How I Got Surgically Sterilized
I was eight when I realized that I didn’t want children. I would see toddlers throw tantrums due to fatigue and overwhelm - perfectly normal, healthy behaviors for little kids. And I knew that I wanted nothing to do with it. But that wasn’t the narrative I grew up with. It seemed like children were an inevitability.
I remember doing the math in my head. If I wanted to have kids by age 30 (when my parents had me) that would mean I should be done with my education and training by then. I knew by age twelve that I wanted to pursue a career in Chinese medicine. If I graduated college at 22, went straight into a graduate program without a gap year, and graduated again at 26-28, maybe I could have kids right after? And start my business a year or two after that? And wouldn’t I have to find a partner and get married by then? Even as a teenager romance was secondary to my other interests, so where would I find the time or inclination?
While I now know many colleagues who had kids while in graduate school, to me it seemed unfathomable. I struggled with this in the back of my mind for another few years. It wasn’t until I was sixteen when I realized that I didn’t have to have kids. My family was going out to dinner with my aunt and uncle. We met them at their apartment and as I looked around, I suddenly remembered that they didn’t have kids. They had been together since college, enjoyed interesting jobs and activities, and moved up and down the East Coast whenever work would allow. I still don’t know whether they were childfree by choice or by physiological circumstances, but whatever the reason, they still have had full and satisfying lives.
I floated home on a cloud of relief that night. I didn’t have to reproduce. I didn’t have to risk my life in childbirth or spend obscene amounts of money to send a kid to school or put my life and my interests on hold to take care of a helpless infant. I didn’t have to endure years of being covered in bodily fluids and catching every toddler illness.
I didn’t have to give up my identity.
BUT WHY DON’T YOU WANT KIDS?
I get a lot of invasive, presumptive comments from people when they find out that I’m childfree by choice. Comments like, “You’ll change your mind eventually,” are probably the most invalidating and condescending. But since I’m writing this to share my story and provide information, here’s a non-exhaustive list of why I’m not having kids:
Because they’re expensive. Do you have an extra 500K-1M to pay for childrearing and education for the next 18-25 years? Because late-stage capitalism is only getting worse, and I’d rather have disposable income.
Because getting pregnant and giving birth sounds miserable and I don’t feel like risking my life. Even my friends who have had “normal” pregnancies had a really hard time with it. I know people who almost died in childbirth multiple times. No thanks.
Because while Christofacsist American culture pressures everyone into reproducing, there is little to no infrastructure to support caregivers. This disproportionately harms single parents and cis women in heterosexual relationships. This is compounded for folks who are low income, disabled, or otherwise impacted by structural oppression.
Because not having kids is the best thing that I, as an individual living in a consumerist nation with poor transportation infrastructure (as opposed to other countries where humans are less of a burden on the environment), can do to slow climate change. While the real burden lies at the feet of destructive corporations, this choice is in alignment with my values.
Because I don’t know what the world is going to look like in 50 years. I don’t know how climate change is going to progress or if we’re actually going to, like, listen to Indigenous people and walk it back. I don’t know if the country I live in is even going to exist anymore.
Because I want to do what I want to do, when I want to do it. Is that selfish? Yes, absolutely. So is choosing to have kids. And that’s okay.
Because my role in the community is Auntie/Zia. My best friend - my sister in all but blood - recently had her first child, and I’m ecstatic. I love getting baby pictures, finding adorable baby gifts, and pinching those little cheeks. I can’t wait to see my nibling grow up. And I love that I can have this experience and then go home to my quiet house with my cats.
Because I don’t want to. End of story.
If you have or intend to have kids, remember that my choice not to reproduce is in no way a judgment on you and your choices. Just because someone lives their life differently or makes different choices than you, doesn’t mean your choices are wrong. It just means that they made the decision that was right for them and their unique situation.
SO WHY NOW?
I was terrified of getting surgery for a long time. When I was seventeen, I had a horrible experience getting my wisdom teeth removed. I remember having a panic attack when I felt myself dissociating and going under. I was still panicking and crying when I woke up. I also struggle with the idea of having something done to my body while I’m unconscious, even with my consent. But my body has always reacted poorly to hormonal birth control, so getting something like an IUD or an implant carries too much risk. If I wanted a permanent solution, surgery was my best option.
Ultimately, my desire for the procedure overcame my fear. The current political climate is obviously a big factor. While I am aware that I, a white woman with consistent income, will always be able to access abortion, that doesn’t mean that it won’t get harder, or require me to travel and take time off from work. And my desire for surgical sterilization is about more than preventing pregnancy – it’s about affirming my gender.
Gender affirmation surgeries and procedures are not exclusive to the trans community. Cis people get gender affirming work done all the time: Breast implants, lip filler, jaw implants, abdominal definition, genital alteration, etc. All of this is a way of affirming your masculinity, your femininity, your ownership of your body. The only difference is that, frustratingly, trans people are required to get therapists to write them permission slips for many of the same procedures that are normalized for cis people. For me, getting surgically sterilized means taking ownership of my body as a queer cis woman.
The other thing that helped me overcome my fear was when a close friend had the same procedure a few years ago. She let me pick her brain about insurance, recovery, and finding a good doctor. Suddenly this thing that seemed so big and scary was much easier for me to wrap my head around. These next few sections will hopefully do for you what she did for me: Help you feel familiar with this process and so that you can make a more informed choice.
FINDING A SURGEON
Given how vulnerable I felt, it was crucial to find a safe and respectful surgeon. I checked out my friend’s recommendation, but it was a little further than I wanted to travel. Fortunately, another friend sent me a link to the r/childfree forum on Reddit, which contains a comprehensive list of doctors that do surgical sterilization. The list also includes anecdotal feedback from patients on their experiences.
Through this resource I found Dr. Karen Tang, who was less than thirty minutes away. Dr. Tang also performs the process I was looking for: laparoscopic salpingectomy. Salpingectomy is the complete removal of the fallopian tubes. The fallopian tubes deliver the fertilized egg to implant in the endometrial lining of the uterus. Without that pathway, sperm cannot fertilize the egg.
This process is permanent. Once the fallopian tubes are removed, the only way to get pregnant is through IVF. The alternative is tubal ligation, which means that the tubes are interrupted, but not necessarily fully removed, and therefore can sometimes reverse. Due to its efficacy and the fact that salpingectomy can also reduce risk of certain types of cancer, it is considered the gold standard.
So how old do you have to be to get this procedure? Dr. Tang says that most doctors will sterilize patients as young as 21 years old, in part because doctors like her respect their patients’ choices and bodily autonomy. Reading through the r/childfree article, you’ll see some horror stories from people who were turned away by doctors who thought they were too young to make their own decisions, or who required a “permission slip” from their husbands. This is not standard practice and is reflective of the doctors’ bias against their patients. If your doctor doesn’t trust your choices, find someone else.
The other reason why Dr. Tang will sterilize patients 21+ is because Medicaid covers this procedure at 21 and up. Most other insurance companies follow this standard, although it can vary by state. In fact, the Affordable Care Act requires insurance to provide surgical sterilization as a form of birth control or other medical need. How much is covered will depend on your copay and deductible, and you will most likely need a referral from your primary care physician.
And it just so happens that Dr. Tang makes fantastic educational content on social media. Check her out on Instagram, TikTok, and YouTube.
PRE-OP
The first step was my consultation. Dr. Tang walked me through the surgical process and provided an excellent PARQ (Plan, Alternatives, Risks, Questions). After seeing her, I received a call with the scheduler to confirm my surgical date, hospital location, insurance, and answer logistical questions.
While the surgery would be short, I wasn’t going to receive the exact time until the day before when they knew the schedule. This was in case an emergency surgery took over the operating suite they had booked. This is important to keep in mind if you get this surgery, or any other: You’ll have to plan to take the whole day off, as well as your following days for recovery. And while you could travel to the hospital on your own before surgery, any procedure with anesthesia will require you to have someone pick you up afterward. Your pickup will have to be on call all day because surgery time can change.
A few days before the surgery I had to go to the hospital for some basic labs: A CBC (Complete Blood Count), a serum pregnancy test, and a PCR covid test. Results were in my patient portal the next day.
THE SURGERY
I had to stop eating eight hours before. I could drink only water up to two hours before my start time. I don’t have any issues with fasting, so this was fine for my afternoon time slot, but if you have trouble with this then you might want to request to have surgery in the morning. I also showered with Hibiclens on the night before and day of surgery.
When I checked in, I wrote down the name and number of my friend who was going to pick me up. A nurse took me back to take my vitals, install my IV, and put on these mechanical compression socks that massage your calves during surgery to reduce the risk of embolism. I changed into a hospital gown and settled into the hospital bed. I was experiencing anticipatory anxiety, so they offered me anxiolytics. I declined knowing that those would make me feel worse due to the dissociation, but if you need them then they should be provided for you.
I waited for a few hours while nurses, doctors, and techs checked in on me with updates every so often. Because my surgery was in the afternoon it was more likely to get pushed back, which was normal. Eventually the anesthesiologist came in to introduce herself and have me sign consent forms. Dr. Tang followed and introduced her surgical team. She explained the process again: This minimally invasive surgery was laparoscopic, which means that three small incisions would be made in my navel and lower abdomen. My abdomen would be inflated so that they had space to work. A small camera and surgical tools would be inserted through the incision to remove both of my fallopian tubes. I would also be intubated while under anesthesia, which is standard for any abdominal surgery in case the diaphragm or phrenic nerve is affected. The entire process would take 1-2 hours.
They wheeled me into the operating suite. Getting wheeled around in a bed was my favorite part. The operating suite is cold, so they cover you with warm blankets. Anesthesia was fed through the IV. I remember looking around the suite and… having vivid dreams about arguing with interior design stylists… and then slowly waking up. I heard the nurses talking over me for a few minutes before I could open my eyes. When I was fully conscious they brought my friend in to sit and chat with me.
My pain levels were next to nothing. A lower abdominal ache at 2/10 if I’m being generous. However, I was slightly nauseous from the inflation, so they gave me some anti-nausea medication, a ginger ale, and saltines. Burping was encouraged to help release the gas. I found that I was able to move around easily in the hospital bed with only a mild feeling of tension. The nurses said that it’s common to have more discomfort than what I experienced.
As soon as I felt stable enough to get on my feet, they unhooked my IV so I could walk to the bathroom. They want to make sure you can pee before you leave to confirm that your pelvic nervous system is functioning well. I felt steady and comfortable walking around. According to the nurses, the anesthesia wore off more quickly for me than it does for most people. Dr. Tang came to check in with me, provide paperwork with instructions and my prescription, and gave me a before and after photo of my uterus. I might get it framed.
And then I was free to go. My friend took me to CVS to get my prescription: ibuprofen, various laxatives, anti-emetics, and some stronger pain medication. She took me home and as soon as she left, I burrowed into bed and fell asleep.
POST-OP AND RECOVERY
My recovery was incredibly easy. I had no abdominal pain, only mild tension. I wasn’t allowed to drive for 24 hours following anesthesia. The second that 24 hours had passed I hopped in my car to get take-out. The post-op instructions encourage you to move around as much as you can to avoid embolism. They also have clear information about when and how to shower, how to take care of the incisions, dosing medication, and what to expect as you heal.
I had some bruising at the incision sites. Everything healed well with no infection. The incisions are less than a centimeter each. The only thing that bothered me was how sore my throat was from intubation. I took one or two ibuprofen for this, but that was all I needed. Two days after surgery I went to a miniatures convention. I had my surgery on a Thursday was back to work without any issues the following Monday.
My only frustration with recovery was the restriction on exercise. I usually lift weights, but had been holding off on joining a new gym. The only exercises allowed were walking and mobility, both of which are encouraged for recovery. I wasn’t allowed to lift anything over 15lbs for 2-4 weeks after, but I had to bend that rule to 20lbs because one of my cats is CHONKY.
Two weeks after surgery I had my follow-up with Dr. Tang. She checked the incisions and confirmed that they were healing well. She said that my ease with recovery, especially my lack of abdominal discomfort, was likely related to my history of weightlifting and core strength. She gave me the go ahead to start gentle weights and cardio as long as I am mindful.
FINAL THOUGHTS
Given how anxious I was about surgery, I had a phenomenal experience. I can’t guarantee that this will be the same for everyone, but if you find a good doctor it will be much less stressful. This is a minimally invasive surgery with a short recovery time. And I couldn’t be more thrilled with my choice. A part of me always resented having a body that could get pregnant. Now I feel like I have a body that suits my life and my identity. I am so much more at home in my own skin.
REFERENCES
The r/childfree friendly doctors list: https://www.reddit.com/r/childfree/wiki/doctors/
Dr. Karen Tang:
Professional Website: https://axiawh.com/providers/dr-karen-tang-center-for-womens-surgery-axia-womens-health/
Youtube: https://www.youtube.com/@KarenTangMD
Insurance coverage in the US: https://tubalfacts.com/post/175415596192/insurance-sterilization-aca-contraceptive-birth-control
Additional salpingectomy information: https://my.clevelandclinic.org/health/treatments/21879-salpingectomy
