You should check out the E-sure procedure. I had it done about a year ago. It is almost completely painless, no recovery time, nothing. You go in like a pap smear (stirrups, etc), doctor uses some fancy equipment to insert a tiny little coil into your fallopian tubes, you go home. 2 or 3 months later you go in and have an xray done where your doctor shoots some dye into your uterus. This is to see if there is any leakage into the fallopian tubes. If there's no leakage, you're good to go. If there is, you wait another 2 months and go back for another xray. During the time between the procedure and the xray you are on birth control. The way it works is that your body will grow scar tissue around the coils, thereby blocking the fallopian tubes. It is ranked right up there with a tubal for effectiveness. My friend did it at the same time I did and both of us would do it again in a heartbeat. When I had it done it was a fairly new procedure at our hospital, so they required that it be done in the OR under general anethesia. Now they do it in the office with a couple pain pills.