Sterilization, a lost friend, and body autonomy

Why I'm having my fallopian tubes removed next month

My fallopian tubes are about to exit stage left. In doing this, I’m ensuring that I’ll never get pregnant. As an added bonus, I’m reducing my ovarian cancer risk by 80%. And yet, it took going to two different doctors before I could get the surgery I wanted.

I’ve heard about “getting your tubes tied” since I was in college. Friends would talk about their moms or aunts having the surgery. It seemed like a good idea. The idea of being a mom had never appealed to me, and after getting pregnant on the pill my first year of grad school and having an abortion (100% the best possible choice for me), I was crystal clear I never wanted to get pregnant again. But then I heard about this magical device called an IUD (intrauterine device) that prevented pregnancy 99.5% for up to 5 years and as an added bonus, it can stop your periods. At least, the one I was looking at—Mirena. I had the insertion and it was HORRIBLE but I made it through and I remember thinking, “Yes! I’m baby proof!” That was 2009. I worked for Planned Parenthood in 2013 and we got free reproductive healthcare as a perk of working there, so I chose to switch out my IUD early knowing I was going to be moving to California that year and wanting to buy myself an additional five years. Sometime in that window the FDA announced that it would actually work for 6 years so in September 2019 I took myself to a clinic and got another fresh IUD. Each time, the insertion process was insanely painful to the point of having vasovagal reactions—getting dizzy and feeling faint. There was no pain management offered other than suggesting taking ibuprofen in advance, and even the kindest doctors would just look at me sympathetically and say “it’s just a pinch, it’ll be over soon” as they clamped my cervix with a tenaculum and dilated it to accommodate the insertion tool. Maybe it’s time to consider something permanent, I said to myself. But I loved having no periods! I would watch my friends lament about their cramps and bleeding through their favorite clothes and having to either abstain from sex or make peace with, as one friend put it, “crime scene sex,” and I would count my lucky stars I didn’t have to deal with any of that. Still…this insertion process was so miserable. Besides, a new lover mentioned that the IUD strings would poke him when we had sex and it was really painful for him. I know all about painful sex so I empathized.

Last summer I went to a new gynecologist and told him I think it might be time to start discussing permanent birth control. After Roe v. Wade was overturned in 2022, it felt more pressing and relevant than ever to have complete control over my body in the ways I was still able to. I’m a sexual health nerd, and big on self advocacy, so I read up on my options. There is the traditional tube tying, otherwise known as a tubal ligation, but I came across another option: a bilateral salpingectomy. That’s when they don’t just clip and cauterize the fallopian tubes—they remove them entirely. I read about that option on OCRA’s Instagram page. OCRA is the Ovarian Cancer Research Alliance. They’re a non-profit I started following after my best friend died from ovarian cancer in February 2022. She asked that donations be made to them in lieu of flowers. So I’m having this conversation with my gyno. He’s open to the idea of sterilization, since I’m 38 he’s taking my wishes more seriously than most doctors would have if I were 28. (The emphasis on wanting kids as the norm and this archaic need to “preserve your options ” is a whole other topic that I’ll rant on at some point). But he did say that if I enjoyed not having my period, I should stick with the IUD. When I brought up the salpingectomy option, he said he does tubal ligations. “I read that it reduces your ovarian cancer risk significantly,” I pressed. He dismissed me. “Those studies only show a negligible benefit,” he said curtly. I tabled the discussion at that point. “Let’s revisit this at another appointment,” I said. Then life happened. I put it out of my mind. I was focused on other things.

But when it became clear that Trump was definitely seeking another term, and worse, his poll numbers were strong and people were starting to wonder if Biden had the political capital to beat him, I suddenly felt an urgency I hadn’t felt before. Even when Biden withdrew and Harris became the nominee this summer to everyone’s relief, I was still concerned. I’d been watching and reading Jessica Valenti cover the fallout of the Dobbs decision (the case that overturned Roe) and it’s getting really fucking scary out there. I have no doubt that if Trump wins, it will be the end of reproductive rights as we know it. And also democracy. Register to vote and vote for Harris!

Then there was the other factor weighing on my mind. Ovarian cancer killed my best friend. She was only 36—diagnosed at 31. They had given her roughly five years to live and she got every one of them. But five years is nothing in the grand scheme. I wanted fifty years with her. Her name was Joanne. We met my first year of college at St. Joe’s when we both pledged AOII. She was my sister literally and figuratively. We bonded over feeling out of place at a fancy private school where most of the students had gone to prep schools and wore designers. We were both public school kids. After college she went to law school. She moved to Florida and became a public defender outside of Fort Lauderdale, spending her career defending those who had no one else. Even when she couldn’t go to the office any longer because the chemo made her too weak and nauseated, she would work from home. She was so supportive of me, so proud of my career. When I was too stressed and depressed to eat, she would send me saltines and ginger ale (my go-to “safe foods” when I can’t eat). When I had media opportunities, she’d send me a postcard encouraging me and a gift card for Sephora so I could get make up. She was amazing and I miss her every day. When I go back to Pennsylvania, I always visit her in the cemetery and bring her red roses—the symbol of AOII. My other best friend Lea, also an AOII although she went to Penn State, went to Joanne’s funeral for me because I couldn’t afford a last minute flight. Thanks to the tech upgrades of the pandemic, I was able to watch her funeral on livestream. It was surreal. I cried and cried. I developed a new understanding of and relationship to grief. And I vowed to honor her memory in every way I could. Including, it seems, to pick the sterilization option that will give me the greatest protection from ovarian cancer. (That gyno was wrong, by the way. The 80% statistic is legit. “A Harvard expert agrees the approach is sound, considering established evidence that many cases of aggressive ovarian cancers arise from cells in the fallopian tubes.”)

Last month I went to see a new OB-GYN. She (yes, in this case I do have a hunch that gender matters) was very supportive of my wish to have a bilateral salpingectomy and echoed the same ovarian cancer statistic. After a few quick screening questions required by my insurance to make sure I wasn’t being coerced into the surgery, she explained the procedure and said that her office would be calling me to schedule the surgery. The date is set for October 23rd and I’ve decided to have a sterilization shower to celebrate. Another friend suggested calling it a “fallopian fiesta” which made me giggle. I figure, I’m never going to have a baby shower. Why should I be denied these “milestone celebrations” (with presents!) just because I don’t want kids? I want to travel the world. I want to eat sushi. I want to soak in hot tubs. I want to spend my hard earned money on myself. And gods dammit, I want to be celebrated for that decision. So stay tuned on the party date and the registry links. I know for sure I’d like to have airline miles on United or Delta so I can finally visit Europe next year—a lifelong dream. But well wishes are also appreciated!

The surgery is laparoscopic (they go in through an incision in my belly button and a small incisions on each hip. I’ll be under general anesthesia but it’s an outpatient procedure). My brother is flying in from Austin to drive me and take care of me after the surgery and it’s such a relief. One of the weird side effects of all of my lovers being long distance is that I don’t have a go-to “I’ll take you to your surgery and take care of you afterward” person. It’s a big favor to ask a friend (although my babes Michelle and Kirstie have also offered to come check on me and I appreciate them so much!)

I’m so excited to be able to exercise this option. I’m happy to do my part to reduce my ovarian cancer risk and raise awareness about it. And I’m delighted to normalize choosing sterilization as an option for those who know they don’t want kids or are done having them. Especially for those of us who can carry them who are in very real danger if we want to terminate a pregnancy (for any reason, including medical reasons) in restrictive anti-abortion states.

Please educate yourselves. Please support reproductive rights. Please vote.

If you want to send me presents to celebrate my sterilization surgery, here’s a link to my Amazon gift registry. Venmo is also welcome! @Ashley.Manta ❤️

---

🌕 11/14 Cosmic Connections mixer (and Farewell Fallopian Fete) at BSPOKE/LA

The Cosmic Connections mixer was created with the intention of bringing sex positive people together. All are welcome, no matter where you fall on the kinky, queer, or non-monogamy spectrum (including not being any of those!) Immerse yourself in an evening of relaxing vibes and engaging conversations. This month we will have a sound bath by Danny Santos, chair massages ($20 for 10 mins) provided by Antone of Royal Treatment Wellness, activations from Autumn Brands, and more!

Meet our curated vendors who will showcase their incredible products and offerings!

In partnership with Los Angeles LGBT Center (safer sex and harm reduction kits will be available)

Admission is free and cocktails are too! 21+ only

Date: Thursday November 14th
​Time: 7:00 PM - 9:00 PM Pacific
​Location: 439 N Fairfax Ave Los Angeles (BSPOKE/LA)
​Cost: FREE! And free open bar!

---