Identifying a female-sterilization-friendly gynecologist

January 15, 2013 7:55 AM

Looking for a gynecologist who will not give me--28, no kids, not in a relationship--a hard time about getting a tubal ligation. How I can ascertain this from the website, a phone call, or (if necessary) the first visit? Maryland/DC area.

Email: [e-mail]

I am specifically not looking for any answers here attempting to talk me out of this decision.


I've recently moved and need to find a gynecologist for my annual checkup in the Maryland/DC area--Gaithersburg, but I'd consider driving a bit for the right doc. I want to have a tubal ligation in 6-12 months (when I hope to have built up more of a social network in case the recovery is rough).

This is something I decided to do three years ago, and I've never wavered. But I've been putting it off because I'm anticipating the kind of patronizing age- and marital-status-related reactions described in this thread. Several women in that thread were operated on by doctors who blatantly disrespected their choices, and I don't want to have to swallow a bunch of bile as I'm going under the knife.

Ideally I would like to figure out from the website or from calling the office whether the doctor's attitude is a good fit. I imagine that the receptionist can answer questions about what procedures the doc performs, but not so much about attitude--even if they have some idea, I'd expect them to be cautious about weighing in since the doc's attitude could somewhat understandably depend on my presentation and explanation of my situation**, which I think are reasonable.

I thought that advertising abortion as a service might be a good indicator, but the gynecologists I'd tend to go to for regular checkups as a person with reasonable insurance don't seem to do this. And if they advertise sterilization it's kind of a "we'll tie your tubes while we're in there doing your second Caesarian!" thing, so it's unclear what they'd think of my case. Providers who advertise abortion services online seem emergency-oriented and don't also advertise sterilization. Is there some other indicator I should look for? Do docs do email or phone conversations with prospective patients?

If pre-visit screening attempts are unsuccessful, I'm afraid that what'll happen is this: I go to someone for one of those long new-patient appointments. Either before or after the doc sticks his or her hand in my vagina, we talk about birth control and I bring up my intention to be sterilized and the doc refuses. Then I have to overcome increased anticipation of anger and pay out of pocket for appointments with different docs until I find one who's amenable.


**Personal details:

I was on hormonal BC for 8 years and at the end was spending several hours per day crying, which stopped within two weeks of removing the last Nuvaring. Off HBC, my periods are not super regular--the reason for starting it at 16--and it's common for several months to pass with only a few episodes of light spotting. I feel good now and value my mental health too much to try any hormonal treatment again, either for contraception or for the irregularity. But basically, if I'm having intercourse I'm a wreck either because of HBC or because there's rarely the assurance of menstruation that I'm not pregnant. I don't trust condoms alone. Yeah, there are non-hormonal IUDs, but if I'm going to have a Procedure, I'd like to just get it over with and be free!

Since I was 19, I've had four relationships lasting 1-2 years each. All four guys wanted children and it was a major source of incompatibility--when I was younger because I didn't really want them but thought I might have to have them to keep the guy, later because I'd done more thinking while single and was sure I didn't and had said so...and the last two were just kind of waffling around hoping I'd change my mind. Two offered to be stay-at-home dads and that arrangement held no appeal. So I don't even want to date anyone until I've been sterilized: I won't have to worry about pregnancy and it will be clear that I'm serious about being childfree. The whole "what if you meet someone" thing--I already had that conversation with my mom, thanks, and I didn't mind her asking--but hearing a potential mate talk about wanting children is a massive turnoff. And all of the people I want to sleep with have sperm-injectors, so...

posted by anonymous to health & fitness (12 answers total)

Planner Parenthood does this.
posted by DarlingBri at 8:00 AM on January 15 [2 favorites]

If you don't have a handy Planned Parenthood, you might also try searching for reproductive health clinic rather than abortion provider. That may help you find the clinics that also provide regular well-woman GYN care and various contraceptive options.

I switched to a local non-PP reproductive health clinic when I was looking to get an IUD without the whole but-you-don't-have-kids-yet fight, and it was a really good way to go. (PP is lovely too, I used to be a clinic escort there and support them whole-heartedly, but the local place is more convenient to me. Plus, hey, local business and all.)
posted by Stacey at 8:17 AM on January 15

FYI, my GYN was opposed to doing a tubal because she felt IUDs were safer and more effective. She wasn't against the permanent birth control aspect (even for a young nullip) but thought the increased risk of ectopic pregnancies was not worth it. Also, if a ligation/Essure fails, you don't know about it unless/until you get pregnant, whereas usually with an IUD you'd notice.
So be aware that you may receive pushback on the specific type of procedure, even if you find a GYN who's supportive of your plans and desires.
posted by katemonster at 8:23 AM on January 15 [5 favorites]

I think you'll have better luck looking for someone to do an Essure or Adiana procedure --- these are less invasive and less risky than tubal ligations but are also permanent.

These will also be cheaper than tubal ligation, and I know my health insurance does not cover any sterilization procedure for men or women. So you should do some cost comparison if money is remotely a concern.

As for finding a doctor, I agree that Planned Parenthood is probably a good start.
posted by zizzle at 8:28 AM on January 15 [1 favorite]

might be worth a look to go on a childfree internet forum and ask female users in your area who are sterilized to recommend an OB/GYN for you?
posted by zdravo at 9:22 AM on January 15

Capital Women's Care is the name of the place I go and they advertise on their website that they will do tubal ligations. I haven't specifically asked about this method (since I'm quite happy with my HBC at the moment), but they have always been friendly and open with me when discussing various options. Their office is in Rockville, but that's close enough to Gaithersburg.
posted by sperose at 9:42 AM on January 15

I'm afraid I can't help you in your search for a doctor as I'm in the UK. However I was very similar to you. I came to the realisation when I was 12 that I was childfree. I promised myself that if I still felt strongly about never giving birth that I'd ask to be sterilised when I was 30. So in 2009 I felt even more certain that I didn't want children and asked my GP if I could be sterilised. Obviously they have to ask all the questions as they need to make sure you realise the implications. I was asked about whether other forms of birth control would be ok, what I'd do if I suddenly decided I wanted children etc.

I'd done a tremendous amount of research into birth control so could explain why I didn't like/want to use that method. I also stated that when I was 12 I decided that even if I did one day want children that I'd never go through pregnancy, choosing instead to adpopt a child who needed a home. I am also phobic about everything to do with pregnancy, childbirth and babies. The mere thought of being pregnant makes me want to scoop my uterus out with a rusty spork.

Thankfully my GP refered me for sterilisation and within a few months I was sterilised. I can honestly say it's the best thing I've done for myself. And I've never regreted it. So I'd suggest having all that knowledge about BC etc in place before you go. I wish you the best of luck in finding a good doctor who's willing to do the procedure for you.
posted by Ranting Prophet of DOOM! at 9:53 AM on January 15

Here is a list of Planned Parenthood locations near Gaithersburg, although it should be noted that only a fraction of PPs perform permanent sterilizations (ex: not a single PP in the entire state of Wisconsin offers this service).

It looks like the PP location nearest to you that offers permanent sterilization is the downtown DC location, which performs (non-surgical) Essure insertions but not tubal ligations.
If Essure is not a suitable alternative to a tubal for you, I'd bet PPMW has a list of friendly, non-judgmental surgical referrals. Unfortunately, Adiana was discontinued in April 2012, partially due to a copyright infringement lawsuit by the manufacturers of Essure; however, some doctors still have them in stock, so if you have a nickle/other metal allergy but are still open to a non-surgical solution, that may be an option as well.

I'm 30, I've shared in your goal since I was in kindergarten, have always had completely nightmarish reactions to HBC, and have always actively and openly disliked children, even when I was one... but I have yet to find a single doctor who will give me full control of my reproductive status because I haven't had children yet. Indeed, my most recent GP simply offered me a Mirena IUD when I asked for a sterilization referral -- it's crazy-making. The constant, silent accusal that you do not know your own mind or your own desires never gets any easier to swallow.

Overall, I get the impression that a branch of PP is the least likely of any clinic in America to give you any kind of grief about taking control of your reproductive future (or blissful lack thereof).
I've got my fingers crossed for you, good luck in your search!
posted by divined by radio at 10:24 AM on January 15

Not to be a wet blanket, but I wouldn't count on Planned Parenthood green-lighting the procedure without some push back. I went to my local PP, in a *very* liberal West Coast city, and was initially denied consideration for an IUD...and I was age 42 at the time. I had to kick up a fuss to have them take my choice seriously.
posted by nacho fries at 1:18 PM on January 15

If the already-mentioned options don't work out, perhaps you can call around to various doctors to ask if they do "Get-to-know-you" appointments. I think you have to pay a small amount for these, but they are simply for meeting your potential doctor and asking them questions so you feel comfortable signing on with them.

I had such an easy time getting my TL; at age 24 I'd had a worrisome scare with a condom, didn't want pills, and had reasons and research very similar to Ranting Prophet of DOOM. I recall I had brought along to my appointment a thick library book on the efficacy of various birth control methods & sterilizations, knew which one I wanted and why I didn't want others. I asked my regular doctor about a tubal ligation, he asked questions, I told him all the above, he referred me, same sort of interview with the surgeon (not a gynecologist IIRC as it is laparoscopic surgery) who did the procedure. I got Hulka clips, (not sure if they're as popular nowadays) because that's what that surgeon preferred.

I hope you find a willing doctor easily.
posted by Anwan at 2:17 PM on January 15

A close friend of mine who is your age and also has no kids recently had Essure performed by Dr. Ellen Whitaker here in DC. She recommends Dr. Whitaker without hesitation.
posted by noonewilleverloveyou at 2:18 PM on January 15

As katemonster mentions, even a doctor who's entirely open to semi-permanent and permanent options may not think a tubal ligation is the best choice for you. My own experience: after the first attempt to install an IUD failed (it slipped out of position after a few days), I thought a tubal was my only option, as I'm seriously allergic to nickel and so not a candidate for Essure. The doctor I met with, who IIRC was the OB/GYN chief, wasn't enthusiastic about that. "A tubal ligation is abdominal surgery under general anesthetic. It's a surgery we do a lot of and we're good at, but it's still abdominal surgery." (He persuaded me to try a second attempt at inserting the IUD, this time using a transuterine ultrasound to be sure it was placed correctly. Six-plus years later, following successful insertion and an interesting oh-so-that's-what-my-uterus-looks-like view of the ultrasound screen, I'm an enthusiastic cheerleader for Team I Love My IUD.) So you may get some pushback, even if it's not coming from a paternalistic attitude of "we know women are fickleminded and will change their minds about sterilization".

That said, my own inclination would be to do as much research as I could, so I could (for example) cite what the current recommendations from the American Congress of Obstetricians and Gynecologists are. Here's a Salon article that might be helpful, too: Why is it so difficult for young women to get their tubes tied?
posted by Lexica at 5:26 PM on January 15