Talking tubals and reproductive rights
This week I did SEVEN tubal ligations - salpingectomies (removal of the fallopian tubes) for sterilization. When the impending Supreme Court reversal of Roe vs Wade was leaked to the press, we gynecologists started seeing an increase in the number of consults for sterilization. After Roe vs. Wade was actually overturned, it became an absolute deluge. My office has been getting anywhere from 30-50 calls a day from patients desperately trying to schedule a sterilization.
The vast majority of these patients found me through social media, and this is why the medical community needs to understand how the average person now obtains their healthcare information, and makes decisions about their health - including which providers they see.
Most of the sterilization patients have found me through a Child-Free subreddit which has more than a million members. Frustrated and fed up with doctors refusing to believe that they truly want a sterilization if they were child-free, unmarried, in their 20’s… this community created a surgeon list of doctors across the U.S. and internationally that had demonstrated that they would respect patients’ reproductive autonomy and perform a tubal ligation or vasectomy for those who are child-free.
A similar movement started on TikTok. I’d previously posted in response to several viral videos of women rejoicing that they’d found a gynecologist who do a tubal for them. Each of those original videos had millions of views, and both of my own videos supporting the autonomy of those seeking tubal ligations each had 1.5 million views. Another Ob/Gyn on TikTok, @pagingdrfran, created her own list of more than 1,000 Ob/Gyns willing to do tubals for those who are child-free, and that list has also gone viral, leading to articles about this topic in the Washington Post and CNN.
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In the comments of these videos are literally thousands of stories of people whose gynecologists refused to do a tubal if they were “too young,” (including women in their 30’s, or even 40’s!) unmarried, child-free, or even for those who already had children. There was literally no age old enough, or number of children high enough, that people were not getting push-back about their decision to seek sterilization.
The underlying reason that there is hesitancy on the part of gynecologists is the fear that the patient will change their mind, and regret their decision. And while there is always a risk of regret, and some patients do change their minds down the line, my argument is that there is literally a risk of regret for any decision that someone could make in life. Who they marry if they marry, what job to take, whether to take a flight or get in a car. We still allow people the freedom to make those decisions for themselves, and do not gatekeep personal decisions based on our own thoughts about another person’s risk.
For every surgery, we have to run through a long list of possible risks with the patient before they sign the consent, so that they make the decision fully informed about all the risks that they’re taking on. Blood clots, infections, hernias, anesthesia complications. For sterilization procedures, that includes the risk of regret - and for salpingectomies, the fact that they are completely irreversible, so if someone regrets it, they would need IVF to conceive. We will always have to tell patients that a risk of regret and irreversibility exists, but then the decision should be theirs.
There are always limits, particularly in terms of age. In the U.S., Medicaid has a minimum age of 21, and because many commercial insurances follow Medicaid/Medicare guidelines to establish “standard of care,” I personally set a minimum of 21, unless there are extenuating circumstances such as severe gender dysphoria, or significant health conditions that would make pregnancy life-threatening. But in general, if I hear that a patient is not 100% certain, or if they ask about reversal in the future, I recommend against sterilization and suggest a long-acting reversible contraceptive instead… regardless of age, marital status, or number of children.
But in this post-Roe world, where every birth control method can potentially fail, some states now do not allow abortion even in cases of rape, incest, or fetal anomalies, and even access to emergency birth control and IUD’s is at risk, I am 1000% supportive of patients’ well-considered decisions that they do not want any future childbearing. It is a joy and an honor to give them this medical service that brings such relief. I can’t tell you how many happy tears I’ve had in the office and in the OR recovery room, from patients that were finally able to take this decision into their own hands, and could now walk into their future with confidence and freedom.
For a deeper dive into everything about tubal ligations, please check out my YouTube video - where I cover how we do tubals, the risks (including whether “post-tubal syndrome” exists), cost, recovery, etc! And I have a YouTube short where I actually show the surgical procedure for a salpingectomy.
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Because it was such a busy week at work, I didn’t get many videos up on TikTok or YouTube, but did make this video: “Why do my LEGS/KNEES hurt when I have my period?!” A lot of people experience this, and think that they’re going crazy, but there are actual medical explanations for it!
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If you like that one, check out an older video I made that explains why you might be getting butt / rectal pain with periods! That one had almost 4 million views, whoa!
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Stay tuned later this week for a new YouTube video on HYSTERECTOMIES - people have been asking me for a video on this forever, and I’m excited to answer all your questions! And as always, let me know if you have other requests for topics to cover!