Surgical Sterilization (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Introduction to birth control
- Permanent methods of contraception (surgical sterilization)
- Tubal ligation
- Hysteroscopic sterilization
- Find a local Obstetrician-Gynecologist in your town
A vasectomy is usually performed by either a urologist or a general surgeon. Under local anesthesia, the vas deferens (tubes that carry sperm from the testicles into the urethra, also known as spermatic ducts) from each testicle is severed. The open ends are then closed off. A vasectomy can be performed in the clinic and involves making two small openings in the scrotum. After a vasectomy, the man may feel tenderness or bruising around the incision site.
A vasectomy does not interfere with the ability of a man to have an erection or the quantity of his ejaculation fluid. After a man has a vasectomy, another second form of birth control should be used until his ejaculate fluid is found to be free from sperm. This usually takes 10 to 20 ejaculations.
Vasectomy reversals are possible, but they tend to be expensive and are not guaranteed to be effective. A vasectomy should be considered a permanent form of birth control.
A vasectomy does not protect a man or his partner from sexually transmitted infections.
Tubal ligation is also known as "having one's tubes tied," or having a "tubal." Tubal ligation is for women, and like a vasectomy, should be considered a permanent form of birth control.
A tubal ligation is performed under general, regional, or local anesthesia and can be performed as an outpatient procedure. The surgeon or ob/gyn uses one of several procedures in order to access a woman's Fallopian tubes (which run from the top part of her uterus to each ovary). A laparoscopy is a procedure in which a small incision is made just below the navel. A viewing tube (scope) can then be inserted through this incision to view and reach the Fallopian tubes. A minilaparotomy is a small incision in the lower abdomen that is sometimes used for tubal ligation most commonly in the postpartum period (after childbirth).
Once the physician has access to a woman's Fallopian tubes, they are closed off by using a clip, cutting and tying, or cauterizing (burning) the tubes. The procedure takes anywhere from 10 to 45 minutes.
Side effects of a tubal ligation may include infection, bleeding (hemorrhage), and those associated with being under general anesthesia.
A tubal ligation blocks a woman's Fallopian tubes. As a result of the procedure, about 1 inch of each tube is blocked off. An egg can no longer travel down the tube to the uterus, and sperm cannot make contact with the egg. Tubal ligation should have no effect on a woman's menstrual cycle or hormone production.
A woman's tubal ligation can be surgically reversed, usually with more success than in men who have had a vasectomy. About 1% to 2% of women in the US seek a reversal of tubal ligation.
A tubal ligation does not protect a woman or her partner from sexually transmitted infections (sexually transmitted diseases, or STDs). It is also not an absolute method of birth control because a small percentage of women become pregnant after a tubal ligation. Pregnancy after tubal ligation is uncommon (occurring in less than 2% of women), and the risk of pregnancy appears to be related to age (younger women have more post-tubal ligation pregnancies) as well as the type of procedure used for the sterilization.
Post-tubal ligation syndrome
A condition referred to as "post-tubal ligation syndrome" (or post-tubal sterilization syndrome) has been the subject of debate in recent years. Proponents argue that women who have had tubal ligations are prone to menstrual irregularities and symptoms such as hot flashes and mood changes as a result of damage to the blood supply to the ovaries as a result of the procedure. This syndrome has also been described as consisting of symptoms such as changes in sexual behavior and emotional health, exacerbation of premenstrual symptoms, and menstrual symptoms necessitating hysterectomy or tubal reanastomosis. A study of over 9500 women reported in 2000 in the New England Journal of Medicine, failed to confirm any association between tubal sterilization and menstrual problems, but some investigators suggest that a minority of women do report menstrual problems or other symptoms following the procedure.
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