Kiska (ifritah) wrote in sexuality101,


For the third installment of the four-week discussion of birth control methods, I'm going to talk to you about sterilization.

Before I get started, I want to make a quick note about the difference between methods of birth control for causing infertility and operations for medical purposes. A hysterectomy (surgical removal of the uterus) is not a form of birth control. Although it is 100% effective in regards to preventing pregnancy, women have the operation to correct a medical problem.

And with no further ado...

A vasectomy is a minor surgical procedure that takes about thirty minutes. The vas deferens (the tubes that sperm travel) is severed by a small incision made in the scrotum (the "balls"). Clips and plugs are also used instead of creating an opening, but an incision is found to be the most effective method. After the procedure (and recovery), excluding possible complications from the surgery, a man's sexual performance will not change. The surgery will not effect erections, amount of ejaculate (sperm only accounts for 5% of ejaculate), or the sensations from ejaculation. Sperm is still created after the procedure, but it's absorbed in the scrotum instead of ejactulated.

Note: After a man has recovered from the procedure (takes an average of a week) enough to have sex, he is not yet infertile. Sperm stored in the man's system before the operation are still present. Depending on how often the man ejaculates, it may take ten or more weeks for the stored sperm to be depleted. About six to eight weeks after the operation, men are asked to return to their physician so that their semen (the fluid ejaculated from the penis) can be tested for containing sperm. Usually a physician will prefer two separate negative test results to be sure that the sperm is no longer in the system.

The Positives:

* The surgery is permanent, so the cost of a one-time minor surgery and check-ups are the only worry.
* Does not effect sensation or mood.

The Negatives:

* The surgery is permanent. Although reversing the procedure can be done (called vasovasectomy), it is costly and not a guarentee. (81 - 98% of vasectomies can be reversed, but only approximately half of the procedures are successful in regards to fertility.)
* Does not protect against sexually transmitted infections.

Effectiveness: Theoretical use - 99.9%. Reported use - 99.8%. (About 1 in 1,000 sterilized men will cause pregnancy in the first year. This can occur from not waiting for sperm to clear out of the semen, or from rare cases of the vas deferens growing back together.)

Tubal ligation is a surgery where the fallopian tubes are tied to prevent the sperm and egg meeting up. Clips or rings can also be used instead, but ligation is the most popular method. There are a few different types of tubal ligation:

Minilaparotomy (occasionally referred to as the "minilap") involves a small incision just above the pubic hairline of the abdomen so that an instrument can be inserted into the cervix. The instrument is used to move the uterus so that the doctor can bring each fallopian tube out through the incision, tie it, and then replace back where it was. The surgery takes approximately twenty minutes, with a stay-over at the hospital for two to three hours, excluding any complications.

Laparoscopy involves a small incision in the abdomen so that a laparoscope (rod-like stainless steel tube) can be inserted. Depending on what type of laparoscope the physician uses, more than one incision may be necessary. Ligation through electrocoagulation (high-frequency electrical current) is also an option during this procedure.

Open Laparoscopy involves a small incision in the abdomen (seeing a theme?) so that a cannula (special tube) can be inserted. The skin around the cannula is sutured (stitched) so that it is less likely for damage to the bowel or blood vessels will occur. It is the least likely used out of the three due to taking slightly longer than a laparoscopy and not many well-controlled studies having been found to show its advantages.

Vaginal Approaches:

There are two types of vaginal sterilization surgeries - Culpotomy and Culdoscopy. They both involve a 3 cm incision in the wall of the vagina, behind the cervix. The fallopian tubes are pulled through the incision, into the vagina, where they are then tied.

These approaches are less often used due to resulting in more pelvic infections, being more difficult to perform, and result in higher pregnancy rates than the other sterilization methods.

The Positives:

* The surgery is permanent, and although more costly than a vasectomy, is a one-time cost, excluding possible complications.
* Does not effect sensation or mood.

The Negatives:

* The surgery is permanent. Reversing the procedure is not only expensive, but reported to be only 50 - 70% effective by some experts, while others find it to be 0 - 60% effective for ligation, 0 - 75% for clips or rings, and 0% for electrcoagulation. Also, women who have reversal surgery are three times more likely to have an ectopic pregnancy (fertilized egg implanted outside of the uterus).
* Complications with the procedure, though becoming more rare, are still possible. They include bleeding, infection, or a negative reaction to anesthesia.
* Does not protect against sexually transmitted infections.

Note: Just as the vas deferens can grow back together in the case of a vasectomy, the tubes tied together for a woman can also grow back. This usually occurs after the first year. Studies show the rate of this anywhere from 1 in 100 women to 4 in 1,000. (Gotta love different sources with different findings.)

Effectiveness: 99.9%
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