Permanent Contraception ... Is It His Turn Yet?

Women willingly accept years of contraceptives, pregnancies, labors, deliveries and post-partum’s. Yet, once the decision for permanent sterilization has been made, the men who have watched them experience all that often balk at the very notion of undergoing the comparatively minimal discomfort and inconvenience associated with having a vasectomy.

Posted on | Lauren Streicher, MD | Comments ()

Women willingly accept years of contraceptives, pregnancies, labors, deliveries and post-partum’s. Yet, once the decision for permanent sterilization has been made, the men who have watched them experience all that often balk at the very notion of undergoing the comparatively minimal discomfort and inconvenience associated with having a vasectomy.

That has always been the case, which is why it’s the women who end up taking responsibility for permanent contraception 75% percent of the time. Every year 1.5 million tubal ligations are done in the US, compared to only 500,000 vasectomies.

While the term “tubal ligation” or  “getting your tubes tied” are commonly used phrases, the more appropriate term is tubal interruption. That’s because there is no actual “tying” involved in most techniques currently used to permanently block the road between the ovary and the uterus. In addition, the ways in which sterilization is performed today are radically different than in our mothers' day.

The very first tubal interruptions were performed as major surgery requiring a large abdominal incision. By the 1970s, a woman requesting sterilization required only an outpatient laparoscopic procedure involving a small incision in the belly button and 1 or 2 other tiny incisions in the lower abdomen. The surgeon would then use clips, rings or electrocautery to seal the fallopian tubes. No matter the method, the result was the same … an inability for the egg to rendezvous with the sperm.

Today, there are new “no incision” sterilization options that can be performed in a doctor’s office with local anesthesia and essentially no recovery.

Essure™ and Adiana™ are both techniques in which a slender scope is placed through the cervix enabling the gynecologist to place tiny coils inside the tubes as they enter the uterus. The coil doesn’t block the sperm; instead it stimulates scar tissue to grow around the coils, which eventually occlude the tube. An x-ray is performed a few months after the procedure to ensure the tubes are completely closed.

The up side? No worries about unplanned pregnancies, no hormonal changes, no incisions, no general anesthesia and no further need for contraception. The major down side to any permanent sterilization? It’s PERMANENT. That means you have to be completely, absolutely, totally 100% sure that pregnancy is not desired.

That seems obvious, but a lot of women who think they are sure, change their mind. Studies have shown that the 3-25% of women regret tubal ligation. The most common reason is a change in marital status, particularly in young women. While post-sterilization pregnancy is possible utilizing in vitro fertilization techniques, the expense is prohibitive for many and relatively few women pursue it.

While the new methods of sterilization are much safer and easier than they used to be, there are still small risks and a procedure involved. Since the women are the ones who endure the discomfort, risks and inconvenience of years of contraception and/or pregnancies, it seems to me that by the time a couple is ready to call it quits, vasectomy is the perfect “thank you” gift.

Blog written by Lauren Streicher, MD
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical...