Many women do not want to have children and still have a sexually active life.At first, each contraceptive has its cons: the hormonal pill is contraindicated for those with a history of vascular diseases and thrombophilia; the IUD is not so easy to get through the public network and the condom can burst.
For those who do not want to take risks, sterilization is the most effective method.
By eliminating the chances of pregnancy, the process is not usually so well regarded by society.
Women who wish to have tubal ligation tend to be victims of prejudice.
But why do we still have such a discriminatory view of this population that it does not want to have children?
In this post, you will know:
- What is tubal ligation;
- Its effectiveness;
- Why women who have undergone the procedure are viewed with prejudice.
What is tubal ligation?
Also called ligation, tubal ligation is a voluntary contraceptive method that completely removes the chances of pregnancy.
In a surgical procedure, the uterine tubes (or tubes, extensions that connect the uterus to the ovaries) are blocked, ligated or cut.
Thus, sperm (which reach the vaginal canal and uterus) cannot reach the eggs (which leave the ovaries).
Anyway, it is a simple surgery, performed by gynecologists in a hospital environment and lasts about 40 minutes.
Is it possible to perform sterilization by the Unified Health System?
Yes. This right is guaranteed by Law 9.263 / 96 , called the Family Planning Law.
What are the types of ligation?
Surgery can be done in two ways:
- Laparotomy: made with a large incision, similar to a cesarean section, it is the most common method in SUS;
- Laparoscopic: performed with the aid of a mini-camera inserted into the abdomen and three small incisions.
Who is able to go through the procedure?
According to the Family Planning Law, the following are suitable for sterilization:
- Women over 25;
- Women over 18 and with at least two children, as long as the second is not the one about to be born. This detail prevents the sterilization from being performed at the time of delivery. It can be done in the third delivery, but not in the second.
However, the main indication for surgery is for those who are at risk of health, both for her and for the baby, if she becomes pregnant .
If she is married, the consent must be mutual, that is, the husband must also allow the woman to do the tubal ligation, with notarized signature.
However, the married man who wants to have a vasectomy also needs his wife’s permission.
Just as in cases where the woman is single, widowed, separated or divorced, it is necessary to bring a witness who proves her desire to undergo surgery.
The decision can only be made after a good conversation with the doctor and a multidisciplinary team, to make sure that tubal ligation is the best option, since the reversal surgery is very complex.
Likewise, for a reversal to be made, there are some conditions:
- The end of the tubes must have been preserved when the tubal ligation was performed;
- The fallopian tube cannot be diseased or dilated.
This surgery is performed by laparoscopy – the creation of small incisions for the insertion of instruments, in addition to the aid of the microcamera.
In this case, confirmation of the return of fertility takes place within 30 days. However, the chances of women getting pregnant decrease by 20%.
That is why the law establishes that between the expression of interest in making a ligation by SUS and its realization, the time period must be at least 60 days.
The intention is that the couple understand about other contraceptive methods, the risks of surgery, in addition to the pros and cons of choosing this method.
How is the process for doing the surgery?
The woman who wants to have the surgery must seek the basic health unit (BHU) in her region and express her desire.
Thereafter, she (and, if any, her spouse) will be referred to some family planning meetings and will be aware of other contraceptive methods that, unlike sterilization, are fully reversible.
After that, it will go through a multidisciplinary team composed of psychologist, doctors and social worker.
They will again question the desire to undergo sterilization and inform them that the method is irreversible, as many women do not know.
After all, the reversal surgery will try to gather the tubes, but there will be no way to undo the process.
That is why the law established the so-called “reflection time” so that the woman thinks a lot before signing the necessary paperwork and begins the referral procedures.
If she wants to give up during this period, she has every right.
The time until surgery varies a lot, because it depends on several factors, such as availability of family planning groups, hospital beds and doctors.
Is tubal ligation really effective?
Yes. According to the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), the sterilization efficacy rate is 99% .
In addition, the percentage of spontaneous reversal of the procedure is very small – 0.5 to 1%.
In fact, the risk of pregnancy, through the French technique of Pomeroy, which ties and cuts the tubes, is the most used in Brazil.
In this case, the risk is one in 2 thousand, while that of the contraceptive pill is two or three for every hundred women.
Finally, depending on the condition of the tubes, reversal surgery may not be possible, which permanently precludes the chances of a pregnancy.
How is recovery from surgery?
Usually, the woman can go home on the same day, as soon as the anesthetic effects pass. However, it is necessary to have a companion.
In the first five days, the woman must rest and avoid tasks that involve taking weight, making a lot of effort and that require a lot of coordination, such as driving.
Have relations sex can be resumed when her feel comfortable.
Abdominal pain such as colic and mild vaginal bleeding are common for the first five days.
Why is it so difficult to get a tubal ligation?
Because, unlike all other methods, tubal ligation is irreversible.
In short: if you regret it, you will not be able to generate children, unless you have another surgery to rewire the tubes – and even then there is no 100% success rate.
However, even reversible methods, such as the IUD, are extremely difficult to obtain through the public network.
In addition, many women are discouraged by their doctors from placing the intrauterine device.
So, even if the woman wants to revert in the future, why is she so judged when making a choice about her own body?
In part, because of the machismo still present in society.
Did you notice that the Planning Law only allows a married woman to have a tubal ligation if her husband also consents?
In other words, she must ask a man for authorization about what she wants to do with her own body, even if she will pay for a reversal surgery if she changes her mind and wants to have a child.
However, another social aspect is the ingrained thought that women were born to be mothers, as something inherent to the individual.
Therefore, opting for tubal ligation would go against your maternal nature.
There is also the thought that women who do not wish to have children are empty, selfish and are preventing men from fulfilling the desire to be a father.
Another problem that may arise is post-ligation regret. Although it can happen, studies show that the number is very small .
Furthermore, one factor that can contribute to regret is the exchange of partners.
The woman has children with an individual and decides to have a tubal ligation.
As a result, when starting a relationship with a new partner, the partner may wish for the pregnancy of a child of the couple, which usually rocks the woman.
There are reports of women who heard that they are not fit for the procedure even if they meet all the requirements, or that the law had been extinguished.
In addition, some health professionals give patients incorrect information to discourage them.
Bad will of the partner
Vasectomy is a much simpler and even more effective surgery. It can be done in the outpatient clinic, without the need for hospitalization and requires only local anesthesia.
However, it suffers from the limitation of vacancies and, mainly, from the refusal and prejudice of the partners.
After all, unfortunately, for women, it is very difficult to have protection from men.
As you have seen, it is possible to perform a ligation by SUS.
In fact, the method is almost 100% effective. However, if the woman regrets, reversal surgery can be complex or even impossible, depending on the case. Therefore, it is worth thinking about it a lot.
If you don’t want to have children, read a lot about the other contraceptive methods and see if any of them can satisfy your needs.
Otherwise, contact the UBS closest to your home and pay attention to all information provided by health professionals.
Also observe what is determined by law, so that you do not receive mismatched and incorrect information.