Birth Control Overview (cont.)
IN THIS ARTICLE
Permanent Methods of Birth Control
Sterilization is considered a permanent method of birth control that a man or woman chooses. Although tubal sterilization, or a tubal ligation, for women and vasectomy for men can sometimes be reversed, surgery is much more complicated than the original procedure and may not be successful. Thus, when choosing a sterilization method you should not have thoughts of future reversal. Female sterilization, tubal ligation About a million American women elect to have surgery to tie their fallopian tubes, known as tubal ligation. Some women have a hysterectomy (removal of the uterus and sometimes also the ovaries) each year, but usually not only for birth control.
Most US women who have undergone sterilization experience either a postpartum minilaparotomy procedure or an interval (timing of the procedure does not coincide with a recent pregnancy) procedure. A postpartum laparotomy consists of a small incision near the navel right after childbirth. An interval tubal sterilization is usually done with the use of small instruments inserted into a woman's abdomen and is called laparoscopic surgery.
The fallopian tubes (through which the egg passes from the ovaries and where the egg is fertilized by the sperm) may be blocked with clips, bands, segmental destruction with electrocoagulation, or suture ligation with partial salpingectomy. Female sterilization prevents fertilization by interrupting the passage through fallopian tube.
Female sterilization, implants
The FDA has approved a small metallic implant (Essure) that is placed into the fallopian tubes of women who wish to be permanently sterilized. During the implantation procedure, the doctor inserts 1 of the devices into each of the 2 fallopian tubes. This is done with a special instrument called a hysteroscope that is inserted through the vagina into the uterus. The device works by making scar tissue form over the implant, blocking the fallopian tube and preventing fertilization of the egg by the sperm.
During the first 3 months, women cannot rely on the Essure implants and must use alternate birth control. At the 3-month point, women must undergo a final X-ray procedure in which dye is placed in the uterus and an X-ray is taken to confirm proper device placement. Once placement is confirmed, you do not need another form of birth control. If the X-ray confirms placement, the likelihood of pregnancy is remote. The procedure cannot be reversed. This is a permanent form of birth control.
Sometimes doctors have difficulty placing the implants. There is risk for ectopic pregnancy, a life-threatening condition that requires emergency medical care. This method does not prevent STDs.
Male sterilization, vasectomy
Vasectomy involves a cut in the scrotal sac, cutting or burning of the vas deferens (tubes that carry sperm), and blocking both cut ends. The procedure is usually performed with the patient under local anesthesia in an outpatient setting. Vasectomy prevents the passage of sperm into seminal fluid by blocking the vas deferens. Some men may develop bruising in their testicles. After the vasectomy, some sperm may remain in the ducts. A man is not considered sterile until he has produced sperm-free ejaculations. Semen is tested in the lab several weeks after the procedure to check that all sperm are gone. This usually requires 15-20 ejaculations (the couple should use another form of birth control during this period, or the man may ejaculate by masturbation).
See Birth Control Permanent Methods for more information on these procedures.
Medically Reviewed by a Doctor on 6/24/2016
Omnia M Samra, MD
Bryan D Cowan, MD
Francisco Talavera, PharmD, PhD
Lee P Shulman, MD
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