Permanent Methods of Contraception (Surgical Sterilization) : Vasectomy

Permanent methods of contraception (surgical sterilization)
Sterilization is considered a permanent method of contraception. In certain cases, sterilization can

be reversed, but the success of this procedure is not guaranteed. For this reason, sterilization is
meant for men and women who do not intend to have children in the future.
Vasectomy
A vasectomy is a form of sterilization of a man. A vasectomy ensures that no sperm will exit from his
penis when he ejaculates during sexual intercourse.
A vasectomy is usually performed by either a urologist or a general surgeon. Under local anesthesia,
the vas deferens (tubes that carry sperm from the testicles into the urethra, also known as ductus
deferens) from each testicle is severed. The open ends are then closed off. A vasectomy can be
performed in the clinic and involves making two small openings in the scrotum. After a vasectomy,
the man may feel tenderness or bruising around the incision site.
A vasectomy does not interfere with the ability of a man to have an erection or the quantity of
his ejaculation fluid. After a man has a vasectomy, another second form of birth control should be
used until his ejaculate fluid is found to be free from sperm. This usually takes 10 to 20 ejaculations.
Vasectomy reversals are possible, but they tend to be expensive and are not guaranteed to be
effective. A vasectomy should be considered a permanent form of birth control.
A vasectomy does not protect a man or his partner from sexually transmitted infections.
Birth Control: How to Decide

Choosing what type of birth control to use can be confusing. It helps to start by answering a few
basic questions. Consider the following:
The importance of protection against STDs
The level of effectiveness you desire
Are convenience and cost are important for your decision?

While abstinence is the only 100% effective birth control method, other methods can be very nearly
as effective when used properly.
Tubal ligation (tubes tied)

Tubal ligation is also known as "having one's tubes tied," or having a "tubal." Tubal ligation is for
women, and like a vasectomy, should be considered a permanent form of birth control.
A tubal ligation is performed under general, regional, or local anesthesia and can be performed as
an outpatient procedure. The surgeon or OB/GYN uses one of several procedures in order to access
a woman's Fallopian tubes (which run from the top part of her uterus to each ovary).
A laparoscopy is a procedure in which a small incision is made just below the navel. A viewing tube
(scope) can then be inserted through this incision to view and reach the Fallopian tubes. A
minilaparotomy is a small incision in the lower abdomen that is sometimes used for tubal ligation
most commonly in the postpartum period (after childbirth).
Once the doctor has access to a woman's Fallopian tubes, they are closed off by using a clip, cutting
and tying, or cauterizing (burning) the tubes. The procedure takes anywhere from 10 to 45 minutes.
Side effects of a tubal ligation may include infection, bleeding (hemorrhage), and any effects or
complications associated with being under general anesthesia.
A tubal ligation blocks a woman's Fallopian tubes. As a result of the procedure, about 1 inch of each
tube is blocked off. An egg can no longer travel down the tube to the uterus, and sperm cannot make
contact with the egg. Tubal ligation should have no effect on a woman's menstrual cycle or hormone
production.
A woman's tubal ligation can be surgically reversed, usually with more success than in men who
have had a vasectomy. About 1% to 2% of women in the US seek a reversal of tubal ligation.
A tubal ligation does not protect a woman or her partner from sexually transmitted infections
(sexually transmitted diseases, or STDs). It is also not an absolute method of birth control because a
small percentage of women become pregnant after a tubal ligation. Pregnancy after tubal ligation is
uncommon (occurring in less than 2% of women), and the risk of pregnancy appears to be related to
age (younger women have more post-tubal ligation pregnancies) as well as the type of procedure
used for the sterilization.
Hysteroscopic sterilization
Hysteroscopic sterilization is a nonsurgical form of permanent birth control in which a physician
inserts a 4-centimeter (1.6 inch) long metal coil into each one of a woman's two Fallopian tubes via a
scope passed through the cervix into the uterus (hysteroscope), and from there into the openings of
the Fallopian tubes. Over the next few months, tissue grows over the coil to form a plug that
prevents fertilized eggs from traveling from the ovaries to the uterus.
The procedure takes about 30 minutes, can be done in a doctor's office, and usually requires only a
local anesthetic. During a 3-month period after the coils are inserted, women must use other forms
of birth control until their physician verifies by an imaging test known as a hysterosalpingogram
(HSG) that the Fallopian tubes are completely blocked.
Like tubal ligation, this form of sterilization is permanent (not reversible) and is designed as an
alternative to surgical sterilization which requires general anesthesia and an incision. About 6% of
women who have the procedure develop side effects, mainly due to improper placement of the coils.
This form of sterilization, like other methods of surgical sterilization, does not protect a woman or her
partner from sexually transmitted diseases (STDs).
Hysterectomy
A hysterectomy is the surgical removal of a woman's uterus and, depending on her overall health
status and the reason for the operation, perhaps her ovaries as well. No woman who has had a
hysterectomy can become pregnant; it is an irreversible method of birth control and absolute
sterilization. A laparoscopic hysterectomy (removal of the uterus through tiny incisions in the
abdomen through which instruments are placed) is possible when there are no complications and no
suspicion of cancer. A partial hysterectomy, which spares the cervix and removes the upper part of
the uterus, is also a common surgical technique.
If a woman has other chronic medical problems that may be helped by a hysterectomy (such as
abnormally excessive menstrual bleeding, uterine fibroids, uterine growths), than this may be an
appropriate procedure for her to consider. Otherwise, contraception should be considered a
secondary benefit and not a sole reason to have the procedure.
Male Condom
Barrier methods involve prevention of contact between sperm and egg. The latex male condom is
the classic method of barrier contraception. It protects against both pregnancy and most STDs.
Couples who use male condoms experience about a 15% yearly pregnancy rate.
Pros: Easy to obtain, inexpensive, protects against most STDs.
Cons: Must be used correctly with each instance of sexual activity.
Female Condom
The female condom is a newer birth control option that is a plastic, pouch-like device put inside the
vagina before sex. It can be inserted up to 8 hours prior to sexual activity. The female condom is
slightly less effective than the male condom in preventing pregnancy. It should not be used together
with a male condom due to the risk of breakage.
Pros: Offers some protection against STDs.
Cons: May be noisy, 21% of users become pregnant.
Birth Control Sponge

The Today Sponge is a foam sponge saturated with spermicide. It is inserted into the vagina and
placed against the cervix. It can be inserted up to 24 hours prior to sexual activity. Its effectiveness is
comparable to that of the cervical cap; failure rates are 16% for women who have not had children
and 32% of women who have given birth.
Pros: Immediate effectiveness, prescription and doctor visit not required.
Cons: Can be hard to use correctly, cannot be used during the menstrual period, does not protect
against STDs.

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Permanent Methods of Contraception (Surgical Sterilization) : Vasectomy

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Permanent methods of contraception (surgical sterilization)

Sterilization is considered a permanent method of contraception. In certain cases, sterilization can

Birth Control: How to Decide

The importance of protection against STDs

The level of effectiveness you desire

Are convenience and cost are important for your decision?

Tubal ligation (tubes tied)

Cons: Must be used correctly with each instance of sexual activity.

Birth Control Sponge

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