Female sterilization: procedure, risks and costs

If a couple decides to use permanent birth control, both the man and the woman can undergo sterilization. In the case of a vasectomy , the vas deferens are severed in men, in the case of tubal sterilization, the severing of the fallopian tubes in women prevents their egg cell from being fertilized. About 30% of German women who have completed family planning opt for tubal sterilization. Would you like to find out more about other contraceptive methods? In our “Contraception” section, we have summarized the best-known methods for you:

How does female sterilization work?

Female sterilization is a major surgical procedure that is usually performed under general anesthesia. Today, the operation is usually performed on an outpatient basis, but it can also be performed on an inpatient basis if desired or in the event of any previous illnesses. The procedure is always preceded by a detailed examination by the treating gynecologist, during which the internal organs are examined with ultrasound. A complete blood count is also made.

During the actual operation, which takes an average of 45 minutes to 1 hour, the procedure can be performed either through a laparoscopy or an abdominal incision. However, the latter is rare and is more likely to be used in combination with a caesarean section or other operations in which the abdominal cavity has to be opened anyway.

In a laparoscopy, an optical device called a laparoscope is inserted into the abdomen through a small incision below the navel. With the help of this small video camera, the surgeon can observe exactly what he is doing during the operation. Before the woman is actually sterilized, the abdomen is inflated with CO2 gas to expand the abdominal wall and make it easier for the surgeon to see. The required surgical instruments reach the fallopian tubes through further incisions in the abdominal area. An instrument is often inserted into the vagina with which the uterus can be moved during the course of the operation.

The actual sterilization of the woman can be carried out in different ways. The fallopian tubes are closed either by welding them with heat or electricity. But they can also be severed with one cut. In rarer cases, a piece of the fallopian tube is cut out or it is completely removed. All methods result in the woman becoming infertile because the egg cell can no longer get into the uterus and sperm can no longer get into the fallopian tubes.

In many cases, before the operation is completed, a drain is placed in the abdominal cavity so that the resulting wound fluid can drain from there. The tube, like the threads of the suture, can be pulled out when the wound healing process is a little advanced. This is usually the case after a few days.

What are the risks of female sterilization?

Because female sterilization is a major surgical procedure compared to male vasectomy, it also carries significantly more potential complications.

• During the operation, for example, neighboring organs, tissues or nerves can be injured unintentionally, which can lead to bleeding, signs of paralysis or numbness. The function of the urinary bladder can also be temporarily impaired.
• Severe scarring of the treated tissue can result in lasting symptoms.
• In rare cases, serious complications such as intestinal obstruction or peritonitis can occur.
• Normally, the operation has no effect on the hormonal balance; the menstrual cycle remains the same, only the length and intensity may change. However, if the peritoneal tissue, which is the supply structure for the ovaries, uterus and fallopian tubes, is injured during the procedure, the insufficient blood supply can lead to premature menopause.

For these reasons, it is important to deal with the possible consequences together with your partner before the procedure. A detailed explanation with the doctor treating you is also absolutely necessary before sterilization. There is also the possibility of obtaining information about the consequences of the procedure from various counseling centers and of clarifying the long-term effects on family planning once again.

How reliable is female sterilization?

Female sterilization is considered a very effective method of permanently preventing pregnancy. The Pearl Index, which indicates the safety of a contraceptive method, is 0.2-0.3 for tube sterilization. This means that only about one in 500 women who have the operation is still fertile despite the procedure. For comparison: the Pearl Index of the pill is 0.1-0.9.

In rare cases, the fallopian tubes become passable again as a result of renewed growth or opening of the blocked area. However, subsequent fertilization results in an ectopic or ectopic pregnancy in about 30% of cases, which cannot be carried to term.

Can a woman have sterilization reversed?

Unlike male sterilization, tubal sterilization is actually irreversible, meaning it cannot be reversed. However, the latest medical methods offer the chance of possibly restoring fertility. However, this process can only be performed via an abdominal incision and involves lengthy microsurgical procedures that not every surgeon can perform. The chances of success of such an intervention also depend heavily on the sterilization method used.

After sterilization, many women suffer from the finality of the procedure. It is not uncommon for tube sterilization to result in psychological problems. This is another reason why a detailed consultation and an intensive discussion of the consequences before sterilization are so important. Many doctors also do not recommend sterilization before the age of 35.

How much does female sterilization cost?

The costs can vary from doctor to doctor, but usually amount to around 700 euros. Since 2004, the treatment costs for sterilization are no longer covered by health insurance companies. Both private and statutory health insurance companies will only cover the costs of the procedure if it is absolutely medically necessary, for example if pregnancy or childbirth poses a significant health risk or if a serious impairment of the child is to be expected. If tube sterilization is only used for family planning, those interested must bear the costs themselves. However, the statutory health insurance companies usually cover the costs for the preliminary and follow-up examination as well as for any medication or sick leave that may be required.