#sterilization consult

[tubal-facts]

Letters, binders and other extensive prep resources: "The Sterilization Binder" (via) - One user's brilliant resource on patient autonomy, informed consent, why you want sterilization specifically,...

How did you convince your doctor to sterilize you?

Letters, binders and other extensive prep resources... What questions will my doctor ask me?... How should I prepare?...

[tubal-facts]

1 in 4 patients who have a sterilization consultation ultimately undergo a sterilization procedure.

The CDC's National Survey of Family Growth found that about 1 in 4 patients who undergo a sterilization consultation ultimately undergo a sterilization procedure.

Consultation refers to an appointment with a doctor to discuss sterilization procedures. Scheduling and attending a consultation already reflects a degree of commitment to the decision to be sterilized.

In the 12 months prior to the study, among subjects of all ages with 0 births, 1.3% had undergone sterilization consultation and 0.3% had undergone a sterilization procedure (pg 126 (138 in the PDF)). This means that approximately 4 times as many subjects underwent sterilization consultation as underwent a sterilization procedure. The other three-quarters did not follow through with a sterilization procedure.

Source:

CDC (US) National Survey of Family Growth: Fertility, family planning, and reproductive health of U.S. women; data from the 2002 national survey of family growth - Pub. 2005 (n = 61,561)

How many of our readers follow through?

With respect to this website and other online discussions, it's more difficult to answer the question, but we can make an estimate.

Though we get a number of questions through our website and see many posts asking about surgery post-op experiences, side effects, recovery periods, etc., we know from messages we've gotten and from follow-up tracking that the vast majority of people who ask questions about sterilization don't ultimately follow through with a procedure. It may be surprising to readers, but based on our data, users who choose to postpone sterilization indefinitely are much more common than users who follow through. Also, our team receives far more questions about sterilization than stories of actual sterilization surgeries, by a ratio of about 25-to-1.

To begin with, we guess from the tone of the questions that most users who ask or post about sterilization are not (yet) actively seeking or pursuing sterilization. They are simply in the early stages of considering it and ask for (very) basic information in accordance with that.

Even among those who originally intended to follow through, there is a natural dropoff. Some can't find a doctor after all. Others may have unanticipated insurance or job changes (or even changes in marital status) that shift them out of health insurance coverage. Most importantly, some people may find they aren't as certain as they thought and back out later in the process. In our experience, these outcomes are (collectively) far more common than successful sterilizations.

But we aren't doctors!

We aren't holding sterilization consultations with patients as medical professionals do; we're having online conversations, which are both free and much less time- and effort-intensive. Many users are only looking for information about sterilization and are not actively pursuing it, so they would talk to us online, but not visit a doctor for a sterilization consultation, so they can't follow through with a procedure.

TL;DR: Users who ask questions online about sterilization should not be interpreted as actively pursuing sterilization.

[tubal-facts]

FAQ: "Why choose sterilization when LARCs are just as effective, less invasive, and carry lower risks?"

Bilateral salpingectomy is the most effective.

Bilateral salpingectomy - the standard of care for tubal sterilization since 2015 - is essentially 100% effective, so it's more effective than any long-acting reversible contraceptive methods. It's also more effective than vasectomy.

Some doctors try to tell you that "IUDs are just as (or more) effective as sterilization", but they're attempting to mislead you. It's especially untrue with bilateral salpingectomy being the standard of care, and it was questionable for years prior to 2015 as well.

Consider aggregate risk.

While the risks of sterilization surgery are minimal, LARCs are generally considered to carry even lower risks. But this fails to take aggregate risks into account. The risks of sterilization surgery are consolidated into a few hours, while the risks of temporary methods are stretched out over a reproductive lifetime. There are side effects associated with the less invasive methods that have not been found with sterilization. Additionally, hormonal birth control has been linked to high blood pressure, weight gain, blood clots, and even an increased risk of breast cancer. Other side effects such as migraines and mood changes are common with hormonal birth control. With IUDs, there is a risk of migration or perforation. The key thing is that all these risks are undertaken continuously for decades. Sterilization is a one-time procedure, so the risks are only undertaken once, not continuously over many decades.

Some doctors recommend trying an IUD before sterilization, which subjects you to the risks of both the IUD and the subsequent sterilization surgery. Such doctors are asking you to take the risks of LARC(s) and surgery, instead of only surgery. There is no medical reason to take on both the risk of LARC + the risk of surgery when the surgery alone would suffice. The surgery will be just as invasive after five years of LARC as it would be at the present time.

If you plan on being sterilized eventually, there is no need to take on the risks of both the LARC method and the sterilization surgery. The worst-case scenario is using hormonal birth control for decades and then undergoing sterilization anyway; then, you face both the aggregate risks of long-term HBC use, plus the risks of sterilization surgery.

Sterilization surgery carries identical risks for those who have and have not had children.

Most doctors who refuse sterilization to childfree patients on the basis of its risks are nevertheless willing to offer the same procedures, with the same risks, to patients who have already had children. Sterilization surgery carries identical risks for those who have and have not had children. The risks are actually lower if one has not had a prior surgery, such as a c-section. Thus, if your doctor is refusing you sterilization on the basis of its risks, but would be willing to sterilize a patient who is older or who has had children, then your doctor is not being forthright with you. We often see doctors use surgical risks as a decoy objection: they claim to object only to the risks, but their true objection is to permanently sterilizing childfree patients; they have no problem offering the same procedures, with the same risks, to patients who have had children.

If this is your doctor's mindset, you should seek out a new doctor. In most countries, and certainly in the US (where most of our readers are located), you do not need to have tried LARCs before you can be sterilized.

[tubal-facts]

Approaching a doctor about sterilization: how to prep for your appointment/consultation

Letters, binders and other extensive prep resources:

"The Sterilization Binder": One user's brilliant resource on patient autonomy, informed consent, why you want sterilization specifically, risks associated with pregnancy and birth, etc.

Hollowdoll's guide "How To Get Nulliparously Sterilized When The Entire World Wants You To Be An Incubator" (via reportthetrolls) explains how to persuade doctors and how to build a convincing track record of wanting to be sterilized.

Childfree Voices: "10 tips for getting fixed"

"The Female Sterilization Manifesto" - "packet of answers to common anti-sterilization statistics and questions"

What questions will my doctor ask me?

Your doctor might bring up statistics about regret and failure rates from the CREST studies that you should know how to counter.

"Why choose sterilization when LARCs are just as effective, less invasive, and carry lower risks?"