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What are permanent birth control methods?
Permanent birth control methods are surgical methods of contraception that are intended to last forever. They are also called Sterilization methods and are performed in couples who have completed their family and do not want to have any more children. These surgical methods are generally considered irreversible, although in some cases, they can be reversed with another surgery.
The procedure done in men is called Vasectomy or male sterilization.
The procedure done in women is called Tubectomy or Tubal ligation or Female sterilization.
Vasectomy
What is vasectomy?
Vasectomy is an elective minor surgical procedure done in men with an aim to provide permanent contraception. In this procedure, the tubes (Vas Deferens) that transport sperms produced in the testis to the ejaculatory duct in the penis, are cut and sealed, so that sperm can no longer travel and come out in the ejaculate. It is also called male sterilization.
How is vasectomy done?
To understand the procedure, we must first learn a bit of anatomy. The testis are the organs that produce sperms in men. They lie in a bag called the scrotum which is suspended from the base of the penis. The sperms produced by testis are carried by a long tube called Vas Deferens to the urethra which opens outside through the penis. On the way to urethra, the vas is joined by glands called seminal vesicles which add their seminal fluid to the sperms to form the semen. The vas deferens lies just below the skin of scrotum and is most easily accessible there.
Vasectomy is usually done as an office procedure, although it may also be done in the operation theatre. It can be done by 2 methods – the conventional method or a newer no-scalpel technique.
CONVENTIONAL OR TRADITIONAL VASECTOMY: First, the scrotum is shaved and cleaned with an antimicrobial solution. Then your doctor will inject the skin of your scrotum with a local anesthetic to numb the skin. This is called local anesthesia. After this, your doctor will make a small cut on the skin of the scrotum, lift out the vas, cut a small portion of the vas, and tie or cauterize the remaining ends, which are put back in the scrotum. So now your vas deferens have been cut and a portion of vas has been removed, so that there is a gap between the two ends and the sperms can not cross this gap and travel further. This is just like removing a part of the bridge from the center so that no one can travel to the other side. The skin is sutured by either removable or self-absorbing stitches. This procedure is then repeated on the other side of the scrotum. The entire procedure takes 20-30 minutes.
NO SCALPEL VASECTOMY: In this technique, the skin is not cut. Instead, the vas deferens is lifted out through a small hole in the skin, which later closes on its own. The rest of the technique is exactly similar to the conventional technique, except that no skin cuts or sutures are involved. The recovery is much faster by this technique.
What happens to sperms after vasectomy?
- After vasectomy, sperms are still produced by the testis, but since the vas has been cut, they are unable to travel through the vas and come out in the ejaculate. So they remain in the testis and finally get removed by the body.
- The seminal fluid is still produced by the seminal vesicles, but there are no sperms in it. So you will still ejaculate after sexual intercourse, but it will be devoid of sperms.
How effective is birth control by vasectomy?
- Vasectomy is nearly 100% effective in providing contraception, but it can take 3-6 months for it to be completely effective.
- Till that time, you should use alternative methods of contraception to prevent unwanted pregnancy.
- You can stop using the additional methods of contraception when the tests done by your doctor confirm the complete absence of sperms in the ejaculate.
- Although very rare, the ends of the vas deferens may sometimes rejoin spontaneously on their own. This can cause a vasectomy failure and pregnancy can then occur. There is no way to find this out unless pregnancy occurs despite vasectomy.
What are the benefits of vasectomy?
Permanent sterilization methods are extremely effective contraceptive methods, with a very low failure rate. However, vasectomy is considered better than tubectomy as:
- Vasectomy is a relatively less invasive and easier office procedure, as the vas deferens lies just below the skin of scrotum. Whereas in tubectomy, the surgeon has to incise and go inside the abdomen to reach the fallopian tubes. So it is more invasive and is done in the operation theatre.
- Vasectomy requires only a local anesthetic whereas tubectomy requires a general or spinal anesthesia.
- Postoperative recovery after vasectomy is faster as compared to tubectomy.
- Vasectomy has relatively lesser chances of complications as compared to tubectomy,
- Vasectomy is a cheaper procedure compared to tubectomy.
The only situation in which tubectomy is considered better is when the abdomen is already being opened for other procedures like a cesarean section or fibroid removal and tubectomy is done along with the other procedure.
What are the risks or complications of vasectomy?
Vasectomy is an extremely safe and effective procedure, with a very low rate of complications or failure. Problems like bleeding, infection, or swelling can occur in some patients, but these are rare and usually recover soon. Some complications of the procedure that can happen are:
- Infection: Although rare, infection can occur as in any other surgical procedure. It is indicated by fever or redness at the operative site.
- Bleeding: again very rare. If it happens, it is indicated by an increase in the size of scrotum or swelling of the scrotum or pain in the scrotum.
- Post vasectomy pain syndrome: About 1% of men who undergo vasectomy, may have persistent pain which does not go away, even after the surgical site has healed. The cause is unknown but it can be easily treated by anti-inflammatory medicines.
- Vasectomy does not protect you from sexually transmitted infections (STIs) For protection against STIs, prefer a monogamous relationship with one partner and use barrier methods.
Always visit your doctor if you have any such symptoms.
Can vasectomy affect my sex drive?
No, vasectomy does not affect your sex drive, orgasm, ejaculation or your hormones in any way.
Can vasectomy cause erectile dysfunction?
No, vasectomy does not cause any erectile dysfunction.
Can vasectomy increase my risk of prostate cancer?
No, vasectomy has not been shown to increase the risk of prostate cancer or testicular cancer.
When can I resume sex after vasectomy?
Vasectomy is a minor procedure and the skin incision heals quickly. You can resume sexual intercourse as soon as next day after the procedure. However, the incisions take 5-7 days to heal completely and till that time, ejaculation can be painful.
As pointed out earlier, the contraceptive effect takes 3-6 months to take complete effect. So during this time, you should use other contraceptive methods till your doctor confirms the absence of sperms in the semen.
Can vasectomy procedure be reversed?
Yes, the procedure can be reversed by reattaching the healthy ends of the vas. However, it is not always possible to do it in all cases. Moreover, even in cases, where the vas is reattached, the results are inconsistent and it may not always work.
It is not wise to undergo permanent sterilization procedures like vasectomy or tubectomy, unless you and your partner are absolutely sure that you have completed your family and do not want to have any more children in the future. In case of even the slightest doubt, choose from other reversible options like barrier methods, oral contraceptive pills or intrauterine devices, which are highly effective but reversible.
Tubectomy or tubal ligation
What is tubectomy or tubal ligation?
Tubectomy or tubal ligation is a surgical procedure done in women with an aim of providing permanent contraception. In this procedure, the fallopian tubes, which carry eggs produced by ovaries to the uterus, are completely or partially removed or are clipped with metal or plastic clips. The purpose of all these methods is to disrupt the continuity of fallopian tubes, so that the egg produced by the ovary is unable to reach the uterus and meet the sperm. It is also called female sterilization.
How is tubectomy done?
All tubectomy procedures are done in the operation theatre under anesthesia. Although the choice of approach and methods vary from surgeon to surgeon, the basic principle of tubectomy is to cut or block the fallopian tubes. This can be done by completely removing both fallopian tubes, or cutting a part of each fallopian tube or blocking the tubes by applying plastic or metal clips.
Based on approach, tubectomy can be done by 2 methods: a minimally invasive technique called Laparoscopic tubectomy or a traditional open approach called Laparotomy or Minilaparotomy.
- Laparoscopic tubectomy: In this procedure, 3-4 small incisions are made in your abdomen, through which an instrument with a camera (laparoscope) and some other instruments are inserted. The camera shows the inside of your abdomen on a screen and the other instruments are used to do the procedure. The procedure is done under general anesthesia. The benefit of this method is that it is minimally invasive as the abdomen is not opened. So the recovery is faster and chances of blood loss, pain and infection are lesser as compared to the laparotomy method. You can be discharged on the same day or the next day. Nowadays, tubectomy is mostly done by the laparoscopic method.
- Tubectomy by Laparotomy: In this procedure, the abdomen is opened with a bigger incision, as in any other surgical procedure. The surgeon reaches the fallopian tubes and ligates them. The abdomen is then closed with sutures. Nowadays, this procedure is done with a much smaller incision and is called Minilaparotomy. The procedure can be done under regional (spinal or epidural) or under general anesthesia. Laparotomy is usually preferred when tubectomy is done in addition to some other surgery already being done by laparotomy. For example, cesarean section, fibroid removal etc. The chances of blood loss, pain and infection are more than that with the laparoscopic approach and the recovery is slower. You will most likely be discharged after 2-3 days.
When is tubectomy done?
- Tubectomy is an elective surgical procedure. So, it can be planned anytime just like any other surgical procedure. It is never done as an emergency.
- Sometimes, patients who undergo cesarean section opt for tubectomy, along with the cesarean section, and tubectomy is then done along with the cesarean.
- Alternatively, some patients who could have otherwise delivered normally, opt for a cesarean section so that they can get the tubectomy done along with the cesarean.
What happens to the eggs after tubectomy?
- After tubectomy, the eggs are still produced by the ovaries, but they are unable to travel towards the uterus as the channels (fallopian tubes) between the ovary and uterus have been interrupted. The eggs produced are broken down and removed by your body.
- The ovaries also keep producing your hormones, just like before surgery. So there will be no ill effect on your menstrual cycles or your general reproductive health, other than the contraception.
How effective is birth control by tubectomy?
- Like vasectomy, tubectomy is also a permanent birth control method and is nearly 100% effective in providing contraception.
- In rare cases, it is possible that tubectomy may fail as the two ends of the fallopian tube may rejoin spontaneously. This is called tubal recanalization.
- Pregnancy may or may not occur after tubal recanalization, but if it occurs, the chances of a pregnancy getting planted at a site away from the uterus (ectopic pregnancy) are higher than normal. Such a pregnancy mostly gets implanted in the fallopian tubes and may cause rupture of tubes with internal bleeding.
What are the benefits of tubectomy?
- Tubectomy offers almost 100% effective contraception.
- Does not affect your ovulation, periods or hormones.
- Does not affect your sexual urge (libido) or sexual intimacy.
- It’s permanent; so you won’t have to remember to take any pills daily or use any special method before sexual intercourse.
What are the risks or complications of tubectomy?
As with any surgical procedure, tubectomy is also associated with the possibility of certain risks or complications. For example,:
- Bleeding: Mild surgical bleeding during the procedure may occur, but heavy bleeding is uncommon in tubectomy.
- Infection: Tubectomy is a simple and clean procedure; so the risk of surgical infection is also very low. Follow postop wound care instructions given by your surgeon strictly.
- Pelvic pain: Mild pelvic pain and stiffness are normal after the surgery and are easily taken care of, by routine painkillers. However, if pelvic pain persists or increases or you develop a fever with pain, you should visit your surgeon right away for an assessment of infection.
- Injury to other organs: Since the surgeon has to go into your abdomen for tubectomy, there is a small chance of injury to other organs like the intestine, ureters, urinary bladder, or major blood vessels like the aorta or the inferior vena cava.
- Ectopic pregnancy: If you become pregnant after tubectomy, the chances of a pregnancy getting implanted at a site away from the uterus (ectopic site) are higher than normal. The most common site of implantation is the fallopian tube. This is a serious condition and can cause catastrophic hemorrhage, if the tube ruptures. If you have early pregnancy and are experiencing abdominal pain, you must consult your doctor immediately. It could be an ectopic!
- STIs: Tubectomy does not protect against sexually transmitted infections (STIs).
- Permanency: Tubectomy is a permanent sterilization procedure. So you should weigh all the pros and cons and discuss them with your partner, before opting in for tubectomy. If there are even the slightest chances that you may want to rethink about it, take your time and then make your decision.
Is tubectomy reversible?
Tubectomy reversal procedures are possible, but they are not possible in every patient. For example, if the tubes have been removed completely, there is no reversal. Secondly, these procedures are complicated and expensive with mixed results. It is also pertinent to remember that the chances of having an ectopic pregnancy become higher after reversal procedures.
In the event of even the slightest doubt, use reversible contraception like oral hormonal contraceptives (see Birth Control Pills I Oral Contraceptive Pills), barrier methods like condoms (see Barrier methods of contraception), or Intrauterine devices, which offer nearly similar efficacy with reversibility. Go in for permanent contraception only when you and your partner are 100% sure of your decision.
Can tubectomy affect my sex drive?
No, tubectomy does not affect your sex drive, sexual intimacy, or your hormones in any way.
Will I have periods after my tubectomy?
Tubectomy does not affect your hormones, ovulation, or your periods in any way. You will continue to have your periods, just the way you had them before tubectomy.
When can I resume sex after tubectomy?
Tubectomy is a minor procedure and the recovery is quick, especially if done laparoscopically. You can resume sexual intercourse within a week after your surgery.
If you had a tubectomy along with a cesarean or after delivery, you may have to wait longer. Your surgeon will keep assessing you and clear you to resume sex, once you have recovered completely.
When can I resume normal activities after my tubectomy?
You will start walking on the same day or the next day of your surgery, depending on the approach used by the surgeon and the anesthesia given to you. You can also climb stairs and do your routine household work after 2-3 days of your surgery.
However, you will have to wait for 6-8 weeks to start bending, lifting weights or doing heavy exercise. This much time is needed by the body to heal itself completely after any surgical procedure.
Carry home message
Permanent sterilization methods are excellent methods of contraception with the highest efficacy of all methods. However, these are permanent. So, these methods should only be adopted by couples whose family is complete and there is no likelihood of them wanting to have a child in the future.
Both tubectomy (female sterilization) and vasectomy (male sterilization) are simple procedures with low rate of operative or postoperative complications. Vasectomy is easier and less invasive, with quicker recovery as compared to tubectomy. It can be done in an office setting, under local anesthesia whereas tubectomy has to be done in an operation theatre under general or regional anesthesia. Both partners should discuss their choice of getting a vasectomy or tubectomy done, as per their mutual decision and after discussion with their surgeon. Stay healthy!
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To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care