Birth Control Overview (cont.)
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. Interval minilaparotomy - a small abdominal incision in bikini area - is performed in surgically challenging circumstances, such as when severe pelvic adhesions are present and laparoscopy is deemed inappropriate.
The fallopian tubes (through which the egg passes from the ovaries and where the egg is fertilized by the sperm) may be blocked with Falope rings, clips, bands, segmental destruction with electrocoagulation, or suture ligation with partial salpingectomy. Female sterilization prevents fertilization by interrupting the passage through fallopian tube.
- How effective: Sometimes this method does not provide permanent birth control. The United States Collaborative Review of Sterilization has examined the failure rate of female sterilization. Rates vary according to the procedure performed. The cumulative 10-year failure rate with each method of tubal ligation is as follows: spring clip method is 3.7%, bipolar coagulation is 2.5%, interval partial salpingectomy (partial removal of tubes) is 2%, silicone rubber bands is 2%, and postpartum salpingectomy (tubes cut after delivery) is 0.8%.
- Advantages: Female sterilization does not involve hormones. It is a permanent form of birth control. There are no changes in libido (sexual desire), menstrual cycle, or breastfeeding ability. The procedure is usually a same-day procedure done in a surgical outpatient clinic.
- Disadvantages: The procedure involves general or regional anesthesia. It is permanent form of birth control, and some women may regret the decision later. The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child. Regret also has been shown to correlate with external pressure by the clinician, spouse, relatives, or others. Regret is difficult to measure because it encompasses a complex spectrum of feelings that can change over time. This helps to explain that while some studies have shown "regret" on the part of 26 percent of women, fewer than 20 percent seek reversal and fewer than 10 percent actually undergo the reversal procedure. Sterilization does not protect you from sexually transmitted diseases. Sterilization involves all of the risks of surgery. Occasionally, sterilization cannot be done laparoscopically, and an abdominal incision may be necessary
to reach the fallopian tubes. There is some short-term discomfort. Tubal sterilization does not protect against sexually transmitted diseases.
Female sterilization, implants
The FDA just recently 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 catheter (tube) that is inserted through the vagina into the uterus, and then into the fallopian tube. 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.
In studies of the device so far, no women using it have become pregnant.
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).
- How effective: The failure rate is determined to be approximately 0.1%.
- Advantages: Vasectomy involves no hormones. It is permanent. The procedure is quick with few risks. It is performed as an outpatient procedure in a clinic or doctor’s office.
- Disadvantages: Men may regret the decision later. Vasectomy does not prevent you from getting sexually transmitted diseases. Short-term discomfort occurs from the procedure. Vasectomy does not protect against STDs.
See Birth Control Permanent Methods for more information on these procedures.
Francisco Talavera, PharmD, PhD
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