Patient Education

Sterilization for Women and Men

Sometimes, men and women do not want to have anymore children. If they have made this decision, there are several options for birth control that they can use, some more permanent than others. Sterilization is a permanent form of birth control for both men and women. For women, the process is called tubal sterilization, and for men, it is called a vasectomy. Sterilization procedures are very safe and usually free of complications. However, many men and women have questions about them. This page should explain some of the basics about sterilization, and answer some frequently asked questions.

HOW SHOULD I MAKE THE DECISION TO BE STERILIZED?

Since sterilization of both men and women is a permanent form of birth control, it should only be performed on people who are very sure that they do not want children in the future. Sterilization is an elective procedure, meaning that becoming sterilized is a surgery that is chosen, not medically indicated. Making the decision to become sterilized requires a lot of thought, and should not be made during a time of stress, such as right after a failed pregnancy or a divorce. The decision to become sterilized also should not be made because of a partner pressuring you. Although sterilization can be attempted to be reversed, there is no guarantee that the reversal procedures will work. Oftentimes, the reversal procedures can be very expensive, and they usually do not work. In men, the results of a reversal surgery vary greatly. However, reversal surgeries in women oftentimes increase the risk of an ectopic pregnancy (fetus developing inside the fallopian tubes) greatly, which can be very dangerous.

If you are not sure that you want to be sterilized, there are many other effective forms of birth control in the meantime. These include:

  • The intrauterine device
  • Hormonal Contraceptives (birth control pills, the patch, ring)
  • Barrier Methods:
    • Male and Female condoms
    • Diaphragms 
    • Cervical caps
    • Spermicides · Natural Family Planning by Periodic Abstinence

Although none of these methods of birth control are as effective as sterilization, they are all reversible, and they are also still quite effective against preventing pregnancy. However, it is important to remember that sterilization does not protect against sexually transmitted diseases (STDs) such as HIV and HPV. Once sterilized, you may still have to use condoms in order to protect against these diseases.

HOW ARE WOMEN STERILIZED?

To understand sterilization, you must first understand the female reproductive organs and how a pregnancy happens. Every month, a woman goes through a cycle of changes that allow and prepare for a pregnancy to happen. This is called the menstrual cycle. It is regulated and controlled by levels of the female hormones estrogen and progesterone. On the first day of your cycle, you are menstruating(having your monthly period). This occurs when the uterine lining (the endometrium) sheds itself through your uterus. On day five of your cycle, the levels of the hormone estrogen will go up, signaling the endometrium to re-grow itself in order to prepare for a fertilized egg. On day 14 of your cycle, your hormones will signal to your ovaries to produce a single, ripe egg, that will travel down into your fallopian tubes, where it will wait to be fertilized by a sperm released by your partner into your vagina. If fertilization of the egg has not occurred by day 28 of your cycle, your hormone levels will suddenly drop, signaling your endometrial lining to shed and for your monthly period to begin again, starting the whole cycle over again. During sterilization, the doctor will seal the fallopian tubes by being surgically cut, tied, or sealed; thus preventing the egg to travel down and become fertilized by sperm.

There are several different ways that a tubal sterilization can be performed:

Laparoscopy-

  • A small incision is made below the navel. A harmless gas may be passed into the abdominal cavity to inflate it so that the doctor can get a clear view of your organs. 
  • A thin, telescope-like device with a light attachment is inserted into the incision.
  • Another instrument is inserted into the abdomen, either through another cut or directly through the laparoscope. This allows the tubes to be held in place. A uterine manipulator may also be inserted into the vagina. 
  • The tubes are sealed using a clip, electric current, or a ring.
  • The gas inserted is then withdrawn, and the cuts are sealed with one or two stitches.
  • Minilaparotomy.

Hysteroscopy -

  • A tiny, spring-like device is inserted into the fallopian tubes through the vagina.
  • This causes scar tissue buildup inside the tubes, which blocks passage of the egg or sperm.

Your doctor will choose which method of sterilization is best for you. During each of these procedures, you will be given anesthesia, so you do not feel any pain while they are being performed. Sometimes, women may choose to have a tubal sterilization performed directly after they give birth. If she has caesarean birth, she may choose sterilization at this time because it can be done right along with the c-section and requires no additional hospital stay. Usually, sterilization is effective right away, and a woman does not need to use another method of birth control afterwards. However, if a woman has a hysteroscopic sterilization, another form of birth control should be used for three months afterward.

After the procedure, it is normal to feel some side effects, such as slight bleeding, dizziness, and abdominal pain. However, sometimes more serious side effects or complications occur, such as:

  • Feeling dizzy, or nauseated
  • Abdominal cramps
  • Feeling gassy or bloated
  • Shoulder pain
  • Sore throat

These symptoms should be addressed by your doctor. Usually, tubal sterilizations do not affect your monthly periods, but it may take a while to get back on cycle if you took birth control pills before your operation. Tubal sterilizations also do not affect the way you enjoy sex or the pleasure of orgasm.

HOW ARE MEN STERILIZED?

To understand how a vasectomy works, it is important to also understand how the production of sperm works and the male reproductive organs. Sperm are made in a man's testes. These are the two organs that hang below the penis in a sac called the scrotum. Sperm leave the testes through small tubes called the vas deferens, which carry sperm to a larger tube in the penis called the urethra. As sperm travel through, they are mixed with other fluid produced by the prostate gland and the seminal vesicles. This new mixture of sperm and fluid is called semen. When the man ejaculates in orgasm during sex, this semen travels out through the penis and into the woman's vagina, which can cause fertilization of her egg. During a vasectomy, a man’s vas deferens are cut, clipped, or tied to prevent the release of sperm, which means that even if he ejaculates, no sperm will come out in the fluid that is released.

WHAT IS A VASECTOMY PROCEDURE LIKE?

Vasectomies are very safe, easy procedures that can be performed in a doctor’s office, clinic, or hospital. Usually, a man can go home the day that he has a vasectomy.

  1. Each side of the scrotum is numbed with anesthesia.
  2. One or two small openings are made in the skin of the scrotal sac.
  3. The vas deferens are located and pulled through the hole until they are visible and make a loop.
  4. A small section from the loop is cut and removed, and then tied and sealed with heat, causing scar tissue to build up which blocks the passage of sperm.
  5. The vas deferens are then placed back into the scrotum, which is then sealed up.

For several days after the surgery, there may be some swelling and discomfort in the scrotum. The man should rest, apply ice packs to the scrotum, and may need to wear a jock strap for extra support. If there is severe pain, the man should call his doctor for immediate attention.
Vasectomies are not effective right away like tubal sterilizations; therefore, another method of birth control must be used until sperm count tests done at the doctor’s office determine that there are no sperm left in the tubes. This may take up to at least 3 months to happen. After a vasectomy, a man’s sexual function does not change. He is still able to orgasm and produce fluid, although this fluid will not contain sperm.

HOW EFFECTIVE ARE TUBAL STERILIZATIONS AND VASECTOMIES?

Tubal sterilizations are extremely effective. Less than 1% of women who undergo sterilization get pregnant, and if they do, these pregnancies are frequently ectopic. If you miss a menstrual period after the procedure, take a pregnancy test. If it is positive, call your doctor, because the pregnancy may be ectopic. Ectopic pregnancies are very dangerous and can cause serious problems in women.

Vasectomies are also very effective. Less than 1% of couples become pregnant after a man has a vasectomy. Usually though, these pregnancies arise because the couple has unprotected sex too soon after the procedure is performed, while there is still sperm remaining in the vas deferens.

IN CONCLUSION

Sterilization for both men and women is an important decision that should be given a great deal of thought before being performed. If you are under the age of thirty and do not want kids right now, it is best to use another method of birth control. You may want kids in the future. Sterilization is a permanent procedure that has low reversal success rate. If you believe that you would like to get sterilized, talk to your partner and your doctor about this important step in life to see if it is right for you and your lifestyle.