Sterilisation is a permanent method of contraception, for people who don’t want more children, or any children. It works by stopping sperm from meeting an egg.
There are different forms of sterilisation and they involve a type of surgical procedure, either for the man or the woman.
Im so grateful to @thesurgeonmum for contributing her knowledge of male sterilisation to this post.
Effectiveness:
Vasectomy (male sterilisation) and tubal occlusion (female sterilisation) are both over 99% effective at preventing pregnancy.
The major benefit – ‘fit and forget‘:
After a successful procedure, you don’t have to think about or use contraception again.
However, sterilisation is rarely reversible, so don’t choose this option unless you’re absolutely certain you don’t want any children in the future.
Female sterilisation
This is done by cutting, sealing or blocking the fallopian tubes which carry an egg from the ovary to the uterus (womb).
The Procedure:
The fallopian tubes are blocked by applying clips or rings, sealing, or tying, cutting and removing a small piece of each tube.
There are two ways of reaching the fallopian tubes – laparoscopy (keyhole surgery) or by a mini-laparotomy.
These are usually done under regional (such as a spinal injection, so you are awake) or general anaesthetic. During caesarean, the sterilisation can be carried out after the uterus has been closed, avoiding the need for extra surgery.
Periods: Sterilisation doesn’t affect periods.
STI protection: No. Use external condoms or internal condoms to help protect yourself from STIs.
Hormones: No hormones.
After effects:
As you generally require general anaesthetic, you may feel groggy for a few days after. You may have some abdominal pain or light bleeding for a few days.
Other risks of the operation include bleeding in the abdomen, infection and damage to the other local organs.
The main disadvantage of female sterilisation is that if the contraception fails (1 in100) and you become pregnant, it is more likely to be an ectopic pregnancy.
You’ll need to use contraception until your operation and for at least seven days afterwards.
It is important to know that female sterilisation is almost certainly permanent. Therefore if you change your mind about future pregnancies, your only option to conceive would be via IVF. Other good, long-acting contraceptive choices with similar failure rates include the contraceptive coils.
Male sterilisation – Vasectomy
Vasectomy involves cutting the tubes (vas deferens) that carry sperm out of the testicles. It is the most effective method of male sterilisation (>99% effective) but should always be regarded as irreversible.
The procedure:
It can usually be performed under local anaesthetic (LA) and takes about 20 mins. The LA can feel like a bee sting when it is injected. A small cut will be made in the scrotum over the tube, the tube will be cut and then sealed with stiches/clips +/- some burning, and the skin cut will be closed. It’s then repeated on the other side.
You can then go home but should rest for a few days.
After effects
Mild bruising/ swelling is quite common, and there is a small risk of infection. You may notice blood in your semen for the first few ejaculates.
There is a small chance it doesn’t work (1 in 250), and an even smaller chance of late failure where the tubes re-join after an initial negative sperm test (1 in 2000). Up to 15% of men report troublesome chronic testicular pain which can be severe enough to affect day-to-day activities in up to 5%.
There is no evidence it causes any long-term health risks and it doesn’t affect your sex drive/erections/ability to ejaculate.
How do I know if it’s worked?
You will NOT be sterile immediately and will need to continue to use alternative contraception until you have been given the all clear from your post-op semen tests. These are done after 12 weeks and >20 ejaculations, as sperm further down the tubes needs to be cleared. If no sperm are seen at 12 weeks you may be given the all clear that you are sterile. If there are still sperm present you will need to produce a further sample a few weeks later to check again.
Conclusion
Generally, if a couple is certain that they dont want any more children, and would like to avoid the need to continue using contraception, male sterilsiation is the method of choice. This is because the procedures have similar failure rates, but with the male version there is no risk of ectopic pregnancy. Additonally a vasectomy is considered a less risky procedure.
For further information, please visit https://www.fpa.org.uk/