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Diabetic. Have normal periods. Wanted birth control. Suggested Tubal ligation. Suggestions?

Mar 2013
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Answered by
Practicing since : 1998
Answered : 5625 Questions
I am 48 years old and single. I recently asked my gynecologist for thoughts on birth control. I've counted for years with no problems, but at this point I'm tired of doing that. I have normal periods every 28-29 days for 4-5 days. I want my periods to stay the way they are until menopause starts kicking in; my mother didn't go through menopause until 54. My doctor suggested tubal ligation by laparoscopy. I'm fine with that. I am a very healthy diabetic so that is why my doctor didn't want to put me on the pill. And some of the other 'very effective' birth control methods could have some big side effects.
My only concern afterwards is this: I have a strong sex drive/libido and I have no problems getting excited- I do not want this to be compromised. I'm wondering if this in any way could be effected by having a tubal ligation. Yes, I've looked online and read many horror stories, but I tend to think people with problems are the people who make entries on these sites.
Posted Sat, 10 Aug 2013 in Birth Control
Answered by Dr. Aarti Abraham 4 hours later
Thanks for your query.
Some statements which might help you choose better -

1. At 48, you have already gone through almost 3 decades of counting ( assuming you used no other method at any point ), so you should consider the logistics of opting for a tubal ligation ( which is after all a surgical procedure, albeit, minor ) just for the sake of the next 5 - 6 years of your life. After all, post menopause, you can enjoy your sex life without any inhibitions / restrictions.
2. For a controlled diabetic, the birth control pill is still an option to be considered. According to the WHO , the advantages of birth control pill outweight any potential risks in controlled diabetics.
The pill would keep your cycles regular, and would be an excellent option for the interim peri menopausal years.
3. Assuming you still are in favour of tubal ligation ( after all, contraception is an extremely personal choice ), then rest assured, that there is no scientific evidence that tubal ligation would negatively impact your libido.
THere is no point in reading online forums, as you rightly surmised that the views come from the people who have had issues with it, and is not a wholly neutral perspective.
To allay your anxiety, please go through the following link, which will address this specific query of yours in a scientific context -

4. As a postscript - have you considered condoms ?? They also could be an excellent option for your situation.

Take care, and wish you luck in making an optimum choice.
Please feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Diabetic. Have normal periods. Wanted birth control. Suggested Tubal ligation. Suggestions? 5 hours later
Thanks for your quick reply Dr. XXXXXXX The site you gave me was an advertisement only. There was nothing else on the page. Sad face here. Could you tell me the publisher of the site? Maybe I could find it on the internet that way...

Another reason I'm strongly considering the tubal ligation it that I have health coverage, I'm a teacher, but being that I am only able to put $2,500 away in Pay Flex a year now, it's also a money saver. Under the new federal healthcare program, this procedure is free. So, it would also save me quite a bit of money over the next 5-6 years. I don't object to using birth control, but the fact that my doctor didn't suggest it- because of my diabetes when I asked her why, is sufficient enough for me. I'm very in control of my diabetes: on a pump, very active- biking, running, weights and diabetic for 36 years with no complications. She told me this would be the closest thing, after surgery, to what I'm doing now- less the counting and more the times for having sex. Happy face here.

Again, if you could give me more information on the site you sent or try to retype it (I know how that goes) I would greatly appreciate it. What does aafp stand for?

Thank you
Answered by Dr. Aarti Abraham 8 minutes later
Hi !
AAFP stands for the American Academy of Family Physicians.
It is indeed strange that you could not access the link, because when I typed in the address, the page did open.
Since you are unable to access the page, am copy pasting the material that was contained on the page .
Here goes, followed by my own comments after the inverted commas close.

" " Does Tubal Ligation Change a Woman's Libido?

Am Fam Physician. 2003 XXXXXXX 15;67(2):420.

In the United States, 26 percent of women 15 to 44 years of age who had ever married chose tubal ligation for contraception. Studies on how this procedure affects sexual activity and satisfaction have given mixed results and generally have involved too few patients to allow reliable conclusions to be drawn. Costello and colleagues used data from the U.S. Collaborative Review of Sterilization to study the impact of tubal ligation on sexual interest and pleasure.

The U.S. Collaborative study enrolled more than 12,000 women who underwent sterilization at one of the 15 participating medical centers between 1978 and 1987. Extensive data were collected on participants before surgery. Participants were interviewed one month after surgery and annually thereafter until 1994. Women who were enrolled before September 1983 were asked about sexuality in annual follow-ups until 1985.

Data were available on 4,576 women for two years following planned interval tubal ligation. The majority (75 percent) were 35 years or younger, had completed high school (82.8 percent), were married (63.9 percent), and were white non-Hispanic (65.8 percent). Sexual interest was reported to be unchanged by 80 percent of women. Overall, 18.3 percent reported increased sexual interest, with the greatest increase reported by white women (20.1 percent) and those who had attended college (20.4 percent). Decreased sexual interest was reported by 1.7 percent of all respondents, with the highest rates among women who had never married (4.2 percent) and those with fewer than 12 years of formal education (4.2 percent).

Sexual pleasure was unchanged in 81.7 percent of women, with 17.2 percent reporting an increase and 1.1 percent reporting a decrease. Increased sexual pleasure was highest in white non-Hispanic women (18.9 percent), married women (18.1 percent), and those who had attended college (18.1 percent). The highest rates of decreased sexual pleasure were reported by women with fewer than 12 years of education (2.3 percent), those with four or more children (2.1 percent), and never-married women (2.0 percent).

A multivariate analysis of several clinical and other factors associated with sterilization showed that regret about the procedure was the only factor associated with a poststerilization decrease in sexual pleasure or interest. Of the 147 women who reported regret, 6.8 percent experienced decreased sexual interest, and 5.6 percent had decreased sexual pleasure. Even in this group, the vast majority reported no change (86.4 percent for interest and 88.8 percent for pleasure), and increased and decreased interest or pleasure were reported equally.

The authors conclude that the majority of women experience no change in sexual interest or pleasure after interval tubal sterilization. Those who do report change are more likely to report positive rather than negative changes.
Costello C, et al. The effect of interval tubal sterilization on sexual interest and pleasure. Obstet Gynecol. September 2002;100:511–7.

editor's note: Even if she does not ask, the woman contemplating tubal ligation (and her partner) may well be worried about the possible effect on sexuality. This study gives us data to positively address the issue. We should routinely discuss the effects of tubal ligation on sexuality during pre-procedure counseling, even if the patient does not express concerns. This study reinforces the value of such counseling, because the effect of regret is striking. Sterilization is an exquisitely personal choice and must never be undertaken unless the woman is certain that it is her best choice. Family physicians can help patients make good decisions and address fears in this most private, yet highly important, area of human behavior. " "

Since the birth control option will NOT convince you, tubal ligation is now a valid option, particularly from the financial viewpoint that you mentioned.
You would do well in going ahead with the option, particularly once your concern about diminished libido is addressed, which the above material should manage to do.

Take care
Above answer was peer-reviewed by
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