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Birth Control Overview (cont.)

What is the effectiveness, and what are the side effects and risks of permanent methods of birth control?

Sterilization is considered a permanent form of birth control that a man or woman elects to undergo. Although tubal sterilization, or a tubal ligation, for women and vasectomy for men are sometimes reversible, reversal surgery is much more complicated than the original procedure and is frequently unsuccessful. Thus, when choosing a sterilization method you should not have thoughts of future reversal.

Hysterectomy or tubal ligation

Each year approximately one million American women elect to have surgery to occlude their Fallopian tubes (i.e. tubal ligation). Some women have a hysterectomy (removal of the uterus and sometimes the ovaries) each year, but usually primarily for birth sterilization to prevent pregnancy.

Most US women who have undergone sterilization by tubal ligation will have either a postpartum mini-laparotomy procedure or an interval (timing of the procedure does not coincide with a recent pregnancy) procedure. A postpartum tubal ligation is performed through a small incision in the lower crease of the navel right immediately following vaginal childbirth. If a Cesarean section is done, the tubal ligation is performed through the same abdominal incision. An interval tubal sterilization is usually performed using laparoscopy with instruments being introduced through small incisions made in the patient's abdominal wall (laparoscopic tubal ligation).

The Fallopian tubes (through which the egg passes after release from the ovary and where fertilization of the egg normally occurs) may be blocked with clips, bands, segmental destruction with electrocoagulation, or suture ligation with partial removal of the fallopian tube (i.e. partial salpingectomy). Female sterilization prevents fertilization by interrupting the passage through fallopian tube.

  • Effectiveness: 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 type of 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%.
  • Pros: 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 facility.
  • Cons: The procedure involves general or regional anesthesia. It is a permanent form of birth control, and some women may regret the decision afterward. The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or the death of a child. Regret has also been shown to correlate with external pressure from a 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 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 (mini-laparotomy). There is some short-term discomfort. Tubal sterilization does not protect against sexually transmitted diseases.

Fallopian tube implants (Essure)

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 and cervix into the uterus. The device works by inducing scar tissue formation over the implants, blocking the fallopian tubes and preventing fertilization of the egg by sperm.

  • Pros: Once placement is confirmed, you do not need another form of birth control.
  • Cons: During the first 3 months, women cannot rely on the Essure implants and must use an alternative method of birth control. After three months, women must undergo a final X-ray (hysterosalpingogram) procedure in which dye is introduced into the uterus and an X-ray is taken to confirm proper device placement and bilateral tubal occlusion. Once bilateral occlusion has been confirmed, it is no longer necessary to use a second form of birth control. If the X-ray confirms tubal occlusion, the likelihood of a future pregnancy is remote. The procedure cannot be reversed. This is a permanent form of birth control.
  • Additional risks and adverse events: Sometimes doctors may have difficulty placing the implants. There is an increased risk for an ectopic pregnancy.
  • STDs and Essure: This method does not prevent STDs.

Vasectomy (male sterilization)

Vasectomy involves an incision made in the scrotal sac, followed by 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 insure that sperm are no longer present. 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).

  • Effectiveness: The failure rate is determined to be approximately 0.1%.
  • Pros: Vasectomy involves no hormones. It is permanent. The procedure is rapid with few risks. It is performed as an outpatient procedure in a clinic or doctor's office.
  • Cons: Men may regret the decision later. Short-term discomfort occurs following the procedure. Vasectomy does not protect against STDs.
Medically Reviewed by a Doctor on 11/20/2017
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