Sterilization is a procedure for men and women that stops them from being able to conceive. It works by creating a barrier so that the egg and the sperm cannot meet. In women, the fallopian tubes are cut or sealed off to keep the egg from travelling into the uterus. In men, the vas deferens is cut and sealed off to keep the sperm from moving from the testicles into the penis. This is also called a vasectomy.
As sterilization is permanent, it should be used only by couples who are completely sure that they will never want to have children, or who do not want to have any more children. When this is the case, sterilization offers a great solution – not having to worry about birth control ever again is a great thing. For many couples, the only real question they have about sterilization is: which partner should get it?
One significant issue is the fact that male sterilization is safer than female sterilization. At least 14 deaths are attributable to female sterilization in the US each year; in men, that number drops to zero. Complications are also less common with male sterilization. For many couples, this fact alone is enough to help them make up their minds. However, this is far from the only factor for most couples, and even though female sterilization comes with a few more (remote) risks than male sterilization, it is still extremely safe.
Couples should consider and discuss all of the factors involved in making this decision. Perhaps one partner has the time available to take off from work and recover properly. Perhaps one partner is deathly afraid of surgery while the other has no problem with it. Whichever partner is chosen for surgery should understand and be okay with the fact that this type of sterilization is permanent. Yes, there are reversal operations, but they are extremely expensive and often do not work.
Vasectomies are done using local anesthetic. The operation takes only about 15 minutes. The scrotum may be bruised, swollen, and painful for a week or so; wearing tight-fitting underpants helps with support. Strenuous exercise must be avoided for several weeks. Most men find that the pain they experience is very mild. Men can have sex as soon as the doctor gives the green light, which is usually as soon as it is comfortable. However, there may still be sperm in the semen for a while after the operation. Men must have a semen test eight weeks after surgery to make sure that the sperm are gone before having unprotected sex.
There are several different ways of blocking fallopian tubes: cutting, tying, clipping, and more. This may be done under general or local anesthetic. Because this is a more invasive procedure than is involved in male sterilization, and because it often involves general anesthesia, women may find that they feel uncomfortable and unwell overall for a few days. Women typically need to take it easy and get plenty of rest for a week or so. They may experience pain as well as slight vaginal bleeding. Women will need to continue to use contraception for several weeks after the surgery.
With either male or female sterilization, patients should follow the doctor’s instructions for post-surgery care. Patients should also understand that neither option is 100% effective, although 99.9% comes pretty close. Couples should discuss all of these issues and decide what is best for them.
– Yvonne S. Thornton, M. D., M. P. H.