So you wanna get a bisalp: The protips the pre-op doesn’t tell you

A few people in my extended social circles have asked me about my permanent sterilization experience, and I wrote so much that it turned into two posts. You can read my lived experience in the previous post here.

Let’s get to the practical parts, the frequently asked questions that no one ever seems to answer unless you go into the depths of the internet. I’m going to get down and dirty here.

The procedure

AFAB sterilization happens by clipping or removing the fallopian tubes so an egg has no way to travel to the uterus. Despite the term “getting your tubes tied”, no tying actually happens, no matter what form sterilization takes. Older forms of sterilization involves removing a portion of the fallopian tubes or putting clips on the tubes so the egg can’t travel to the uterus. But tubal clips can come off, so removing the fallopian tubes altogether (called a bilateral salpingectomy or bisalp) has become the gold standard. Those mofos are useless anyway. (Random fun fact, many forms of ovarian cancer start in the fallopian tubes, so yeeting the tubes significantly reduces your risk.)

This is surgery performed laparascopically. You’re under anesthesia for a couple of hours but you can go home from the hospital the same day. Gas gets pumped into your abdominal cavity and some tiny tools remove your fallopian tubes. You need a few days to recover before going back to work; I had surgery on a Thursday and was back to work at my desk job on Tuesday. (That Monday was a holiday. No complaints here.) You might feel like you can work the next day, especially if you work from home with a desk job, but I’m glad I had a few days off to recover. If you have a physical job, talk to your doctor first about what to expect.

Bonus: since your doctor is already poking around inside you, they’ll probably take a general look around your other reproductive parts. If you think you have endometriosis or something else, this is their chance to verify that and maybe remove what they can.

(I joked about keeping my tubes so I could display them. My doctor assured me I did not want to.)

Health insurance coverage

If you’re in the United States, ACA-compliant insurance plans are required to fully cover at least one form of female sterilization. Their words, not mine; I assume they mean AFAB sterilization. The type that your insurance covers may be different for each provider; I’m on UHC through my work and it was covered 100% with code 58661 (bilateral salpingectomy) for sterilization (diagnostic Z30.2). I did have to pay for an unrelated large polyp removal, which blew past my deductible in January. But hey, it could have cost a lot more. Thanks Obama!

For this reason, if you already know you want permanent sterilization, I recommend doing it sooner than later. Full coverage of elective sterilization is a recent addition, and that’s likely to change if Republicans get a trifecta in 2024. We won’t talk about all their other crap here.

Permanence and age

Since we’re talking about permanent sterilization, be absolutely sure you want to do it for you alone, not for anyone else and not solely as a knee-jerk reaction to current events. Long-term reversible birth control options exist for uterus-havers, and a permanent solution isn’t a choice to make lightly. If you’re unlucky, you may run into a doctor who suggests that your partner have a vasectomy instead if they’re AMAB. Going over the risks and alternatives is medically responsible; this is permanent surgery, after all. Trying to change your mind is not cool. Fight for your own autonomy.

If you’re really young (under 25 or so), you may have a hard time finding a doctor who will sterilize you. That’s the unfortunate reality. If this is the case for you, look at the doctors on the list who have performed similar procedures on young people. Bringing a sterilization binder can also help here if you’re going to an unknown doctor or if you’re especially young.

Because of the crapshoot that can be finding a doctor willing to perform such a surgery, I highly recommend starting with the childfree-friendly doctor list on Reddit. If you have success with a doctor not on this list, be sure to message the r/childfree mods to add the doctor so others can find them. I found my doctor on the list and she’s fantastic; I’m keeping her as my regular GYN because I needed one anyway. (Atlanta locals, hit me up and I’ll tell you who.)

Surgery prep and recovery pro tips

There are a zillion things that no one tells you in the pre-op or post-op paperwork that you wish you knew ahead of time. The paperwork and people will probably tell you not to drive yourself home and to have someone around you for 24 hours, but not much else. (One of my friends took the day off to drive me to and from surgery.) This list is a combination of what I’ve read on Reddit and my own experience; I’m not a medical professional, and I don’t play one on the internet.

Cut your toenails a day or two before surgery if they’re getting long. Trust me, you don’t want to bend over to do it later. If you have slip-on shoes for walking around outside, use those. Unfortunately for me winter is not sandals season, but I propped my feet against my trash can to put on shoes for the first week.

Do any chores in advance. It’ll feel really nice to have a clean house for the first few days after surgery. And if you don’t take out your trash the day before, the first time taking out your trash a few days later will suck.

If you won’t have another person to help with meals and fetching things in the first few days after surgery, have a plan for your meals. I cooked over a week’s worth of meals in advance and froze them. Make sure a few days’ worth of meals are within easy reach, especially if your freezer is one of those slide-out drawer freezers under the fridge because bending over sucks for the fist few days. (I hate it, for the record. But it’s too new and expensive to justify replacing now.) The hospital may recommend easing back into regular food over the next day; I ignored their advice and was fine because come on, I hadn’t eaten since yesterday. My friend and I ate takeout pho and eggplant after getting home from surgery, and I went back to my regular diet the next day.

Put the important stuff at a height that you can reach easily. This goes back to the difficulty of bending over. I put my ibuprofen and Gas-X on the bar in my kitchen instead of in a cabinet. My friend noticed my prescription meds at the bottom of my entryway shelf and moved them to my desk before she left. I did laundry the day before surgery and left the clean clothes in the basket on my dryer instead of putting them away so I wouldn’t bend over as much to get dressed.

Put the really important stuff where you plan on sitting or lying most of the time. For me, it was my couch so I kept my phone, laptop, chargers, heating pad, glass of water, laptop desk, snacks, and the TV remote on the side table. And then I had to disturb the nest when a friend came over to watch anime and play games and stay over Sunday night.

If you read the previous post or my Twitter updates, you may remember me talking about gas. Yes, it’s real, and after about a day the gas was worse than the actual pain. Bisalps are usually performed as laparoscopic surgery, which involves pumping gas into your abdominal cavity so the doctor can see everything. Some of that gas remains in your body after the surgery, and it takes its sweet time leaving. Be prepared. I found a heating pad for my shoulder and some Gas-X helped, along with some sodas so I could burp some gas out.

Move around a little bit if it doesn’t hurt too much, even if it’s just pacing around your own home. This helps with the gas that your body contains an excess of after surgery. You probably won’t feel like it for the evening or even the next day. I definitely didn’t. Be sure to drink a lot of fluids too; they’ll make you pee more often, which means you (hopefully) get up to do that.

I’ve heard that the good pain meds may make you constipated; I didn’t take any of those after getting home so I don’t have any experience there. I included a lot of beans in my meal prep, so I tackled any constipation in a different way.

Your doctor may tell you to wait a couple of weeks before having sex. There’s a reason for this besides the general post-surgery discomfort. Depending on where you are in your menstrual cycle, the egg you release during your menstrual cycle may still be floating around in your uterus, which is untouched during the bisalp. So yes, you could still get pregnant for a few weeks. There’s a reason I had to take two pregnancy tests during my pre-op appointment. If you want to play it very safe, wait until after your next period for any unprotected penetrative sex. Oh, and if your period is coming up right after your surgery, use pads. Don’t stick anything up there yet.

Remember my complaints about the pants problem? If you like dresses, your day has probably arrived. I work from home so I wear pajamas about 80% of the time. Low-cut pants that won’t bother your scars for the first couple of weeks are your best friends. It took a couple of weeks for me to wear anything besides sweatpants or pajama pants without bothering the belly button scar.

If you sleep on your side like me… prepare not to for a few days. I didn’t get much sleep for the first couple of days because of this. I did prop myself up with a bunch of pillows but this helped only so much because I’m so stubbornly a side sleeper. One of those small wedge pillows may help here if you have one.

Your scars from laparoscopic surgery are tiny and, after some time, barely noticeable. There are three scars, one inside your belly button and two off to the side. The ones outside the belly button are barely the length of a fingernail. My doctor used medical glue to cover my scars. It’s fine to get the glue wet, although you probably won’t feel like showering for a day or two. I let the soap wash over the area instead of rubbing over the glue directly for a week. After a week the glue starts to peel off on its own. Apparently it’s possible to have an allergic reaction to the glue, so let your doctor know if this happens. (It didn’t for me.)

This wasn’t the case for me, but you may notice a change in your hormones after surgery. This is normal and expected if you’re also coming off hormonal birth control at the same time, and I’d guess it takes some time to get used to. Otherwise you should notice no difference; your ovaries control your hormones and a bisalp doesn’t touch those. Whether to stay on birth control for other reasons is between you and your doctor.

How long until you can go back to your regular lifestyle? That depends on your lifestyle. I went to dinner with a friend a week after surgery (although pants were a problem). I did skip Pokemon Go raid hour for a couple of weeks, partly because the raid boss was meh and partly out of an abundance of caution so I wouldn’t wear myself out for the one I wanted to go hard for and the trip I took three weeks after surgery. If your lifestyle involves lifting weights or running long distances or massive Ikea runs, then you won’t be doing that for a few weeks. If you look around Reddit you’ll find people running around two days after surgery. Everyone’s recovery is different. Don’t judge yourself based on someone else’s easier recovery. Do what works for you.

And… that’s it! My post-op appointment was yesterday, and I gave my doctor the baby I found in a king’s cake over the weekend. She loved it.

I also got the all-clear to go skydiving and weightlifting. But until I actually start doing those things, I’ll stick to walking.

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