Access to Female Sterlization (Tubal Occlusion)

First up – if you’re my mother and you’re reading this? You shouldn’t be. If you’re any other member of my family and you’re reading this? You can also go away. If you want me to block access to my blog where I talk about my sex life from your computer then we can arrange that – it’s why I installed TeamViewer on it.

Last summer I was sterilized via the method of surgical tubal occlusion. I was 29. It was a long process for me to get there, with many difficulties along the way. I’m writing this blog to help other young women get this treatment. All references within this post are to the NHS in the UK.

It used to be standard practice to refuse surgical sterlization to all women below the age of 30 unless there was a medical reason to carry it out. While that policy is no longer in existence, the right to decide on a case by case basis is now given to the consultant in charge of your surgery. They are free to make the decision whichever way they feel, hopefully with the patients best interest in mind. I think it’s important to understand and be aware of the fact that consultants are people too, with their own opinions, morals and cultural backgrounds. Therefore the treatment that they give can sometimes be affected by these things, because they are normal human beings. I just want to give advice on how I feel you can get yourself into the best position to get this surgery.

My experience.

  1. Referral from the GP #1. I had no problems with this one. It was a doctor who has known me since I was a child. He questioned me briefly on why I wanted it, told me he felt the pill was still best for me, but referred me anyway.
  2. Referral to consultant #1. First trip to the gynae unit I met with a junior doctor. I found him deeply patronising and after half an hour he declared that I was a ‘difficult’ case and that he wasn’t prepared to make a decision. I had to have a meeting with his supervisor. (Why they didn’t look at my paperwork, see I was young and childless and reschedule me I don’t know.) Two months later I got an appointment with his supervisor, the consultant. I also found the consultant deeply patronising and quite misogynistic. If I’m honest, I didn’t really want him to operate on me. He didn’t want me to have surgery, but reluctantly agreed after I challenged his ‘no’ in a letter.
  3. Surgery #1. Cancelled after I arrived at the hospital due to other priorities in theatre. Rescheduled for three days later when I couldn’t get myself a lift to the hospital and someone to stay overnight with me. Because I couldn’t make the rescheduled date I was removed from the list and would have to start the process back at my GPs. If I was a cynic, I’d think it was all a bit of a coincidence.
  4. Referral from the GP #2. Was a little more difficult than the first time around. The female doctor that I saw was clearly quite uncomfortable with the idea. Nonetheless she referred me to the consultant.
  5. Referral to consultant #2. Gosh, finally in this process I met someone else who got it. I walked in, sat down, and he immediately said ‘I’m going to give you the surgery’. Then he went through the mental checklist that he had to ensure that I’d covered all the bases with my knowledge. He had to understand that I knew about every different alternative. And that I’d considered why I wanted to have it – and why my lifestyle dictated that I should have it. He was extraordinarily brilliant. Even explaining that ethically he felt some of his team might have a problem with the surgery, and that he wasn’t quite behind it, which meant that he would perform the surgery himself. Top bloke. He didn’t patronise me either.
  6. Surgery #2. Less good. For lots of reasons. Mostly involving people who didn’t believe I should be having the surgery.

 

Know yourself.

I know, this sounds deeply patronising. You should really be sure that you want this surgery. I’m going to point it out how (just as many people will point it out to you during your journey) that this is permanent. The NHS will not perform operations to reverse this procedure. You might be able to get a reversal privately, but they have a very low rate of success. I hated people telling me this, it felt like they were insulting my intelligence. But I understand that it’s an important point to reinforce.

If you have even the slightest amount of doubt, then you will not get through the process. They will pick up on this.

Arm yourself with knowledge.

There are several things you need to prepare and learn for your consultations.

The other different types of contraception that are available on the market. Here’s the cheat sheet:

Caps
Combined Pill
Condoms (Female and Male)
Implant
Injection
Patch
Diaphragms
IUD
IUS
Rhythm/Natural family planning
Progesterone only Pill
Vaginal Ring
Vasectomy

You should know exactly why the above options are not suitable for you. You should especially know exactly why you would rather have a sterilisation rather than your partner having a vasectomy. It is medically more risky for you to have this procedure than the equivalent being done to your partner. Female sterilisation involves giving you a general anaesthetic and stopping your breathing, allowing a machine to breathe for you. This is dangerous. The consultant will want to hear why you are opting for the dangerous option.

Know why previous methods have not worked for you (or are not working for you now).

My primary argument for surgery was that hormone treatment had not worked for me in the past. I had an awful experience with the injection and had been through six or seven types of pill to try and find one that worked. LoEstrin was the one that worked best for me, however I still had emotional side effects from the hormones. I was also concerned at the level of protection I was getting because of the fact I also have some food allergies which… lets just say… they sometimes made my stomach empty quicker than it should. On such a low dose of hormones, if I had a day where I had an upset stomach it meant I was likely completely unprotected.

Really know that you don’t want any (more) children. (Or make the point that you’d rather adopt or foster.)

I approached this from the point of view that I didn’t want to have children, ever. This would be a very bad thing in my life. I laid out to myself – very clearly in my head – all the reasons why I didn’t want to have children. My most convincing argument appeared to be that I was in the first year of my undergraduate degree and I also had a masters and a PhD to go. Having to take a break out of education for a few years to have children wasn’t in my plan. It’s a shame that ‘I just don’t want them’ isn’t fully supported, but perhaps in time it will be.

I also argued that as an adopted child (at birth) I see no reason why there should be any desire to get pregnant and push a child out of my vagina rather than adopting a child because their parents cannot care for them. And in fact, due to my social justice warrior leanings, I’d be more likely to consider fostering difficult teenagers anyway if I desperately felt the need to have children.

Understand arguments for equality.

I was asked during my first consultation how I would feel if I met a rich man (I was single) and he wanted children. I politely pointed out that I felt the doctor was rather sexist – and if he felt that my morals were so low that I’d change my entire world view just to get a bit of money then I’d prefer that he asked me to leave right now so that I could request a different hospital. He was pretty uncomfortable, the nurse in the corner who was taking notes sniggered a little big. Don’t be afraid to stand up for yourself. This is your body. You are an intelligent and bright person who is capable of deciding for herself if she wants children in the future or not.

Know how much you want to tell the consultant, and prepare factual descriptions of your situation.

I am single, pansexual and non-monogamous. At the time of my consultations I had no nesting or long-term partner.

I did not tell the first consultant I saw about my sexuality or non-monogamy, I just told him that I was single. When I went for my second attempt at getting the surgery a year later, I had a bit of a ‘fuck it’ attitude and decided to see if that would actually help my case. It did. The consultant praised me for being an informed young woman who had clearly researched the available options and how they applied to my individual situation.

I toyed for a while with taking a friend to pose as my boyfriend, however I decided I wouldn’t be able to play it convincingly. The second time round I just wanted to be respected for my own opinion.

Take a friend to surgery. Or your partner. But not a male friend.

On the day of my surgery I took a very good male friend of mine, who had supported me through the whole process. I felt that he was the best qualified person for things like, driving me to the hospital, seeing me vomit after I work up from anaesthetic, helping me take my clothes off and get in the shower, etc. There was nobody else I really wanted to see me in that state.

However it concerned a member of staff that I had a man with me who wasn’t my partner, but who I was sure could stay in the room while my procedure was discussed. Turns out that basically they thought he might be my pimp and I was being coerced. I was deeply unhappy at their treatment of me in this case and I made a full complaint to the NHS PALS service afterwards. I just thought it was logical that he was with me after they’d already started drugging me up, so that if I forgot any bit of information he’d heard it too. Also I have no secrets from him. And we’re very open about sex.

I would suggest – unfortunately – that you take a female friend on the day with you, if you don’t have a male or female intimate partner. It would just make things go smoother and be less stressful.

 

So that’s it really. Hopefully this will help other young women in my situation get the treatment that they’re looking for.