Session I: Characteristics of

Tubal Ligation (Female

Sterilization)

Session I, Slide #1
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What Is Female Sterilization?

• Female sterilization is a family planning method that

provides permanent contraception to women and
couples who want to limit births or do not want any more
children.
• The two surgical approaches most often used are
minilaparotomy and laparoscopy.
• Female sterilization is also referred to as “tubal
occlusion,” “tubal sterilization,” “tubal ligation,”
“surgical contraception,” “voluntary surgical
contraception,” “tubectomy,” “bi-tubal occlusion,”
“minilap,” or simply “the operation.”

Session I, Slide #2
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 Key Points for Providers and Clients

• Female sterilization is a surgical

procedure.
• The womb is NOT removed. The
woman will still have menstrual
periods.
• It is permanent—for women who
will not want more children.
• It is very effective.
• It is very safe.
• There are no long-term side effects.
• It does not protect against STIs,
including HIV.
Source: Adapted from: WHO & Johns Hopkins Bloomberg
School of Public Health. Center for Communication Programs.
Information and Knowledge for Optimal Health (INFO). 2005.
Decision-making tool for family planning clients and providers.
Baltimore, Maryland: INFO; and Geneva: WHO. Session I, Slide #3
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Effectiveness of Female Sterilization

• In this diagram on the progression of effectiveness of FP

methods, where would you place female sterilization?
Implant Female
sterilization
Male sterilization
More
effective Intrauterine device

Progestin-only injectables

Combined oral contraceptives

Male condoms

Standard days method

Female condom

Less Spermicides
effective
Withdrawal

Session I, Slide #4
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Relative Effectiveness of Family Planning
Methods

No. of unintended pregnancies among

Method 1,000 women in 1st year of typical use
No method use 850
Withdrawal 220
Female condom 210
Male condom 180
Pill 90
Injectable 60
IUD 8/2 (Cu-T/LNG-IUS)

Female sterilization 5
Vasectomy 1.5
Implant 0.5
Source: Trussell, J. 2011. Contraceptive failure in the United States. Contraception 83:397–404.

Session I, Slide #5
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Explaining How the Method Works

• A segment of the
fallopian tube is removed,
and then the tube is tied
or blocked.
• Sperm are blocked from
fertilizing the ovum
ovary
Fallopian tube
Fallopian tube

Uterus

Source: Adapted from: Roy Jacobstein and John Pile, Global

Technical Brief -Female Sterilization: The Most Popular
Method of Modern Contraception, Engenderhealth and JHUCCP
2004 Session I, Slide #6
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Female Sterilization: Health Benefits

• Protects against risks of pregnancy and childbirth

• Lower risks of ectopic pregnancy
• May lower risks of developing ovarian cancers

Session I, Slide #7
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 Modified Pomeroy Technique for Tubal
Occlusion
• The modified Pomeroy is the preferred method.
• After transfixing a suture in an avascular area of the
mesosalpinx, one side (proximal) of the tube is tied, then the
other (distal) side of the looped tube is secured with a square
knot, and the tube is excised.

a) A section of tube has been b) One side of the tube is ligated or c) Both ends of the tube are tied and
identified and a suture transfixed. tied a section of the loop above the
ligature has been excised.

Source : EngenderHealth, 2003, Minilaparotomy for female Session I, Slide #8

8
sterilization : an illustrated guide for service providers.
Closure of the Surgical Wound, Recovery, and
Discharge

• After occlusion of both tubes, the surgical wound

is closed.
• The client is transferred to a separate recovery
area/ward/room to recover from the effects of
pain management drugs and for observation.
• The client is discharged in stable condition, with
postprocedure instructions.

Session I, Slide #9
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Client Safety

• Female sterilization is a safe method of

contraception.
• The incidence of complications is low, estimated
at between 9 and 16 per 1,000 procedures.
• The risk of death is also very low, estimated at
1–4 deaths per 100,000 procedures in the United
States (most associated with general anesthesia)
and at 5 per 100,000 procedures globally.

Session I, Slide #10

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Side Effects and Complications

• Complications of female sterilization are rare.

• Immediate side effects of minilaparotomy are transient and
include nausea, vomiting, and minor abdominal discomfort.
• Complications may be:
– Surgical
o Injuries to other viscera
o Bleeding or hemorrhage/ hematoma formation
o Infection
o Small risk of failure leading to pregnancy(ectopic or
intrauterine)
- Anesthesia-related
o Respiratory depression
o Drug overdose

Session I, Slide #11

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