Tubular: a general overview of getting your tubes out

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I recently underwent a laparoscopic bilateral salpingectomy (the fancy big name for getting one’s tubes removed). Friends and acquaintances were supportive and curious about the process, several of them because they were interested in undergoing the procedure themselves.

Even though my reasons for it and specific experience with it were, like anything a single human undergoes, unique to my own self, I thought it would be good to share with others. Ownership of one’s own body and understanding of what one can do with it is important. And now if anyone asks what it was like I can point them to this pile of words. I’ve tried to be very thorough, as not everyone is a familiar or comfortable in hospital settings as I am. It’s pretty long, so settle in.


Salt the earth

In my mid-twenties I was already trying to figure out how to permanently erase any option of pregnancy. Permanent choices are slim and expensive for folks with ovaries, and at the time those options needed a medical justification for sterilisation. There were “reversible” options starting to be normalised, but they also were dicey (and still haven’t got great long-term results, honestly). Seeing no good options, I figured sterilisation was an impossible dream.

But nearly ten years later, a manager at my work, happy mom to two kids, got her tubes removed. I chatted with her about it and it turned out the procedure was totally covered by our employer’s insurance, bolstered by the state of national insurance at the time. Sterilisation, surgical sterilisation via removal of fallopian tubes, was classed no differently than any other form of birth control.

Of course, before I could have my tubes yanked out and thrown in the garbage I had to find someone to do it. A confession for clarity: I’m a person with a uterus who has been in a long term, childless, monogamous relationship with a cis male for 13-plus years. The last time I went in for a gyno exam was about 13 years ago. I’m a terrible role model, be better than me and get checked regularly.

In my defence, the last time I went in I had an actively awful experience and then swore off hormonal birth control. I got very good at barrier method birth control and kept asking friends if they liked their gyno doctor. Everyone I knew went to Planned Parenthood (yay!) but never had the same doc (dang!). I really wanted a doctor I could build a relationship with, for various reasons. Finally, FINALLY, shortly after learning about the magic and mercy of our insurance, a co-worker recommended her doc. I made an appointment.


Yes, we have no babies

It’s a little bit of a weird situation to tell the stranger who just finished medically feeling around your genitalia that you’d like to be surgically sterilised, but a good doc will take it in some stride. I’m noting now, I was very lucky to find the doctor I did! She not only performs surgeries, but she is a caring and kind person who knows how to listen. That’s not to say it was easy to go from “how do you do” to “how do I get these things out?”

I’m comfortably in my thirties, in a very long term childless relationship and am confident as hell in doctors’ offices. My doctor, good as she is, still had to fulfil her “ethical duty” in making sure I was not interested in any other birth control option. If I was younger or less aggressive, this would have been upsetting instead of annoying.

Here’s my advice: keep saying no to any other option. “No I do not want hormonal birth control,” and “no I do not want that form of hormonal birth control.” Don’t feel like you have to offer why beyond that you do not want and never want to have children. What your doctor needs to be sure of is that you are making this decision on your own and that you definitely want the non-reversible option. Remember, a good doctor will believe you and treat you like a human adult being. If they don’t they’re dead to you. Period.

Once we were through the gamut, my doctor scheduled my surgery appointment and my pre-op appointment a week before the surgery and that was it.


Off the hook

Based on the suggestion of my manager who’d had the same surgery, I scheduled a week off following the surgery. I’m extremely lucky that I had the luxury and the PTO to do this. You’re not supposed to lift anything heavier than 10-15 pounds post surgery and I knew that if I didn’t force myself to heal by avoiding work I’d do something stupid.  I am not good at taking care of myself, sometimes.

In the couple of weeks leading up to the surgery, things got very, solidly, real. I received a bunch of mail and phone calls leading up to the day:

  • A letter from my insurance saying “yes, we approve this thing your doctor is doing.”
  • A packet from the anaesthesiology department at the hospital that included pre-surgery prep instructions, an outline of what The Day will be like and post-surgery info.
  • A call from surgery pre-admissions confirming my medication, medical history, and personal stats.
  • A call from another department at the hospital confirming more of my personal stats and what I was going into surgery for.

And in the middle of all that was my pre-op consultation, which also went over pre-surgery prep and medical record confirmation in addition to going over the procedure.

My doctor discussed the surgery steps with me to make sure everything was clear. I signed a document saying that the surgery had been explained to me and I understood what was involved. In addition, I confirmed my medical history contact (my partner) and that info could be shared with them. I was asked if I could be given a blood transfusion and if any leftover tissue could be used by the testing lab for their own science needs.

It’s re-asserted that you are choosing a permanent sterilisation procedure. I made my doctor laugh by mentioning that my main worry was that I’d be told I couldn’t have it done at the last minute. Her laugh was kind and we finally understood each other. She still had to tell me, however—that if I was hit in the head soap-opera style and had a complete change of self—that my ovaries would remain intact and dumbly hanging out full of my eggs, so I could use IVF to get pregnant.

From what I know of hospitals, this level of “who are you and what are you getting done” is not just because I was getting a non-reversible sterilisation, but because I was getting surgery and surgery is serious because they cut you the fuck open.

We also discussed pain management and my doctor wrote me prescriptions to fill prior to surgery. Because it’s a “clean” procedure, a prescription for antibiotics wasn’t necessary. She confirmed my surgery times once more and let me know the hospital would call and confirm the time the day before the surgery as well.

I found all this double-checking to be very reassuring, because, y’know. Surgery is getting cut the fuck open.


The birds and the bees

Here’s the very general basics of what surgical steps are involved in getting your tubes out:

For a laparoscopic bilateral salpingectomy, they make three cuts, with placement based on your anatomy. They make a big slice in your bellybutton and then a littler cut is made over each of your fallopian tubes. Laparoscopic surgery uses cool teeny tools housed in tubes to perform surgery, avoiding the big cuts and longer recovery time of traditional surgery. Getting your tubes removed via laparoscopy is an outpatient procedure, which means you get to go home the same day.

The abdominal cavity is inflated with gas so the surgical team can see clearly into your innards. While they’re in there the doctor will take a gander at the surrounding landscape: ovaries, appendix, etc. If something noticeably No Good is apparent then it is dealt with while they’ve got you there. If it’s beyond what the doctor feels comfortable with, like a messed up appendix, then they get surgeon who knows that bit better to do the job. If it’s just something like a cyst on your ovary then the doctor herself will remove it and send it off to the lab to figure out what its deal is.

The fallopian tube is completely removed via these openings and sent off to a lab to give it a once over. You can decide during pre-op if they dispose of leftover pieces or if the lab can use them for science. The gas is removed and they stitch you up and lay some surgical glue over the cuts and they’re done.

It’s a pretty dang straightforward procedure (and takes about 30-40 minutes!). The two weird things that are common are this:

  • The gas they put in you doesn’t always all get sucked out and bubbles of it can make your shoulder hurt. It’s weird. Bodies are weird. It goes away after a day or two.
  • What you can wear post-surgery depends on where all your bits are. My manager could only wear dresses while she healed because her bellybutton and the cuts over where her tubes had been were exactly where every waistband she owned landed. There was no in-between. I was able to wear yoga-ish pants with a wide stretchy waistband because they fell perfectly between the tube cuts and my navel and my underwear rides low enough that it landed below the fallopian tube cuts. I suggest overalls for folks not into dresses and unsure of what their comfort levels will be.

Post-surgery there are some big nos, all of them logical. Don’t lift heavy things, no soaking/baths for the next two weeks (a shower after two days is fine), avoid strenuous activity. Your junk just got a pretty rough ride so that also means no penetrative sex (and I’d suggest avoiding strenuous non-penetrative for a while) and no tampons for the next two weeks also.

The no tampons rule is an issue for some because you’re going to leak some post-surgery and if a cyst is removed from your ovary that can trigger your regular menstrual cycle. That would be my reaction too, if I was that bunch of organs and got knifed, honestly. If pads aren’t your regular game, remember to stock up before surgery so you don’t have to buy them at the hospital shop like I did.


The marvels of modern medicine

Now, I hadn’t had surgery in 15 years. The surgery I had back then was super invasive and I was treated like a minor, so I wasn’t a very active part of it. In comparison, getting my tubes out in these magical modern times was moments away from a musical number, it was so easy and chill.

Know as you read the following that my partner and I are not normal or moneyed looking people and I don’t always fully pass as white. We were particularly ragged looking on surgery day thanks to the early hour and extreme weather, but it didn’t matter. We were treated 100% as human beings in this hospital and I’m eternally grateful for that.


The day before surgery

I had my last solid food well before midnight (the Mogwai rule) the night before surgery and only took sips of water as needed up until I checked in at the hospital. The doctors don’t need breakfast mashing around your insides while they’re in there too. Before surgery they’ve got to give you a pregnancy test, which is done via urine or blood draw. Hope for blood draw because limited liquid makes a pee test a bit of a challenge.

You are instructed to have a warm shower with antibiotic soap the night before surgery, change into clean bedclothes and sleep in freshly washed sheets. Then, the morning before surgery, you need to shower again with antibiotic soap and change into a fresh set of clean clothes. You don’t get to put on any lotion, oil or powder after these showers, so my skin felt super dry and awful. But so very clean.


The day of surgery

My partner and I arrived at the hospital two hours before the scheduled surgery, as directed. You are asked to have someone there to be your handler, basically. The human body coming out of anaesthesia is not a logical object, nor a safe one to let out onto the streets, still groggy and sore. The doctor also needs to have someone there to check with in the rare case of something going south, so you need to bring along a friend, partner or family member who is your medical contact (someone who the hospital can chat about your medical records with). This person is also in charge of getting you home, either by driving you or wrangling the taxi or car service.

We waited in line and checked in, I proved my identity with an ID card and had the first bracelet check as the receptionist snapped the hospital ID around my wrist. You’re given a stack of papers and a sheet of stickers and intake papers that match the information on your bracelet. Every person you interact with from check-in on will look at your bracelet and ask you to repeat your full name and birth date. After the third or so time, it’s like shaking hands to introduce yourself, weirdly archaic but comforting.

Stack of papers in hand, we were directed to the short stay ward. We didn’t wait long before my name was called and a nurse took me and my documents to a little room, leaving my partner in the waiting room. She did a bracelet check and confirmed my stats and health history while taking my blood pressure.

Another nurse came in and did a bracelet check before taking my temperature and drawing blood. She used a total Star Trek tool to take my temperature, rolling it across my forehead and neck for a couple seconds. When I commented on it being futuristic and that this was a totally different experience from when I’d last had surgery, the first nurse excitedly said “everything is so much better now.”

The first nurse took me back out into the short stay waiting room, collected my partner and went to the surgery wing. “This is your spot” she told us while pulling a curtain around the waiting chair and bed. She carefully and clearly explained the things on the bed and what I needed to do next. Drawing the curtain closed behind her, she wished us well and left. Laid out with precision before me were:

  • A small clear bag for my shoes.
  • A larger clear drawstring bag to put my things in (including my shoe bag). Once I was wheeled off they’d put the bag in a locker. No money could go in this bag, any cash had to taken out of my walled and handed to my partner.
  • Grippy socks that are grippy on both top and bottom so you can’t put them on wrong.
  • A gown that closes in the back, but in a way that doesn’t leave your ass out.
  • A pack of two antibiotic wipes that I needed to scrub my abdomen with for thirty seconds each.

Once I was stripped down, clean and gowned, I needed to hop up into the bed and wait for the primary nurse of my surgical team. I snuggled under the hot-air filled plastic blanket as directed and waited.

Announcing herself outside the closed curtain, my nurse checked if it was okay to enter (it was) and opened the curtain. After a bracelet check she strapped leg compresses on me and hooked them up to a quiet air pump that circulated gentle massaging pressure around my legs to keep circulation going and avoid blood clots while I was laying prone.

She introduced me to the IV technician, and I made sure to let her know the issues I’ve had with IVs before. My veins look like they’re easy to get but they roll and slip as soon as you aim for them. While I chatted with the nurse about pain goals (what do you expect to feel post-surgery, what will be too much, do you have your prescriptions, etc), the IV technician let me know each step of her process as she numbed the IV site and then inserted the big needle. The two of them were kind and did a great job balancing distraction and information in a way that kept me aware of what they were doing while giving me an out to not think about it.

The IV tech left and the nurse finished her questions. She let me know that getting up to pee wouldn’t be as difficult as it looked, even though I was hooked into multiple things by this time. I took her up on this almost instantly, and she unhooked the air tubes going into the leg compresses and helped me carry my IV bag of saline to the single-occupancy bathroom. For safety reasons the doors don’t lock, but they have a little occupied-unoccupied designators. You hang your IV bag on a hook on the wall and there is enough play in the tubes for you to use the toilet and reach the sink. It’s weird, but well laid out.

After that was more waiting, interrupted enjoyably by cameos from my surgical team. Each one did a bracelet check, introduced themselves, chatted about their role in the surgery and answered any questions I had. Finally, the head anaesthesiologist came by and put some starter knock-out juice in my IV. While we waited for it to kick in, I said goodbye to my partner and was wheeled off into nothingness.

After my surgery, my doctor went to the waiting room and chatted with my partner about how it’d gone. She let him know they had to cut a cyst off one of my ovaries and gave him some paperwork and laparoscopic photos to give me when I was sensible again.

For me, there was nothing and then a kind voice was talking to me and I realised I was, more or less, awake. The attending nurse gave me the deets on where I was, that I was out of surgery and told me to take my time waking up. She checked my pain levels and believed me when I said it felt really just like I’d done way too many crunches. When I appeared more lucid, she wheeled me and my bed to the recovery area. I got to ride an elevator in a surgical bed and it was really thrilling, honestly.

My partner was brought into my curtained recovery bay and I was offered juice or water and crackers or cookies. I took both of each because I will not turn down snacks. Post-anaesthesia, the team wants to make sure you can hold down food, as some bodies do not do well with aesthetic drugs. Even though I had no history of nausea post-surgery, I had been given a little round patch behind my ear with anti-nausea drugs, you can keep it on for up to three days post-surgery if needed.

A nurse came and checked on me and saw I was doing well. She reminded me that I’d menstruate a bit post-surgery and that I was wearing a hospital-grade pad, which I’d been still too out of it to notice. The nurse also let me know that urinating would sting for a while because I’d had a catheter in. She brought me my bag of belongings so I could more comfortably wear the pad against my body with my underwear.

I spent some time playing on my phone, chatting with my partner and crushing the snacks and juice. When the nurse came back around she said if I felt up to it I could put on my clothes. I did, carefully and slowly. Once I had shoes on I went off to use the restroom, happily free of the IV bag. When the nurse returned again she let us know that if we didn’t have any follow up questions for my doctor we could go when we liked.

My turn-around time post-surgery was pretty fast. All bodies react to surgery and anaesthetic differently. The folks in the recovery bay next to me had a slower time of it. The important thing is to not push yourself beyond comfort and the nurses were really wonderful at supporting you in going the speed you needed to go.


No place like home

Once I was home I ate some more, took some pain medication, drank lots of water and fell asleep with a hot water bottle. The first day was mostly eating, sleeping, drinking liquids and resting. Though I hadn’t experienced catheter burn during that first pee at the hospital, I very much encountered it at home. It is not great. The only thing to get past it is to keep hydrating and eventually one of the times you go to urinate it doesn’t sting like you’re peeing acid.

Thanks to the breathing tube, my throat was sore the first day and was probably more uncomfortable than my incisions. They were only bruised looking and sore, but not painful, if that makes sense. The ache really did feel like working out too hard, or a heavy bruise. They hurt the most the day after the surgery and also reached their peak “holy shit what a bruise” colouring then as well.

Coughing, laughing and sneezing all twinge the healing incisions, the best way to stay comfortable is to hug a pillow across your abdomen to counteract some of the spasming pressure.

All bodies heal differently, but the best route to wellness is giving yourself enough fuel and rest to let it do its thing. After surgery you need to be aware of things like excessive nausea, weird discharge, or fever, indicators of a possible infection. You get a nice clear list from your surgical team that lets you know what to watch for. You want to limit your exposure to habits that can restrict healing, especially if they’re not things that mix well with the pain medication you’ve been prescribed.

As relatively minor a surgery as a laparoscopic salpingectomy is, it’s still several holes punched through your stomach wall and it’s good to remember that. It’s okay to rest and take your time to heal properly and thoroughly. You’re worth it. Feeling tired a couple days after surgery is totally normal and not because you’re weak.

About two weeks after surgery is a follow up appointment with your doctor. They’ll see where you’re at in healing and let you know if you can resume any suspended activities (like lifting things or penetrative sex). And soon enough the whole thing, including scars, hormonal birth control and barrier methods, will be a faded memory.

Also published on Medium.