Sterilization procedures have skyrocketed since Roe v. Wade was overturned.
When the Supreme Court reversal of Roe v. Wade was leaked to the press in 2022, we gynecologists started seeing an increase in the number of consults for sterilization. After Roe v. Wade was actually overturned, it became an absolute deluge. My office was getting anywhere from 30 to 50 calls a day from patients desperately trying to schedule a sterilization.
Most of the sterilization patients found me through a child-free subreddit that has more than a million members. Child-free, unmarried, and younger women were finding that doctors were refusing to believe they knew what they wanted. Frustrated and fed up, this community created a list of surgeons across the U.S. and internationally who had demonstrated that they would respect patients’ reproductive autonomy and perform a tubal ligation or female sterilization procedure (also referred to as “getting your tubes tied,” even though nowadays we’re more likely to completely remove the tubes than simply tie them) or vasectomy for those who are child-free.
A similar movement started spreading on TikTok: Both of my videos supporting the autonomy of those seeking tubal ligations had 1.5 million views each. Another OB-GYN on TikTok, @pagingdrfran, created her own list of more than 2,000 doctors willing to do tubals for those who are child-free, and that list also went viral, leading to articles about this topic in the Washington Post and CNN.
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 30s and even 40s!), unmarried, or child-free. Even patients who already had children were sometimes denied. There was literally no age old enough or number of children high enough for some surgeons to stop pushing back on a patient’s decision to seek sterilization. I’ve heard these same stories from my own patients, who had often already sought care from one or more other gynecologists before seeing me.
The underlying reason that there’s hesitancy on the part of gynecologists is the fear that the patient will change their mind and regret their decision. While there is always a risk of regret, and some patients do change their minds down the line, my argument is that there is 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, whether to undergo any other surgery. We still allow people the freedom to make those decisions for themselves and don’t 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. We talk about blood clots, infections, hernias, and anesthesia complications. For sterilization procedures, we also discuss the risk of regret and the fact that the surgery is completely irreversible with the currently preferred method of sterilization, which is bilateral salpingectomy or complete removal of the tubes. We always tell patients that a risk of regret exists but that the decision should be theirs.
There will always be 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.
Regardless of age, marital status, or number of children, if I hear that a patient isn’t 100 percent certain or if they ask about reversal in the future, I recommend against sterilization and suggest a long-acting reversible contraceptive instead.
But in this post-Roe world, where every birth control method can potentially fail, some states now don’t allow abortion even in cases of rape, incest, or fetal anomalies, and even access to emergency birth control and IUDs is at risk. I have always been 100 percent supportive of patients’ well-considered decisions, and now the stakes are even higher in states with strict abortion bans.
It’s a joy and an honor to provide this medical service that brings such relief. I can’t tell you how many happy tears I’ve seen in the office and OR recovery room from patients who were finally able to take this decision into their own hands and could now walk into their future with confidence and freedom.
Considering the procedure, but have more questions? My videos and book offer a deep dive into how tubal ligations work. Between the videos and the book, I cover everything from how we perform tubals and the risks (including whether “post-tubal syndrome” exists) to cost, recovery, and more.
Karen Tang, MD, MPH, is a board-certified gynecologist and minimally invasive gynecologic surgeon based outside of Philadelphia. She’s the author of It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told). As @KarenTangMD on Instagram, TikTok, and YouTube, she reaches millions of viewers each month with her educational videos about gynecologic health topics.
