People should get to choose what happens to their bodies—always. And that includes the decision of whether or not to become pregnant or have children.

Parenting is a lifelong commitment with significant physical and emotional demands. And for some, pregnancy can result in lifelong health consequences. These are big decisions that deserve respect, care and medical support.

If you are certain you do not want biological children for any reason, there are medical options to support that decision. Still, asking for permanent birth control can feel frustrating or even intimidating—especially if you have been questioned or dismissed in the past.

Here is a guide on how to have a conversation with your provider and advocate for the choice that feels right for you.

Starting the conversation about permanent birth control

If you are certain you never desire to become pregnant in the future, clearly let your provider know. This will help them understand your priorities and tailor the conversation to your needs. You can absolutely say from the start, “I want permanent birth control.” If they are not a gynecologic surgeon themselves, they should refer you to one.

When you first meet with a gynecologic surgeon, even when seeking permanent sterilization, they will start with a complete review of both reversible birth control and permanent contraceptive options. This is a standard part of a process called “informed consent.” It is not intended to change your mind, rather, to ensure that you have been properly counseled on all available options and alternatives to permanent sterilization. Next they will review permanent sterilization in detail.

Permanent sterilization in detail

There are two common permanent birth control options: one for people with fallopian tubes and ovaries, and one for people with testicles.

Salpingectomy (removal of the fallopian tubes)

Fallopian tubes are the pathways for an egg released from the ovary to reach sperm after sex. Years ago, if someone wanted sterilization, we would “tie” or block the fallopian tubes to prevent an egg and sperm from reaching each other.

Modern practice has changed. Today, we generally recommend removing the tubes entirely because we now know this can reduce one’s lifetime risk of certain types of ovarian cancer. The procedure is called a “laparoscopic bilateral salpingectomy” during which both fallopian tubes are removed by a minimally invasive surgery involving three tiny incisions that are usually less than one centimeter each. This is a quick procedure with a relatively easy recovery. It is performed in the operating room under general anesthesia and patients go home the same day. It does not cause menopause or affect your hormones because the ovaries remain in place. You will still get your period, and your ovaries will continue to produce hormones.

It is important to know that once your fallopian tubes are removed, this procedure cannot be reversed. In vitro fertilization (IVF) remains an option if you ever decide to pursue pregnancy later, but natural conception will no longer be possible.

Vasectomy

This is the sterilization procedure for people with a penis and testicles. It causes the semen released from the penis to not contain any of the sperm that are formed in the testicles. Vasectomy is even less invasive than laparoscopy, less expensive, and is generally performed in a medical office with local anesthetic. The recovery time is short and vasectomy is over 99% effective in preventing pregnancy. Vasectomy reversal may be possible, but is not guaranteed. So for some couples, this is the best choice.

What about hysterectomy?

Some patients will ask if they can have their uterus removed by a procedure called hysterectomy instead of just removing the tubes. While hysterectomy does also leave a person sterile, it is not typically recommended for the sole purpose of sterilization. Compared to salpingectomies, hysterectomy is a major surgery with more surgical risk and a longer recovery. However, if you have additional symptoms caused by the uterus such as fibroids or chronic bleeding, it may be something to consider and discuss with your gynecologic surgeon.

Why permanent birth control gets pushback

If you are under 30 and have requested sterilization, you may have already been told “you’ll change your mind someday” or “you just haven’t met the right person yet.” This is an antiquated and paternalistic attitude towards young people that can cause them to feel dismissed. This has no place in medicine. No one should be denied care based on assumptions about age or identity.

In my practice, I have met many people who have known their whole lives, since childhood even, that they never want to be pregnant. Some plan to adopt. Some just don’t want kids at all. My job is not to convince them otherwise. It is to make sure each person fully understands the permanence of the procedure and feels supported in their decision.

If your provider tells you “no”

Some providers may not feel comfortable doing the procedure, but that should not prevent their patients from having access to permanent sterilization. You can respond with: “I’d like to continue this conversation with someone else. Who do you recommend I talk to next?”

You want someone who respects your decision and feels confident providing the care you seek.

Relief and validation

There is a deep sense of relief that comes with being heard, respected and finally getting what you need. Many patients have told me that it was only after completing sterilization, they felt they could fully imagine or pursue the life they always wanted.

If you are ready to talk to someone who won’t make you justify your choice over and over again—we are here. It’s your body, your future and your decision. Schedule a consultation >