If you tell your GP you’re sexually active but don’t want children, you’ll more than likely be offered the pill, the coil or the implant as a form of contraception.
But women looking for a more permanent solution have been turning to female sterilisation instead.
According to government figures, more than 13,000 female sterilisations were performed in NHS hospitals between 2014 and 2015.
Yet female sterilisation (or even the idea that a woman might not want children) is still taboo, despite the fact that we openly talk about male vasectomies.
To break the silence and help you get clued up on something that is an option, here’s everything you need to know about the procedure, access and the long-term pros and cons.
What is female sterilisation?
Female sterilisation is a method of contraception designed to permanently prevent a woman from falling pregnant. It is usually extremely difficult to reverse, so is only suitable for women who’ve decided they never want to have children, rather than those looking for short term contraception.
The method works by preventing eggs from travelling down the fallopian tubes, therefore stopping them from meeting sperm during sex. Because of this, fertilisation cannot happen.
When eggs are released from the ovaries they are absorbed naturally into the woman’s body.
What does the sterilisation procedure involve?
Female sterilisation requires an operation that will either be conducted under general or local anaesthetic, depending on the individual’s needs.
According to the NHS, there are two sterilisation methods used in the UK: hysteroscopic sterilisation (also known as HS) and tubal occlusion. Use of the former method has recently been suspended.
A hysteroscopic sterilisation (HS) is when a device is implanted to block the fallopian tubes. In the UK, the brand name of the HS technique used is Essure.
The implant is non-surgical and is inserted via a narrow tube, which is passed through your vagina and cervix. Once in place, the implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.
However, the sale of Essure implants has been temporarily suspended in the EU and a recent report by the BBC’s Victoria Derbyshire show suggested a number of women have experienced “painful” side effects, with some forced to have a full hysterectomy to remove the device. Hospitals have reportedly also been asked not to use existing stocks while investigations are underway.
Tubal occlusion is still available. This method involves blocking the fallopian tubes - for example, with clips or rings - or by tying or cutting the tubes.
To carry out the procedure, a surgeon will need to access the fallopian tubes by inserting a laparoscope or mini laparoscope through a small incision by your belly button. A laparoscope is a flexible rod with a camera on the end, which allows a surgeon to see inside the body without making large incisions.
What are the benefits of female sterilisation?
According to Dr Clare Morrison, from online pharmacy MedExpress, “sterilisation can be 99% effective in terms of preventing pregnancy” and “you do not have to worry about pregnancy when you have sex”.
“Sterilisation will not affect your sex drive or hormone levels,” she told HuffPost UK.
Due to the latter, female sterilisation may suit women who’ve experienced adverse affects when using hormonal contraception, such as the pill.
What are the risks of female sterilisation?
While female sterilisation is thought to be 99% effective, blocked tubes can rejoin immediately or years after a woman has undergone the procedure.
“Sterilisation can sometimes fail, resulting in a pregnancy. In such a case, there is a small increase in risk of an ectopic pregnancy,” Dr Morrison explained.
“If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed.”
She pointed out that sterilisation does not protect you against STIs so women who have the procedure should still use condoms. Women also need to use contraception for one to three months after the operation in order to protect themselves from pregnancy.
Although some women have reported feeling in too much pain to move after the procedure, Dr Morrison said most women will simply experience “slight vaginal bleeding and/or cramps” after sterilisation.
“Your periods should continue being as regular as they were before sterilisation. Some women find their periods become heavier, but this is normally because they have stopped using hormonal contraception,” she said.
“You may feel unwell for a few days after the anaesthetic and need some time off work [and] sex can be uncomfortable for a few days afterwards.”
How easy is it to access female sterilisation?
The NHS recommends that any woman considering sterilisation has counselling to discuss whether the treatment is right for her and how she might feel afterwards.
The website explains that “your GP does have the right to refuse to carry out the procedure or refuse to refer you for the procedure if they do not believe that it is in your best interests”.
In other words, your doctor may have more of a say over what you do with your body than you do.
Journalist Holly Brockwell has spoken about the difficulties of accessing female sterilisation after she was forced to undergo “a long and frustrating battle with the NHS” before undergoing the procedure at the age of 30.
She claims that even on the day of her sterilisation, her surgeon tried to talk her out of the procedure.
“He was clearly, vocally against the procedure and spent what felt like forever trying to bully me into changing my mind,” she previously told HuffPost UK.
“He even brought in a doctor from the IVF department to guilt me about how difficult it is to have a baby by IVF.”
Model and blogger Faith Roswell also found the lack of access to female sterilisation frustrating. She finally underwent the procedure after a decade of fighting to be sterilised.
“I told my doctor: 'I’m 28. If I told you that I had been trying to get pregnant for 10 years, you would be helping me,” she said.
“I’m now telling you that I’ve been trying not to get pregnant since I was 18. I want you to help me.’
“If I’m trusted to make one decision about my contraceptive health, I should be trusted to make another one as well.”
For more information about female sterilisation and contraception, speak to your GP.