb), usually in a fallopian tube.

An ectopic pregnancy can be very dangerous if it’s not discovered early. Get medical advice straight away if:

• you think you might be pregnant, even if a home test is negative and / or
• you have a light or delayed period, unusual vaginal bleeding, or a sudden or unusual pain low in your tummy, which may be on one side