Contraception is a complex of methods and means of preventing unwanted and unintended pregnancies, as well as a way of protection against sexually transmitted diseases. Methods of contraception include traditional and modern means. They are divided into male and female contraception. There are permanent birth control and temporary means. The choice and use of this or that method should be carried out by a qualified specialist, taking into account the age characteristics of the organism, sex, health status, and the effectiveness and harmlessness of the method. Today we would like to talk more about permanent birth control, about its varieties, effectiveness, and advantages and disadvantages.
What Is Permanent Birth Control?
Permanent birth control (also known as permanent infertility) is a specific surgical (and non-surgical) procedure that leads to permanent sterilization. You may choose a permanent birth control method only if you are 100% sure that you don’t want to have children. Or if you have some specific indications for such a procedure.
Are These Methods Truly Permanent?
The aim of these procedures is permanent sterilization. Still, you may try out a tubal reversal if you are a good candidate (based on your age and the type of tubal ligation you had done). The reverse of the procedure is possible only if you had small parts of your fallopian tubes removed, or your tubes were closed using clips or rings. A vasectomy can also be reversed sometimes. But you need to know that reversals of permanent birth control procedures are very complicated. What’s more, they are expensive and are considered to be more complicated surgeries than the initial ones. Also, the result is not guaranteed. Non-surgical permanent birth control, like the Essure inserts, cannot be reversed. So, while making the decision about permanent birth control, you must be really sure about your choice.
Vasectomy: Permanent Birth Control for Men
Vasectomy (Latin Vas – vessel, duct + ectomy of Greek ἐκτομή – excision, truncation) is a surgical procedure for male sterilization or permanent birth control. During the procedure, the male vas deferens are severed and then tied or sealed in order to prevent sperm from entering into the urethra and thereby preventing fertilization. This operation leads to sterility (inability to have children). The sexual functions stay the same. The man after vasectomy retains sexual behavior: libido, erection, ejaculation. The obstruction of the vas deferens only leads to the absence of spermatozoa (azoospermia) in the ejaculate. Vasectomy is used as a radical contraceptive. In medicine, it is usually recommended to men who already have children and don’t want to have more kids in the future.
Pros and Cons of Vasectomy
- With a relatively regular sexual life, vasectomy is more effective than all known types of contraception, including condoms, birth control pills, and tubal ligation. Its efficiency even at the most stringent estimates is at least 99.85%. The use of this type of permanent birth control eliminates the need for other methods of contraception.
- Vasectomy is a fairly simple procedure in terms of surgery. It can be performed on an outpatient basis with local anesthesia. The whole procedure takes no more than half an hour. The patient can return to normal life within a day or two. The mortality rate for a vasectomy is zero. The procedure has no long-term side-effects and does not pose a threat to the health of men.
- It does not affect the male libido in any way, as it prevents only the ejection of sperm during ejaculation but not the release of testosterone. There is no reliable evidence that vasectomy affects the man’s sex drive.
- Vasectomy is a reversible procedure, that is, even after its implementation, a man has a chance to have children in the future. But keep in mind that the reverse surgery is very complicated and does not guarantee the result. At the same time, the degree of reversibility of vasectomy is much higher than that of female sterilization.
- It does not give a 100% guarantee. Although, the effectiveness of vasectomy in terms of preventing unwanted pregnancies is very high. At the same time, according to the American physicians, every 100th vasectomy can be ineffective within 5 years after the procedure.
- Vasectomy, unlike condoms, does not protect against sexually transmitted infections, so even after this procedure, men are recommended to use condoms when having sex with new/unknown partners.
Additional methods of contraception will have to be used for several months immediately after the procedure since spermatozoa can still exist in the ejaculate in this period. On average, doctors recommend using additional methods of protection for 3 months or 20 ejaculations.
- Recovery of a man’s fertility after a vasectomy is a long, laborious and, accordingly, expensive procedure. The surgery can last several hours. In addition, recovery is not always successful. The data on the percentage of failures vary. And even with the successful restoration of the male capacity for fertilization a year or more can pass before the onset of pregnancy.
- Immediately after the procedure, men may be bothered by side-effects: pain, swelling, inflammation, a general feeling of discomfort. Some men subsequently complain of chronic pain in the testicles for several years.
Permanent Birth Control for Women: Tubal Ligation
Tubal ligation (female sterilization) is a method of permanent birth control that can be used by women with children who are firmly convinced that in the future they will not want to have more kids.
Female sterilization (tubal ligation, “tubes tied”, voluntary surgical contraception) is a surgical procedure that results in the loss of the ability to conceive and give birth to a child. This is a highly effective method of permanent birth control. Tubal ligation is a surgical procedure for sterilization in which a woman’s fallopian tubes are clamped and blocked or severed and sealed, either of which prevents eggs from reaching the uterus for implantation. The mechanism of sterilization is the following: artificial obstruction of the fallopian tubes is created, hence, fertilization is no longer possible since the egg is isolated from spermatozoa.
The aim of the procedure is to prevent the penetration of the egg into the uterine cavity. In order to achieve this, the patency of the fallopian tubes must be somehow eliminated. The ovaries of the woman will continue to function but the ovum, released during ovulation, will remain in the abdominal cavity and will soon resolve. Thus, the process of fertilization itself is prevented. Spermatozoa simply cannot overtake a female cell.
After the ligation of the tubes, no additional methods of protection are required. An exception is 3 months after the surgery. During this period doctors recommend to use barrier or hormonal contraceptives.
Many people are worried about the question – can I get pregnant after sterilization? Pregnancy is almost impossible but isolated cases of ectopic pregnancy after sterilization have been identified. The frequency of these situations is less than 0.5% (depends on the method) in the first year after the operation. In the subsequent years, the possibility of pregnancy is reduced to zero.
How Is This Procedure Done?
Sterilization is mainly performed by laparoscopic surgery. The laparoscope is a narrow tube that is inserted into the abdominal cavity through a small incision, under endoscopic control. With the help of the laparoscope, the doctor applies clamps on the fallopian tubes. Such an operation is considered to be reversible. Clamps can be removed, and theoretically the ability to conceive can recover. However, practice shows that the recovery of the patency of tubes after such an operation is very difficult. Complete excision of the fallopian tubes is also possible.
Varieties of Female Sterilization
There are several types of surgeries for the sterilization of women.
- Electrocoagulation. With the help of electrocautery forceps, the doctor creates artificial tube obstruction. For a greater reliability, the tubes can be cut in the place of coagulation.
- Partial or complete resection of tubes. The part of the fallopian tube is removed completely. There are various techniques for sewing the remaining tubes, and they are all fairly reliable.
- Clipping of tubes, installation of rings and clamps. The tube is pinched by special clips or rings made of non-absorbable hypoallergenic materials, thereby creating a mechanical occlusion.
- Non-operative introduction of special substances and materials into the tubes. This is the youngest method, which has not been studied sufficiently yet. During hysteroscopy, a special substance is introduced into the fallopian tubes, thus clogging them.
Interventions can be performed with laparotomy (abdominal opening) or endoscopy (laparoscopic sterilization). During laparotomy (as well as mini-laparotomy), resection of the tubes and clamps are most often performed. The installation of clips and rings are more often made endoscopically.
Tubal ligation can be performed as a separate surgery or after a cesarean section and other obstetric and gynecological interventions. If we talk about sterilization as a method of permanent birth control, then this is a voluntary procedure, but sometimes there are medical indications (including urgent ones) for the tubal ligation.
When Is Permanent Birth Control a Necessity?
Sometimes there are situations associated with a number of diseases or disorders in which the birth of a child can be extremely dangerous for the life and health of the mother. And at the same time, the most reliable hormonal or intrauterine contraceptives can carry a certain health risk or are generally contraindicated. In such situations, sterilization can be the only birth control means. As a rule, after the tubal ligation and vasectomy, men and women can live a full sexual life, without fear of pregnancy and possible negative consequences for the health.
What Are the Effects of Sterilization?
Sterilization does not lead to changes in the physical state, hormonal system or psyche. And, as medical research proves, sexual activity can even increase.
Keep in mind that sterilization is a protection against an unplanned pregnancy but not from sexually transmitted infections, including HIV infection. If there is a risk of an infection, it is better to use a condom.
As for any other surgical intervention, there are contraindications to tubal ligation. Among them are the following factors:
- Acute gynecological inflammatory diseases;
- Active diseases, sexually transmitted diseases (treatment is performed before the operation);
- Significant adhesions of the abdominal cavity and small pelvis which complicate surgical intervention;
- An umbilical hernia;
- Violation of blood clotting;
- Chronic diseases of the lungs and heart.
Many women are concerned about the reversibility of tubal ligation. The procedure is proposed as a method of irreversible, permanent birth control and should be considered by patients only in this aspect. Restoration of the patency of the tubes with certain types of occlusion is possible but this is an extremely expensive plastic surgery which does not always lead to the desired result.
The consequences of a woman’s sterilization do not affect her ability to bear a child, therefore an IVF procedure is possible. The absence of the tubes generates certain risks, but with constant monitoring of the doctor, the chances of successful gestation are very high.
Thus, we can distinguish the pros and cons of women’s sterilization.
Pros of Permanent Birth Control for Women:
- reliability of the method;
- the absence of influence on the menstrual cycle and libido;
- low risk of complications.
- the surgery is more complicated than vasectomy;
- a small risk of ectopic pregnancy.
Is Permanent Birth Control a Good Option for Me?
Your decision about permanent birth control will, of course, depend a lot on your life circumstances. But keep in mind that permanent birth control is a very serious step. You need to be sure that this option is for you. Before going to a surgery ask yourself the following questions:
- Am I done having children?
- Do I want a permanent birth control?
- Have I tried other means of contraception?
- Do I constantly worry about having an undesired pregnancy?
- Is my partner sure that he/she does not want children in the future?
- Am I considering this just because my partner wants it?
- Do I have medical issues that can make pregnancy unsafe?
- Have I discussed all my options with my healthcare provider?