Some people unbox beauty products on TikTok; Sadie shows off surgical scars. At home in front of a bathroom mirror, wearing floral printed leggings and a chestnut brown sweater, Sadie pointed out three tiny incision marks coming on their belly button, and both sides of the hip.

Yep, you fucking heard it, Sadie (@sadieanneliza), a 26-year-old Uber driver from Denver who uses they/them pronouns, said in the video. Their voice slurredthey admitted to being fucking zooted off of pain medicationas they talked about the sterilization procedure theyd had earlier in the day.

They didnt just tie my tubes either, they fucking took them, Sadie went on. They took them from me, never, ever to be pregnant. Im fucking stoked. (Sadie asked that The Daily Beast keep their last name private.)

Sadie grew up in a religious family in Texas. They speak in the patient, lilting tone of a summer camp counselor. I was told that children are what fill up your life and make it worthwhile, they said. Youre not really a woman until you have children. As a kid, they always wanted to be a mom.

But then life got in the way. Sadie was diagnosed with rheumatoid arthritis (RA) during infancy, and spent their life taking harsh medications known to induce miscarriages. The unthinkable happened when Sadie was 16, got pregnant, and ultimately lost their twins. Years later at age 22, they were in a fluorescent doctors office, asking for a sterilization.

Sadie says the gynecologist said they would need permission from their then-husband to go through with the procedure; he declined. Were not married for that reason, and other reasons, Sadie said. When the marriage ended, Sadie moved to Colorado. On their way to town, they got in a serious car accident that caused an immune system flare up unlike the ones they were used to from RA.

Sadie felt strands of hair fall out by the fistful and noticed blotchy patches sprout all over their skin. Their nails turned black, then withered away. They finally saw another doctor, received another diagnosis: lupus, a particularly debilitating autoimmune disease.

At that point, I realized that if I were to get pregnant, it could literally kill me, Sadie said. Even if I were able to go to term, I would need a cardiologist, neurologist, rheumatologist, gynecologist, and I would still be high-risk.

And if they had a baby? Just think about all the extra loads of laundry Id be doing, the car seat Id have to carry, the stroller Id push, Id have to pick up my kid, take them to practice, and be able to financially provide for them. It makes less and less sense the more you think of it.

Sadie describes a grieving period, where they came to terms with a child-free future. But the hardest part was yet to comeSadie never knew how difficult it would be to ask doctors to sterilize them.

Ive seen seven or eight doctors, they said. I had to fight for it for several years.

Sadie is not alonetheir video quickly hit over 34,000 views on TikTok, with thousands of women taking to the comments to party along with herand maybe project a little envy, too.

I want this soooo bad, one said. But my gynecologist doesnt want to...Been asking this for the past 4 years now.

Please tell me the secret to convincing a doctor to accept that you want to be surgically sterilized, another begged. How did you do it?!?!?!?

#Sterilization has been viewed on TikTok over 29.5 million times. #FemaleSterilization has nearly 930,000 views. #ChildfreeByChoice, a related hashtag, has almost 6 million.

Sadie describes a community on TikTok and Reddit of women and non-binary people tired of getting turned down by doctors for the sterilization procedures they desirean undiscussed facet of the pro-choice movement.

The r/Childfree subreddit, a page which refers to those who do not have and do not ever want children (whether biological, adopted, or otherwise) boasts 1.3 million members. The page links to a much-loved, regularly-updated Childfree friendly doctors list that breaks down practices in each state where women have had success getting sterilizations.

Sadie added their OBGYN, Dr. Lindsay Eun of Westside Womens Care in Denver, to the list. I felt on top of the world [post-op], they said. I felt validated, liberated, seen, and listened to. But the more I thought about that, I got pretty angry. This procedure in my life should not have been some grand victory. Its nothing more than adequate healthcare.

One of the risks for sterilization is the potential for regret.

Sadie ended up getting a bilateral salpingectomy, or the surgical removal of both fallopian tubes. Thats a different procedure than a tubal ligation, colloquially known as getting ones tubes tied, where the fallopian tubes are cut, tied, or otherwise blocked.

But both types of sterilization have the same, permanent, desired outcome: the prevention of pregnancyforever.

The American College of Obstetricians and Gynecologists (ACOG) cites sterilization as the most common form of contraception for married couples. The CDC found that 18.6 percent of American women age 15-49 have been sterilized, with the rates increasing with age. Just over 4 percent of women between 20 and 29 had had the procedure. But 21.6 percent of women age 30-39 were sterilized, compared with 39.4 percent of women age 40-49.

The procedure is frequently scheduled postpartum if a woman decides she does not want to have any more children. One study found that 700,000 surgeries are performed annually, half of which are performed 48 hours post-partum. Ten percent of births in this country are followed by a sterilization. When done correctly, it is a normalized, basic procedure.

But given the United States shameful history of compulsory sterilizations and eugenics aimed to reduce the rate of certain mental and physical disordersprocedures that unfairly targeted the poor or people of colormany gynecologists are hesitant to sterilize women under 30.

This week, the Dutch government apologized to trans and intersex people impacted by a law that ran from 1985 to 2014 that required they agree to sterilization before being able to legally change their gender. The victims were awarded a compensation of 5,000 euros (around $6,000) each. In 2018, Sweden issued a similar payout.

In the U.S., a woman must be 21 to get a sterilization covered by federal funds such as Medicaid or the Indian Health Service. (That age restriction does not apply to those with private insurance.) The procedure can cost up to $6,000a vasectomy, for men, runs about $1,000.

ACOGs official guidelines encourage doctors to discuss the risk of regret with patients. A survey cited by ACOG followed women for 14 years after the operation and asked how they felt about their sterilization. Around 20 percent of women who got the procedure before they were 30 reported feeling regretful; only 6 percent of those above that age felt the same.

I want to be very, very clear: I do not mean that everyone who gets a sterilization when theyre younger regrets it, Jennifer Villavicencio, MD, MPP, an ob-gyn and the Darney-Landy Fellow at the American College of Obstetricians and Gynecologists, told The Daily Beast. But as with any treatment you engage in, there are risks and benefits. And one of the risks for sterilization is the potential for regret.

When any patient asks Dr. Villavicencio for a sterilization, she asks them to start from the beginning.

I want them to tell me about themselves, and I want to get to know them and understand why theyre coming to this decision, she said. I ask a lot of questions and try to get a sense of where theyre at.

We have an unfortunate trend in this country of not really trusting women or people with reproductive capacity to make decisions about their reproduction.

Dr. Jenniver Villavicencio

But Dr. Villavicencio acknowledges that not all doctors feel similarly. Ive had patients who have come to me saying three doctors would not do the procedure, she said. We have an unfortunate trend in this country of not really trusting women or people with reproductive capacity to make decisions about their reproduction.

Its common for doctors to tell young women who ask for sterilizations to consider therapy. Its frankly absurd to suggest that just because someone is 21 and doesnt want children needs therapy, Dr. Villavicencio said. That being said, given this is a permanent procedure, I have a conversation with patients about the context in which theyre seeking this decision.

Shes seen patients requesting sterilization who have a history of severe depression, or who are experiencing domestic violence in their relationship. Permanent contraception might make sense in those circumstances, but it will not fix the underlying problem.

There have been scenarios where Ive said, do you think it makes sense for you to speak to a therapist before we move forward? Its not a recommendation, but its something Ive brought up when the context suggests it could be helpful, Dr. Villavicencio said.

Women who are on Medicaid are required to wait up to 30, but no more than 180 days, after their consultation before getting a sterilization. This federal law theoretically prevents low-income women from undergoing compulsory procedures. But women with private insurance have no such restriction, which makes many see the waiting period as discriminatory.

Any time individuals face barriers to receiving care, it is under-resourced and marginalized communities who bear the brunt of that, Dr. Villavicencio said. Young people fall into that category. There are so many thoughts, opinions, and beliefs about what they should be doing with their bodies.

Dr. Jennifer Lincoln is an OBGYN in Portland, Oregon, and something of a sex ed influencer with 1.4 million followers on TikTok. She has made videos on the app debunking the myth that a womans spouse must consent to her sterilization procedure. In an interview, she said that doctors cannot hold someones fertility hostage until theyre 30 as long as the patient understands all risks.

Its great to see that people are talking about it on TikTok and opening up about the right to their fertility, Dr. Lincoln said. Its not that you need to be a woman with kids in order to be a good member of societyyou are in charge of your own fertility.

In a few days, Lindsay Hull (@lindsayloohoooo) will celebrate the one-,year anniversary of her sterilization. She found her Phoenix, Arizona gynecologist on the r/Childfree list. You would think it would be easy to go ask for something like that, but I had to go to three or four different doctors before I found one who actually listened to me when I talked, Hull, who is 26 and works as a videographer, said. It wasnt the easiest thing to do.

It was the same thing every timedoctors telling her she was too young, she should wait a few years, with some even asking What would your future husband think?

The answer: He wouldnt be my future husband if he didnt agree with me on this subject, Hull said. I grew up in a really small town where everyone had this thing where they would follow the same template of what you need to do in your lifego to college, do a career, get married, have kids. I decided I didnt want that.

Hull is currently engaged to a supportive fianc. Back when she was dating around, the topic of sterilization would most definitely come up. In your late twenties, people start thinking about getting serious and having kids, she said. I always let whoever I was seeing know that I dont want kids and that was not something I was going to budge on. One person thought I was going to change my mind, but I wasnt.

Before her sterilization, Hull took birth control for about 10 years. Sometimes she forgets about her procedure and thinks, Oh, its time for me to take my birth controlwait, I dont have to do that anymore.

Hull says its common for her to receive unsolicited commentary from people she tells about her procedure. People have told her, to her face, that shell regret her decision.

They ask, What if you change your mind? Then I say, What if I got pregnant, and I tell you Im going to have the childwould you say the same thing, that I was going to regret it or change my mind? No, you would never say that. So why are you doing it this way, now? Hull explained.

None of the people who spoke with The Daily Beast for this story said they ever regretted their decision to go through with a sterilization.

Montana Blum (@toiletbowlgod), 24, lives in Northern Virginia, and is a full-time college student studying business management. (Blum is non-binary and uses they/them pronouns.)

For me, having kids just isnt in the picture, and Ive been saying that ever since I was 15, Blum said. A lot of people laughed it off and said theyd change your mind. A lot of us non-binary people get a partial hysterectomy for our dysphoria. After I did a lot of research and learned the loopholes Id have to jump through, I managed to get my tubes removed at 21. But Im still currently looking for a doctor to do my hysto. (A hysterectomy is the surgical removal of the uterus.)

Its hard for trans and non-binary people to get reproductive health care. A lot of doctors either invalidate it or ignore it, thinking well change our minds. In their eyes, its a mental illness to not want children.

Montana Blum

Blum currently sees a therapist who is on board with providing a gynecologist with a note that supports their decision to get a hysterectomy. Its hard for trans and non-binary people to get reproductive health care, Blum said. A lot of doctors either invalidate it or ignore it, thinking well change our minds. In their eyes, its a mental illness to not want children.

Though Blums family is on the conservative side of things, their mother has supported the choice to be child-free. When people ask about my choice, I say, Why on earth are you worrying about my fertility? Blum said. Its odd. People think that they are owed insight on your family planning. Its the same for those who want to be a parent, too. People dont have a right to those things.

Though their work on TikTok, Reddit, and various Facebook groups, Blum says theyve helped over 40 trans, non-binary, and cis people get sterilization procedures. I have cried about it, they said. It has made me really happy. A lot of people have been trying for 10 years, seen over 30 doctors, and finally found one through me. It helps a lot knowing they have this option.

Blum recommends people searching for sterilizations to try teaching hospitalsthose tend to be more progressive. Obviously womens clinics and anywhere that is queer-friendly is a good start, too. In conservative states, access can be limited. But liberal bastions are not quite havens for sterilizations, either.

I helped someone who wants a procedure recently who lives in California, Blume said. A lot of gynecologists there tell people to just keep having abortions, that thats empowering. My friend had five gynos who fed her that propaganda. When she finally found a doctor [who would perform her sterilization], they said, Thats the reputation for California. They are very liberal, and just pro-abortion.

Feminists dont like to admit it, but feminism is rooted in cishetero-normativity, Blume said. Pro-choice only focuses on abortion. Nobodys saying thats a bad thing, but there are other health-care issues, too. I myself as a childfree person has been criticised by conservatives but also by feminists who are pro-choice. Theres a lot of hypocrisy.

When anyone with a reproductive system chooses permanent contraception, they reject the age-old ideal that has been thrust upon women since the Virgin Birth: being a mother is their highest calling. Of course, that is not true for everyone. Still, those who desire sterilization before experiencing parenthood are encouraged to wait it out, just in case.

Sadies partner is a 23-year-old man who knew his whole life he never wanted to have children. This year, he asked his doctor for a vasectomy.

He went to one doctor, one single doctor, and said, I want a permanent, irreversible vasectomy, Sadie said. They were like, Cool, sign the papers. They had him in and out in 30 days. No one raised an eyebrow. Hes three years younger than I was when I got my sterilization. When I was his age, I was begging doctors for a similar procedure and they looked at me like I was crazy.

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Meet the Women Telling Their Sterilization Stories on TikTok - Daily Beast