Permanent birth control

Timaree answers your questions

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Sex advice shouldn’t be syndicated. We wanted a local feel to ours so we’ve enlisted the sound advice of resident sex professor Timaree Schmit. Have a question about your love life that needs answers? Email her at asktimaree@philadelphiaweekly.com. | Image: Redlite photos

“I’ve known that I’ve wanted to do this since my late 20s,” says Emma D’Arcy of her decision to get tubal removal surgery, a permanent method of birth control. 

She says: “I am very comfortable and happy being by myself, and I don’t have an overwhelming urge or need for dependents.”

The Fairmount resident has faced a lot of strange reactions about this choice, especially when she lived in South Carolina. 

“Everyone is married young and has multiple children,” she says of the region, adding, “The idea that a woman in her 20s would elect to not have children or get married is about as normal as a two-headed snake.”

It’s one thing to have family or community members not understand, but quite another when medical professionals respond dubiously. D’arcy said she had otherwise good doctors but “When I would ask about what my options were for permanent sterilization, I had been told, ‘but what about your husband, what does he think?’ even though I was neither married nor in a long-term relationship.”

One doctor, after going over the surgical risks of the procedure, told her, “But the biggest risk of all is the risk of regret.” 

“The idea that a woman in her 20s would elect to not have children or get married is about as normal as a two-headed snake.”

She is far from alone in this experience. Women have reported being turned down by their doctors for a variety of long-term contraception options, including IUDs. The rationale is not lack of effectiveness – because intra-uterine devices and surgical sterilization are the most effective methods available. The issue isn’t safety either – modern IUDs and tubal surgeries are safe for most patients.

Some medical professionals still hold misconceptions about IUDs, according to survey data. There are those who mistakenly believe the devices aren’t safe or able to be used by those patients who have never been pregnant or given birth. There are other reasons though, too, like a religious objection to the use of birth control.

Even if you or your doctor does not belong to the Catholic church, this can still be an issue if they operate out of a Catholic hospital. For many Americans, the only nearby option for medical care may be a Catholic-run facility, especially in the Midwest. For others, insurance designates this choice for them. 

As a result, patients can be denied contraceptive devices or having them removed, be refused sterilization surgeries, or given substandard care when miscarrying. If you want to have a surgical sterilization performed while you’re already getting a C-section, for instance, a Catholic hospital would refuse, requiring an entirely separate and needlessly dangerous second surgery.

Another reason that a doctor might refuse a request for long-term contraception can be the belief the patient might regret the decision. There is limited – and largely dated – data about how many people regret their surgical sterilizations. Women who have these surgeries before the age of 30 are more likely to regret the decision than if they do it later, but the percentage is still a minority. 

This paternalism extends to men in some ways as well, since married men seeking vasectomies are often required to get their wife’s written permission, even though there is no legal requirement to do so.

“It is absolutely possible that a person might regret any major life decision, of course: including having children. The key is taking time to think and getting education to make an informed selection.”

It is absolutely possible that a person might regret any major life decision, of course: including having children. The key is taking time to think and getting education to make an informed decision. 

For Emma D’Arcy, the decision of permanent sterilization was something she came to after much thought, as well as a variety of negative experiences with other forms of birth control. She says being on the pill made her depressed, she suspects her IUD caused UTI and bladder issues, and the Essure device – which involves metal coils in the Fallopian tubes – was taken off the market just before she was able to get it. 

When she tried a hormonal implant, she says, “it changed my personality, ruined my then-relationship, destroyed my sex drive and caused me to pile on over 40 pounds.” 

“Knowing that I was sure I never wanted children, I decided a permanent solution was needed,” she says, adding, “I also would rather rely on myself for birth control than a male partner, so having my tubes removed was the best option for me.”

After she moved to Philadelphia, the 33-year-old got a new doctor and asked about permanent options. She says she was “fully expecting the usual third degree,” and “was really surprised, but pleased, that she laid out all my options for me clearly and without a hint of judgment.” 

Her new doctor asked about the other methods she’d tried and made sure she understood the permanence of the procedure. According to D’Arcy, she was told that IVF would potentially be an option in the future if she changed her mind about getting pregnant, but it would be expensive and not covered by insurance.

“I felt heard and understood,” she says.

“I finally felt like I was able to make a decision for my body and my life. It was a very comforting feeling.”

For those who are seeking long-term contraception – or any medical procedure – and are refused, don’t give up. First, tell your doctor to note in your chart that you asked and were denied. Make it clear that you have done your research by detailing your understanding of the risks. If necessary, try another doctor or hospital. Long term, when looking at potential insurance plans: consider what hospitals will be in network.

Have a question for Timaree? Send an email to asktimaree@philadelphiaweekly.com.

  • Timaree Schmit Headshot

    Timaree Schmit is basically an episode of Adam Ruins Everything, but in the shape of a person. She has a PhD in Human Sexuality Education and years of experience in community organizing, performance art, and finding the extra weird pockets of Philly.