Making the decision to permanently prevent pregnancy can be as powerful as the decision to have children in the first place. Individuals should discuss carefully with their partner, physician, and/or a therapist who specializes in fertility issues.
People usually choose sterilization when they feel their family is complete and want freedom from worrying about accidental pregnancy. They may also wish to avoid passing on hereditary diseases, or they have a health condition that might make pregnancy dangerous.
It’s important for you and your family to know the basic information about the common forms of permanent birth control and points to consider when making the decision.
Tubal ligation or occlusion
In a tubal ligation, a portion of the fallopian tubes is cut, burned, or blocked by the placement of a ring or clip. This can be done when a C-section is performed or as a separate surgery. A tubal occlusion procedure such as the Essure procedure is when coils are placed into the fallopian tubes. Scar tissue then grows into the coils, thereby blocking the tubes. This surgery can be done in an office setting and is done through the cervix, so no abdominal incisions are needed. Both of these methods prevent the woman’s egg from traveling from the ovary to the uterus and also block sperm from being able to move into the fallopian tube. Tubal ligations are effective immediately, but an x-ray needs to be done three months after the occlusion procedure to make sure the tubes are fully blocked so an alternative birth control method needs to be used until then.
In a vasectomy, tubes in the testes called the vas deferens are cut. This prevents a man’s sperm from mixing with semen. During ejaculation, the semen does not contain any sperm, thus preventing pregnancy. This quick procedure is usually done by a urologist in an office, and only a local anesthetic is needed (as opposed to general anesthesia that is needed for most female sterilization procedures). It is important to know that before a vasectomy can be used for birth control, the man must undergo a semen analysis to document that there are no residual sperm; this is usually done about three months after the procedure.
Which to choose?
A vasectomy is safer, easier to perform, more affordable, and has a lower failure rate than any female methods of sterilization. Despite this, tubal ligations and occlusions are by far the most common method of permanent sterilization, with about 27 percent of women undergoing these procedures versus only roughly 9 percent of men having vasectomies.
Side effects and other concerns
Some men worry that vasectomies will lead to impotence. Permanent sterilization for men and women does not impede their sex lives and can possibly enhance it by removing the fear of an unwanted pregnancy.
While reversal procedures can be done after tubal sterilization or vasectomy, many are unsuccessful and insurance often does not pay for these surgeries. Therefore, anyone considering sterilization should be 100 percent sure. If any doubt remains, long-acting reversible contraceptives (LARCs) such as the IUD, implant, or injection should be used. LARCs are just as effective as permanent sterilization, but have the benefit of being completely reversible.
Risk of regret is possible, and how old a person is when they undergo sterilization is a huge factor. In women younger than 30 years old, 20 percent will wish they had not had the procedure. That number drops to only 6 percent in women over 30 years old. Again, if any doubts are present, other methods should be used so regret does not occur.
Nothing prevents pregnancy 100 percent of the time except abstinence, and this applies to tubal sterilization and vasectomy too. Of those who have these procedures done, 5-10 out of 1,000 people will still become pregnant. This is a very low risk but still one to consider.
If you are thinking about sterilization, remember that the decision is completely up to you and that you can change your mind at any time—even right before the procedure. It is also important to remember that sterilization offers no protection against sexually transmitted infections. If you have questions or concerns about whether this is the right choice for you and your family, you might benefit from speaking with your primary care doctor, gynecologist, or urologist.
Obstetrics & Gynecology. Sterilization in the United States.
Johns Hopkins. Tubal Ligation.
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