Maybe you’ve had your desired number of kids or you’ve made the choice not to become a biological parent. Either reason could be why you’re considering permanent birth control. We’ve got the details on various methods and their risks so you can arm yourself with info before making this big decision or talking through options with a partner.
Permanent contraceptive procedures (like tubal ligation or occlusion for people with uteruses and vasectomy for people with penises) are the most common forms of birth control worldwide according to a 2015 report in the International Journal of Gynecology & Obstetrics. Procedures performed on people with uteruses outnumber those performed on those with penises by a ratio of 5 to 1. However, a vasectomy carries less risk, is more effective and is a simpler procedure, says the same report.
Here’s a look at what permanent birth control methods, also called sterilization, entail.
For uteruses: Tubal ligation or occlusion
Surgical permanent contraceptive procedures are 99 percent effective according to Planned Parenthood. If you’ve just given birth, you may choose to have a tubal ligation while still in the hospital. If you’ve never been pregnant, have had an abortion or have waited several years after having children, you may also opt for a permanent birth control method. When you’ve just had a baby and are still in the hospital, the procedure is called a postpartum tubal ligation. If you’re having the procedure not in relation to a childbirth, it’s called an interval laparoscopic tubal ligation, or occlusion. You may have also heard these terms referred to as “having your tubes tied.”
Sterilization methods are designed to be permanent, and you should be sure you don’t want a future pregnancy before undergoing one. Reversal procedures do exist, but they have varied rates of success according to the Mayo Clinic. Risks are low and related to undergoing any pelvic surgery and anesthesia. Although, if the procedure doesn’t work and you do conceive, you have an increased chance of an ectopic pregnancy, especially if you have a tubal ligation or an occlusion at a young age (before 28) according to a 2014 study in Fertility and Sterility.
Postpartum tubal ligation
Postpartum tubal ligation accounts for about half of permanent contraceptive procedures in the U.S., says a 2016 article in Current Opinion in Obstetrics and Gynecology. The type of anesthesia you receive may be general, regional or local, depending on how you’ve delivered your baby and when you’re having the surgery. If you have this procedure after a vaginal birth, your surgeon will make a small incision called a minilaparotomy near your navel. If you’ve had a cesarean section, your surgeon may use your delivery incision according to the American College of Obstetrics and Gynecologists. The fallopian tubes are then cut and closed or completely removed to prevent pregnancy. Ask your doctor which method they use. The Pomeroy technique is the most common for its simplicity and effectiveness, says the Global Library of Women’s Medicine.
Interval laparoscopic tubal ligation (occlusion)
If you’re having interval laparoscopic tubal ligation, or occlusion (not right after childbirth), you’ll probably undergo the procedure laparoscopically. That means having small “keyhole” incisions in your abdomen. You’ll also likely have outpatient surgery (rather than staying overnight) and have general anesthesia according to a 2016 article in Current Opinion in Obstetrics and Gynecology. Methods are similar to postpartum tubal ligation. Discuss with your surgeon the various options, including electrocoagulation, blocking the fallopian tubes mechanically with bands or clips or partial or total removal of the tubes.
You may have heard of the Essure method, as well. This option can be done vaginally in your doctor’s clinic with a local anesthetic, but it does have some additional considerations. With Essure, nickel-titanium coils are inserted into the fallopian tubes. People have reported complications with injury, infection, perforation and pelvic pain. Talk to your doctor thoroughly about all risks and the required follow-up if you’re contemplating this option.
Total salpingectomy
You have the choice of a total salpingectomy, whether undergoing a permanent contraceptive surgery right after delivery or not in relation to childbirth. A total salpingectomy is the complete removal of your fallopian tubes, and it could offer some protection from ovarian cancer.
For penises: Vasectomy
A vasectomy, which is the cutting or blocking of the vas deferens tubes, prevents sperm from becoming part of the semen that is ejaculated. A vasectomy is a nearly 100 percent effective form of permanent birth control according to Planned Parenthood. But you should use another method of contraception for a few months until you’ve passed a post-surgery semen analysis and received the all clear from your doctor. You can have a vasectomy as an outpatient procedure and may undergo one of two methods. The incision method requires two cuts in your scrotum, and the no-scalpel method involves just a small puncture. With both options, the vas deferens tubes are then tied, blocked or cauterized.
Risks associated with a vasectomy are generally minor and temporary, such as pain, swelling or possible infection according to Planned Parenthood. And a vasectomy is not associated with prostate cancer, says a 2018 study published in the International Journal of Clinical and Experimental Medicine, negating previous research on the topic. You should consider a vasectomy to be permanent, but reversal surgeries do exist with varying results according to the Mayo Clinic.
Other considerations
As with any major medical decision, if you’re contemplating a permanent contraceptive option, weigh all the pros and cons and talk through the risks and any other considerations with your physician. Keep in mind that sterilization methods do not protect against sexually transmitted infections.
Although you might discuss your options with your partner, don’t let someone else pressure you into undergoing a procedure you’re apprehensive about or talk you out of one you want. Permanent birth control may be more convenient for you than other methods. And some women may find that hormonal contraception (like the pill, ring or patch) or long-term birth control methods (like an IUD, hormonal or non-) may not be right for them because of risks or side-effects. Ultimately, the choice is yours to make as an individual.
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