It was 2019. I was 26-years-old and wrapping up a late night retail shift when a friend, also clearing the check-out desk, picked up a sad-looking pair of baby booties that lay abandoned nearby. Smiling, she wiggled them in my face. I sipped my water, confused. “Maybe you’ll need these someday,” she teased. I silently choked.
“I definitely won’t,” I laughed. Compose yourself, Sara. “I mean, I won’t be having children. It’s not my thing. But they're very cute,” I replied, trying to conceal my potential social faux pas. She nodded solemnly. “Maybe you’ll change your mind when you’re older,” she shrugged, and tucked the booties away. If only she knew how I really felt.
By 2021, my desire to not have children had morphed into an intense fear, so much so that I began to avoid intimacy with my long-time partner. I fretted constantly about accidental pregnancy, and while my partner and I had agreed on not wanting children, we were on different pages when it came to what we'd do if I ever actually did fall pregnant. I knew if I terminated the pregnancy, I’d lose him. If I didn’t terminate the pregnancy though, I’d lose myself.
My fear, admittedly, was almost irrational. I was on Nexplanon (a form of birth control proven to prevent pregnancy by over 99%) and having been diagnosed with endometriosis, I also knew I’d likely encounter fertility issues, should I choose to use my organs for their biological ‘purpose’. But despite these barriers in place, nothing felt like enough. Until a Google search presented a new possible solution: the complete removal of my fallopian tubes.
What is a Bilateral Salpingectomy?
The procedure, known as a bilateral salpingectomy, sounded as though it symbolised an end to my constant stress around accidental pregnancy. A sudden sense of relief, excitement and empowerment flowed upon discovering this alternative to traditional birth control.
Female sterilisation can be primarily broken into two categories: tubal ligation and salpingectomy – and it's more common than you may think. In 2019, over 7,600 female sterilisations were performed in the UK alone. While a tubal ligation (also called “tying the tubes”) is the most common method, a bilateral salpingectomy (or a “bisalp” as many online communities call it) offers more security.
“Tubal ligation might fail to stop every pregnancy and there's a small risk of ectopic pregnancy if not done appropriately,” says Ashfaq Khan, OB-GYN of Harley Street Gynaecology. Not only that, but salpingectomies can also be used to treat a host of other conditions as well, like ovarian cancer and even endometriosis, should the endometrial tissue exist solely within the fallopian tubes.
Two methods exist when it comes to performing a bilateral salpingectomy: abdominal and laparoscopic. “The laparoscopic approach is less invasive, has a shorter recovery time, and a lower risk of complications. Because of this, it's often the method your health care provider will opt for first,” says Iryna Ilyich, OB-GYN and medical advisor at Flo Health. “In this method, the doctor uses a thin tool with a light and camera at the end, called a laparoscope. Using small incisions in the abdomen, the surgeon inserts the laparoscope and other surgical tools to remove the fallopian tubes. After the procedure, they'll close the incisions with stitches or medical glue.”
As far as costs are concerned, sterilisation procedures are available for free under the NHS. However, should your doctor refuse surgery (more on that later...), you'll need to either seek another doctor, or go private, which can cost as much as £6,000.
Given that it’s a very big and permanent decision, doctors often encourage patients to wait until their late twenties or thirties before getting sterilised. However, there’s technically no minimum age requirement in the UK. Per the NHS, your gynaecologist may also suggest counselling before signing off on the procedure, but it’s not legally necessary.
In my case, my doctor was swift in agreement. We spoke about the technicalities and the possibility of regret. He was no stranger to the complex fears I faced, and agreed that removing my fallopian tubes could significantly improve my mental health. I’ll admit that I was, and continue to be, fortunate for his ongoing support and alliance.
When Doctors Say No
Unfortunately, it’s not always easy to get sterilised, and it’s common for people to face adversity when bringing up the topic with both loved ones and doctors. Outdated studies, deeply ingrained stereotypes and personal beliefs are often why patients are denied surgery. Even worse: some people report being wrongly misinformed by their doctor that they don’t meet the age requirement (despite there not being a minimum age for medical sterilisation in the UK).
Thankfully, support groups with valuable resources are available; Reddit forums like r/childfree exist as a way for people to connect, share their experiences and ask questions. The forum also includes an extensive list of doctors, both in the UK and abroad, who are known in their field to help people gain access to sterilisation procedures.
Like with any surgery though, risk factors and side effects may occur. Temporary short-term ones may include pelvic pain, bloating, cramps, and feeling unwell from local and general anaesthesia. During surgery, there is also a risk of damage to surrounding tissue and organs, leading to long term repercussions, although this is rare.
The risk factors are more than just physical too – mental health implications should also be considered. Personally, I’ve never regretted my decision for a moment. But there are past studies that suggest some younger women may regret their decision later in life, given the permanent nature of sterilisation. The potential for regret might explain why UK sterilisations have seen a drop in recent years, along with the continued rise in reversible contraception. However, it’s also important to note that many of these figures [regarding regretting the procedure] date back as early as the 1980s and may not reflect the views of today's society.
Although the procedure isn’t reversible, alternative options do exist for anybody who does change their mind, such as IVF and adoption. With that said, most people who opt for sterilisation to prevent having children do not feel regret, nor become depressed later in life due to their decision. Although it’s been less than a year since I left the hospital, not a moment has passed where I’ve regretted my choice – and it's one that my partner has always fully shown support for too.
Once I had both my fiancé and my doctor on board, it was time to move forward with my decision and tell our families. Striking the balance between excitement and sensitivity wasn’t easy, but thankfully they were respectful and supportive of our decision (at least on the surface, I’ve since discovered my parents are secretly pained by my choice and I suspect my partner's may be too). But I've still never wavered in my decision.
When Cancer is a Concern
While many people opt for a bilateral salpingectomy solely to prevent childbirth, there are other reasons too. Mercedia, a 29-year-old Software Engineer from London, says while she's never had a desire to bear children, cancer prevention was an added bonus. “It was reason number two for me,” Mercedia explains. “Bad outcomes for reproductive organs run in my family, there's a history of both ovarian and endometrial cancers, so nipping that in the bud was a feel-good moment.”
When it comes to cancer, the parallels between Mercedia’s story and my own are striking. My own mum has faced — and beaten — an aggressive stage of ovarian cancer. My maternal grandmother, on the other hand, had a devastatingly terminal battle with breast cancer. “Women who have a strong family history of either ovarian or breast cancer may carry a mutation [known as BRCA] and are presumed to be at higher-than-average risk,” says Harley Street Gynaecology’s Ashfaq Khan.
There are 7,500 new cases of ovarian cancer diagnosed each year in the UK, with 3% of those cases having a family history. According to studies, a salpingectomy can prevent ovarian cancer in high-risk individuals at a rate of between 29.2% to 64%. Like Mercedia, I knew that removing my fallopian tubes would only increase my odds for survival later in life. “I can worry a bit less about my genetics causing me problems down the line,” she echoed.
Although many people who have a bilateral salpingectomy identify as women like Mercedia and myself, that’s not always the case. For those who identify as non-binary, a bisalp surgery can help a person to feel more comfortable with their body. For Rowan, a 21-year-old biochemistry student, a bilateral salpingectomy aided in alleviating their feelings of gender dysphoria.
“Being reminded of my biological sex as well as the traditional social role and the dysphoria associated with that brought me immense discomfort,” Rowan says. Thankfully, Rowan was able to locate a doctor who was accepting of not only their desire for a salpingectomy but also their gender identity too. “He was very accommodating and even asked for preferred pronouns before we spoke.” By choosing to remove their fallopian tubes, Rowan feels more at home in their own body. “It feels amazing to buckle down and finally get it done,” they said.
For me, permanently removing my fallopian tubes was a right of passage in a different sense. It was the ability to move freely into the next stage of my life, without the constraints of parenthood and genetics. Occasional bloating or weight gain is no longer a reason to spiral into a pregnancy scare, and physically removing what’s often considered a 'sacred' part of a woman’s body hasn't left me impaired, but rather empowered.
My relationship with my fiancé has new meaning, too – we've been granted a sense of peace that we couldn’t have found otherwise. Our careers have prospered, our finances feel more secure, and our plans for the future have flourished.
Sadly, society has not been as graceful to others looking to undergo the same procedure. Too often biological females are pressured to have children and discouraged from sterilisation due to its permanent nature. But when scrutinising someone about wanting a child-free life, there's one thing I'd urge you to remember: yes, sterilisation is indeed a permanent decision. But then again, so is having kids.
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