Sterilization

Treble-Up: Use 3 Forms of Contraceptive

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Sterilization

CHAPTER 9

Sterilization is a surgical procedure to prevent pregnancy and is chosen when your family is complete, when pregnancy is medically dangerous, or when parents have genetic problems they don’t wish to pass on to their children. It may also be 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 it 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 when the physician blocked only one tube and forgot the other. Sometimes the wrong tubes are tied. Similar errors also occur in vasectomies—the vas deferens is very 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 all the sperm to clear out.

Generally speaking, the advantages of sterilization are 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 STIs, 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 it may be offered at a reduced price at certain clinics. At full price, sterilization for women can cost 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.

Tubal Ligation for Women

In tubal ligation, 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 with the patient under general anesthesia in a hospital. It can be done by laparoscopy or a mini-laparotomy.

For a laparoscopy, the surgeon makes a small incision through the abdomen and inserts 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—in which an 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 immediately after birth, especially C-section births, since the woman is already in the hospital and 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 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 primary care physician, 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.

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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