For much of last year 2023, I'd been planning to pursue a hysterectomy this year as gender-affirming care. Specifically, I wanted a total hysterectomy with bilateral salpingectomy, i.e. removal of my uterus, cervix, and fallopian tubes.
How it's going
Over the last couple weeks as of the time of writing (1/13), I read many positive experiences from people who had bilateral salpingectomy and endometrial ablation within the last few years. They ranged 28-36 years old, so similar age range to me; I'm 33.
Great, I thought. Maybe I'll get an ablation instead of a hysterectomy ... but, well, to be honest, I'd still also want the salpingectomy.
Why it's not the usual situation
With respect to the salpingectomy, the complicating factor is that I've already been sterilized. If I'd been able to get a salpingectomy instead of a tubal ligation when I was sterilized in 2013, I thought maybe I'd be fine with getting an ablation instead of a hysterectomy. This is purely to do with efficacy--I've had no issues/complications related to my tubal ligation.
Then, I thought, if it's possible for me to still get a salpingectomy now, salpingectomy + ablation is still lower-risk than hysterectomy.
There's also the recovery. While I'd love to evict my uterus, hysterectomy recovery is too intense and prolonged. From experience, recovery from sterilization surgery is much easier.
The problem is insurance coverage; will my insurance cover a salpingectomy for a patient who has already been sterilized?
I guess we'll find out.
Why I didn't get a salpingectomy in 2013
For context, I had my tubal ligation in 2013. Even back in 2013, I knew that salpingectomy was the better sterilization procedure. I knew salpingectomy was virtually 100% effective as a method of birth control, with a failure rate of virtually zero. Also, I'd seen research indicating that most ovarian cancers originate in the fallopian tubes. Through the internet, I was aware of salpingectomies being done for sterilization at that time--mostly in British Columbia, Canada--though they weren't common yet. All of this led me to conclude, even in 2013, that my preferred method of sterilization was complete bilateral salpingectomy.
Unfortunately, salpingectomy wasn't the standard of care for sterilization at the time. My health insurance at the time didn't consider salpingectomy to be a sterilization procedure at all, so they wouldn't cover it at all--zero coverage. Even in hindsight, I can't fault my then-insurer for not covering a then-nonstandard procedure.
Topics intentionally omitted from this blog
Topics better discussed with your doctor: details about medical procedures, surgery, risks, recovery, etc.
Details of my own medical appointments unless strictly relevant to potential readers.
Details about costs: Insurance and healthcare costs vary greatly by state/region, insurer, number of dependents, amount of subsidy if applicable, and other details.
Details about personal factors/motivations: I touched on it briefly above, but I won't get into it more unless strictly relevant to potential readers.
