Scarleteen

Hi there Scarleteen team!

I have a question I don't see addressed too often on the message boards, but I'm curious as to what I should do when it comes to potentially getting sterilized - especially with the way the political situation is going in the U.S.

For context, I am in my mid-twenties and have known my entire life that I have never wanted to be pregnant or go through childbirth. If I ever were to have children in the future, I strongly feel that they would have to be adopted because the idea of giving birth absolutely terrifies me. I've come to terms with the fact that I will never have bio kids and my long term partner is supportive of that fact as well.

I recently found a doctor who agreed to do the procedure for me. I was really excited and felt great until I signed up for the bisalp (tube removal, no reversal possible) surgery and then I started feeling really REALLY anxious. The idea of such an invasive surgery (even though I know it's minor, but it still involves anesthesia and cutting/recovery) has me really freaked out. I've never had a surgery like this before.

I've tried to educate myself about the procedure and talked about the risks with my doctor and she reassured me that I should be very safe. But I'm also nervous now because I still live at home with family and rely on them for some financial help while I'm in school. I'm nervous that they might find out what the procedure is really for and be upset with me. Or something could go wrong after surgery resulting in scarring or complications that they'd find out about. My partner is supportive in my desire to remain childfree, but isn't crazy about the idea of me going through with surgery. He said that he will support me no matter what I do but prefers the idea of me considering a long term form of birth control first since I'm so young (and I don't live with him to have him help me post-surgery).

I feel like I'm a bit pressed to have this surgery maybe sooner than I would otherwise with how the political environment is impacting women's rights and I feel a bit anxious about what the future holds. I feel very grateful to have even found a doctor who listened to me and is willing to perform this surgery when so many women can't access it, so I feel almost guilty thinking that I might have to postpone it. But now that I'm scheduled, I can't stop obsessing over potential issues that could happen with the surgery and worrying that 10 years from now I might change my mind (I really really don't think I would but my obsessive anxious mind is saying "what if?!"). And I feel really alone in having this done because I can't really tell anyone about it for fear that they'll judge me or reject me.

I'm often worried about getting pregnant, but maybe my fears are irrational because I'm already using birth control? I've been on Slynd birth control pill for a bit and I haven't noticed any really bad side effects (previously trying to find the right pill for me was a challenge hence seeking sterilization also), but I'm worried that maybe it's not effective enough on its own? I'm pretty responsible about taking my medications correctly, so I'm not really worried about missing pills. But I feel like I should have a backup option just to be super safe. My partner and I see condoms as a last resort (we're both tested so STIs aren't an issue) and I prefer that I be in control with birth control (like not relying on a partner to withdraw). So not sure what options might be good to add on?

I previously avoided the IUD because I was afraid of the pain of insertion and thought that sterilization would be the "easier" option. But after talking to my doctor and hearing about the recovery time for sterilization, I'm considering that the copper IUD might be one painful insertion and then I'm covered for 10 years.

I didn't ask her about doing the IUD along with keeping my pill, but I wonder if that's an option and the pill might help reduce IUD bleeding (Slynd really lessens my periods) and the pill would make me feel more secure should the IUD slip out or something.
I know it seems excessive... but I really really don't want to be pregnant.

Sorry for the one big long rant, but I'd really appreciate it if you could help me gather my thoughts before my pre-op appointment with my doctor where I need to decide if I really want to go through with this. I feel less anxious when I think about not having to go through with the surgery, but I feel anxious thinking about a world where birth control isn't accessible too. Thank you!!

Hi Mallory! Welcome to our boards — you can write as much as you want to here and we'll be happy to read it.

I passed your question along to our co-director, Heather, who will respond to you in the morning. Heather has a wealth of knowledge about this stuff and plenty of personal experience with surgery, so I think they'll be the perfect person to help you process your thoughts. Thank you for writing in!

Hi there, Mallory.

There's a lot here that you want to address, and I first want to make sure I've got it all. I'm seeing that you want to talk about:
• How safe this kind of surgical procedure is or isn't
• If we think it's something you should do
• What the recovery process is like and what you'll need when it comes to that if you do go forward with the surgery
• How much or how little to have your partner involved in any aspect of this, down to your own decision to do it or not
• Concerns you have about recovering at home and your privacy
• If your fears of pregnancy are or aren't rational
• What backup options there are for you to use with a birth control pill (and I am curious about why you and your partner think condoms are a last resort when they are one of the simplest and easiest methods to back up with)
• And if the copper IUD might be a good backup method for you

Does that cover all of it? Let me know, and we can start hitting all of these issues.

There are a few things I can offer up to get started on this conversation.

I'm a bit concerned with how much say your partner is wanting to have in this, since it's your body here that this involves, not theirs. Something about that is hitting me some kind of way since it also feels off to me to have them expressing care in one way, but not in others, like, for instance, offering to have you stay with them while you recover if you don't feel like your home is a good place for you to do that (mind, recovery from this is not long or complicated, but still, it is a recovery and any given person recovering from a surgery gets to want what they want when it comes to that recovery, like in-person help with things or care). Since it sounds like they also have not been willing to use the one reliable method they could on their own bodies for backup, I'm just having an extra "huh" about the way they are engaging with all this. Can you fill me in some on the history of this relationship and maybe say some more about all this?

I can also tell you that this kind of surgery -- the tubal and also any laparoscopic procedure as a whole -- is very safe and poses minimal risks. Recovery tends to be short, just a couple days, really, and that's mostly about limiting how much you move around. I've had a laparoscopic surgery for a different reason, and even as someone chronically ill, I found the recovery very quick and easy, I was just often reminded over the first week or so when I reached too high for something that there were staples in my abdomen and that I needed to keep that in mind when I moved around.

The biggest risks with this surgery and the usual biggest risks with surgeries, and that's primarily infection after the fact. The good news about that is that so long as you just follow all the instructions you are given for aftercare following the surgery to the letter, that is very unlikely. Other, risks are issues of being under anesthesia, damage to other organs or blood clots, and these are usually easily avoided so long as your surgeon and the surgical center are good. You can always look for any complaints about healthcare providers by looking them up via the medical board or related websites for your state. In Indiana, you can look here: https://www.indianapcf.com/ and you'll look under provider by your doctor's name.

Since you are thinking about this, still, even if you aren't decided, I think you should go to that pre-op appointment, and come with the list of questions and concerns you have. Then you'll know you did your due diligence, and you'll have all the information you can to decide if this is right for you, if it isn't, or if you're still unsure enough that maybe you feel better with another solution for now until or unless you feel differently about this one. Since it is permanent, I do think it's something anyone doing it wants to be as sure as possible is what they want and what feels best for them before they do it, especially since there absolutely are other options out there that are highly effective. I also get really, really not wanting to be pregnant, but IUDs don't just slip out, and birth control pills paired with something like a condom are a very effective combination when used correctly. If sterilization just doesn't wind up feeling right for you right now, you absolutely can do something else that gives you nearly an identical level of protection.

Let me know where you want to take this conversation from here and we can keep moving forward with it. <3

My partner and I actually just had a long conversation about this last night again after I posted. I totally get that it's my body and my choice what I want to do with it and regardless of him or any partner I've ever been with, my choice has always been the same - no pregnancy for me. I've made that clear to him in every conversation, and my partner has been very understanding of that. I guess my anxious mind "seeks reassurance" from others that I'm making the right choice even when I know what feels right for me, and it makes me feel a little on edge when it's different from what my parents or peers might think is right, even though I get that's part of being an adult.

Unfortunately, my partner lives at home with his family, so I can't really stay there with them. He did offer to drive me to and from the procedure and come over to my house though and support me in any way that I need him to help me out with things. And I guess I could tell my parents I'm having another procedure done so they understand that I have some recovery involved.

My partner and I have been using condoms all the time, so it's not that he's unwilling. And he's willing to support me in doing whatever makes me feel comfortable. But my anxious brain liking to plan for the future says that it would be nice not having to use condoms every time so we could be more spontaneous if that makes any sense.

I think what I'm looking for is something that offers that nearly identical protection, but maybe doesn't involve surgery because I'm so scared of cutting and scarring (even though I know this procedure is so so minor).
I know I'm probably going to have to get surgery at some point in my life, but it feels different to me knowing that this is an elective surgery that I'm choosing when maybe I could have chosen a better option vs. needing to get surgery to save my life (in that case I would know surgery is definitely the best option and I don't feel as anxious thinking about that!)

I was thinking about trying the copper IUD to have that long term protection, but keeping my pill for the benefits it provides in eliminating my periods/hopefully curb any heavy bleeding from the IUD... although I know IUDs come with their own painful insertion, but for some reason now comparing that to the surgery feels like mayyyyybe a better option? It lasts such a long time but it does offer me a chance to "reverse" which like I said I really don't see myself doing, but it might make me ruminate less on the "what-ifs"? Do you have any stories or experiences on the success of a copper IUD in women who've never given birth?

Or I saw another post on here about combining a spermicide with the pill and that seemed to have a very high effectiveness rate, so if I'm combining this pill with a spermicide or condoms or getting an IUD, maybe my fears about pregnancy are kind of irrational?

I totally agree with you on going to the pre-op appointment to discuss my concerns with my doctor. But I guess seeing as how I had to fight so hard to get a doctor to agree to do this (and I'm grateful she did!), I feel anxious that if I back down, she might not take me seriously should I decide I want to be sterilized down the road and might refuse the surgery?

Thanks for filling me in more!

As someone who has had to have surgeries, I totally hear you that it's different to make choices with elective surgery. You're right! Because yep, a time may come when you have to have one that isn't a choice, and with surgery always having risks, often costing money, needing recovery...well, it makes sense to be careful with when we choose to have one.

I'm not worried about your ability to have an honest conversation with your surgeon and then them refusing you. Since they already offered this to you, the only way I see them refusing is if *you* made very clear it's not something you want now. I think you can have that appointment and feel free to ask them whatever you want.

In terms of your other options: spermicide is literally the least effective thing there is (even more than withdrawal). It also is effectively dish soap, which is why it tends to irritate so many people's genitals. On top of that, condoms are way easier to use and have sex still be spontaneous than spermicide. I think if what you are looking for is the most protection you can get, looking to one of the least effective methods just doesn't make much sense, you know?

So, I have been working in this arena for over a quarter century. There is no method I haven't heard loads of people having good experiences with (though again, spermicides are probably what I'd say I have heard the least raves about). Millions of people every year get IUDs who haven't given birth: it's absolutely common for people like you to have good experiences with them and we hear from them all the time. There are also ways to manage pain or discomfort with insertion, and here's a piece here on that should you want or need it: https://www.scarleteen.com/read/sexual- ... insertions The one thing I would just talk about with your healthcare provider about them is that the copper IUD can result in more painful periods for people sometimes, though if you're suppressing your periods with a pill, that should be a non-issue for you. Still, I'd talk about it.

I do wonder, though, if it might not be worth it for you to talk about a Mirena IUD instead, which would offer you what your pill does now (so you wouldn't have to take it) when it came to your periods AND that localized progesterone helps avoid cramps rather than making any worse like the copper one can. Another option for you would be an implant: all by itself it is more effective than your pill and offers you those same benefits, but it may be that you have mixed feelings about it as a device put into the body.

Let's talk about what is and isn't rational. It makes sense to be worried about pregnancy when you don't want one and are doing things that could create one, especially right now, in this country (and in Indiana in this country, more still) where abortion access is becoming more and more limited. I don't think that's irrational. But I do think it's worth looking at the difference between say, 98% effectiveness and 99% effectiveness and recognizing that when you know that those are based on every 100 people, that difference is actually very, very minor. That's one of the reasons why using something highly effective like the pill then adding a much less effective method like spermicide is really only going to cost you money and add one more thing to do rather than actually adding much protection. That's also why condoms are a better backup if you want to keep using your pill.

Once -- and if -- you have something like an IUD, unless you need the pill for other benefits, there really isn't any reason to keep using it because you would already be using a more effective method than the pill. It might also help you to know that the pill is actually something whose typical use rates are some of the lowest because it's so easy for people to mess up. So, if you have had that work for you so far, perhaps it can give you some confidence in how well any of these methods work? Do you know what I mean?

It does sound different with your partner than the vibe I was catching, so thanks for filling me in there. I would, however, just perhaps suggest that they not say things to you like that they would rather you wait on a surgery that is for you and your future. Particularly since your partner isn't a person who can himself become pregnant, to me, that kind of weigh-in on this just feels out of order. But it might be that he just isn't particularly informed about things like that if you can't recover at his place, you're not in any kind of grave danger: this is an easy, quick recovery, it's not like recovering from a heart transplant, or even a broken bone. He may also not understand that pregnancy actually poses higher health risks than this surgery does?

That all said, how might you feel about going to your per-op appointment and asking all the questions you had, but then also asking your provider to talk to you about the two kinds of IUDs? If you could have a conversation with all that in it, I think it would serve you very well.

Thank you! Good to know regarding spermicide, because that helps me rule that out and know condoms are the safer choice.

Yes, I think I could have a conversation with my doctor about all of those things. I feel like in my last appointment, I was focused on needing her to take me seriously about sterilization and so I didn't get the chance to ask about the other options.

I have never had bad period cramps or heavy bleeding so I wasn't super concerned about that being an issue with the copper (was more concerned about potential expulsion), but those concerns are statistically about the very very small percentage of people who do experience that, so again, fears are probably unfounded. I'm a bit more nervous about trying a different hormonal option because I'm not sure how that would affect me mentally, but I will definitely discuss all options and the implant with my doctor.

Every time I think about having to go through with surgery right now, I get a lot of anxious/panic symptoms, and for the past couple weeks since I signed up for it, I've been panicking on and off about having to go through with this. Talking it out with you has me feeling more like I'm just not ready right now. Some slight anxiety would seem normal, full-blown crying and not being able to sleep/eat due to fear feels extreme for me.

I feel like a long term option could give me the piece of mind that I'm looking for without committing to surgery right now. I guess for me it's accepting that being childfree doesn't have to equate to being sterilized and there are other ways to be safe that don't involve elective surgery. And maybe in the future, I'll feel more ready or I'll have a safer home to recover in (if I move out, move in with partner, whatever the future holds). But again, I will make sure to talk about all this with my doctor at our appointment and try not to feel pressured that I have to have the surgery this time or it's off the table forever. That all or nothing approach really contributes to the anxiety.

I'm also talking to a counselor about ways to manage my anxiety (about everything!) and it's an ongoing process. Anxiety about the future is real, but I also can't predict the future, so making decisions that feel safe and right for me now might be more important than what I think *might* happen in the future. But it's been so helpful to talk to someone who knows more about sex-related issues, so thank you!

Hi Mallory. I'm so glad that writing back and forth with Heather was helpful! It sounds like you've done some great self reflecting and had a productive conversation with your partner. I hope that helps give you confidence in continuing to have conversations with your doctor and your counselor.

I strongly support the idea of making decisions that feel safe and right for you now. I know that anxiety makes it difficult to know what the best ways of caring for ourselves are, but I can see that you're working hard on untangling the different threads and checking in with yourself.

We have a lot of resources about pregnancy and birth control related anxiety and it's a topic that we talk through with users here all the time. So if you'd like to read more or talk more about your pregnancy fears or your feelings about birth control, we would be happy to help!

Mallory, I'm so glad I was able to help.

I agree with you, it sounds like this just isn't feeling right to you right now, going forward with the tubal. It definitely sounds like the best move for you right now is to try and find a different method or combination of methods that you feel good, not scared, about. I also agree that the all-or-nothing way of thinking about this isn't serving you well. Just because you decide not to have a tubal now doesn't mean you can't change your mind at any time and have one later.