Sterilization

Sterilization is a surgical procedure to prevent pregnancy and is chosen when your family is complete, when pregnancy is medically dangerous, or when couples have genetic problems they don’t wish to pass on to their children. It is also sometimes chosen by younger people who are certain they do not want children, but there is a lower incidence of regret when a person is older (> 30 years).

Generally speaking, for women the tubes are blocked or cut, so the egg can never reach the uterus. For men, the vas deferens are blocked or cut so the sperm never reach the ejaculate. Sterilization is generally not reversible, and provides the best protection of any form of birth control.

That said, it isn’t perfect, and pregnancies sometimes happen with either form of sterilization. Further, there are several different techniques that can be used, and some are more effective than others.

Some of the reasons for failure include medical error. There are occasions where the Doctor only blocked one tube, and forgot the other. Sometimes the wrong tubes are tied. Similar errors also occur in vasectomies—the vas deferens being pretty small and easily missed.

Another failure mode is failure of the blockage, and sperm or eggs still get through tiny channels. However, the most common error for failure of vasectomy is failure within the first three months because sterility is not immediate. It takes some time for the sperm to clear out.

Generally speaking, the advantages of sterilization is that it is hormone free, permanent and discreet. Further, since all you are doing is blocking the tubes, there should be no change in your body, sex drive, or periods.

The disadvantage is that the method requires some intervention inside your body and therefore there will be some pain. There can be complications from any surgical procedure. Also, sterilization does NOT protect against STDs, including HIV.

For more information on sterilization, see:

https://www.uptodate.com/contents/permanent-sterilization-procedures-for-women-beyond-the-basics

http://www.uptodate.com/contents/vasectomy-beyond-the-basics?source=search_result&search=vasectomy&selectedTitle=3%7E29

Sterilization is covered by most health insurance and Medicaid, and may be offered at reduced price at certain clinics. At full price, sterilization for women can cost anywhere from $500 to $5,000 and a vasectomy can cost as much as $1,000. For a lifetime of use, that’s a pretty good price.

In the past, sterilization for women was a fairly major surgery and required recovery times of up to two weeks. However, a non-incision based method is now available for women. It takes less time, is cheaper, and you go home the same day. However, back-up birth control is needed for three months because the sterilization is not immediate. A follow-up x-ray is needed to be sure the tubes are totally blocked. The incision methods, by contrast, are effective immediately, but cost more and require surgery, general anesthesia and therefore longer recovery time.

Nonsurgical Sterilization for Women

The nonsurgical permanent contraception procedure—called Essure—can be performed in a doctor’s office with local anesthesia. In the same position as a Pap smear, the Doctor will use a special instrument to place tiny spring-like coils called micro inserts through the vagina and cervix into the opening of the fallopian tubes. As with any insertion into the cervix, there may be some pain and cramping.

Within three months, the inserts cause your body to form a tissue barrier that prevents sperm from reaching the egg. During this three-month period, you need to use another form of birth control.

After three months, you must return to the clinic for a special x-ray to make sure the tubes are completely blocked. In clinical studies, most women reported little to no pain and were able to return to their normal activities in a day or two.

However, in 2016, the FDA ordered changes in the package labeling for Essure to include a boxed warning and a “patient checklist,” both designed to ensure that women understand the risks and benefits of the device. The FDA is also requiring the manufacturer of Essure to conduct a clinical study to determine risks of Essure for particular women. Be sure and talk with your health care provider about any potential risks and benefits.

Tubal Ligation for Women

With this type of sterilization procedure, the fallopian tubes are blocked with a ring or burned or clipped shut. Portions of the tube can even be removed. This procedure is typically performed under general anesthesia in a hospital. It can be done via a laparoscopy or a mini-laparotomy.

For a laparoscopy the surgeon makes a small incision through the abdomen and inserts a special instrument called a laparoscope to view the pelvic region and tubes. He or she then closes the tubes using clips, tubal rings or electrocoagulation (using an electric current to cauterize and destroy a portion of the tube).

The patient can usually go home the same day and resume intercourse as soon as it’s comfortable. Risks include pain, bleeding, infection and other postsurgical complications, as well as an ectopic pregnancy—where the egg implants in the tubes instead of in the uterus.

During a mini-laparotomy, the surgeon makes a small incision (about two inches long) and ties and cuts the tubes without the use of a viewing instrument. In general, mini-laparotomy is a good choice for women who undergo sterilization right after childbirth. Patients usually need a few days to recover and can resume intercourse after consulting with their doctors.

Often tubal ligation is done right after birth, especially C-section births, since the woman is already in the hospital undergoing surgery. This option has the advantage of being very discreet.

Vasectomy for Men

During a vasectomy the testicles and scrotum are cleaned with an antiseptic and possibly shaved. You may also be given an oral or intravenous (IV) medicine to reduce anxiety and make you sleepy.

The vas deferens is located by touch. A local anesthetic is injected into the area.

Your doctor makes one or two small openings in the scrotum. Through an opening, the two vas deferens tubes are cut. The two ends of the vas deferens are tied, stitched, or sealed. Electrocautery may be used to seal the ends with heat. Scar tissue from the surgery helps block the tubes.

The vas deferens is then replaced inside the scrotum and the skin is closed with stitches that dissolve and do not have to be removed.

The procedure takes about 20 to 30 minutes and can be done in an office or clinic. It may be done by a family medicine doctor, a urologist, or a general surgeon.

A no-scalpel vasectomy is also available. This method uses a small clamp with pointed ends. Instead of using a scalpel to cut the skin, the clamp is poked through the skin of the scrotum and then opened. The benefits of this procedure include less bleeding, a smaller hole in the skin, and fewer complications. The no-scalpel vasectomy is as effective as traditional vasectomy.

In the “Vasclip” implant procedure, the vas deferens is locked closed with a device called a Vasclip. The vas deferens is not cut, sutured, or cauterized (sealed by burning), which possibly reduces the potential for pain and complications, but some studies show that clipping is not as effective as other methods of sealing off the vas deferens.

If you are interested in sterilization, talk to your doctor about the pros and cons of the various methods available before you decide which type of procedure to use.


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