Sterilization is a procedure that makes a person incapable of reproducing. Surgi- cal sterilization is the most common method of birth control among Americans. Surgical sterilization for a man is called vasectomy. This procedure involves cut- ting both vas deferens, the tubes that carry sperm from the testicles. This proce- dure can be performed on an outpatient basis in a hospital, clinic, or doctor’s ofﬁce. It takes about 20 minutes and requires only a local anesthetic. An incision is made on both sides near the base of the penis. On each side, the vas deferens is freed from the spermatic cord, pulled up through the incision, made into a loop, cut, and tied. (The vas deferens may also be cauterized, or sealed off, with an electric current.) The incision is closed with three or four sutures. When the local anesthetic wears off, the man may experience a mild, dull ache or pain for a few days. The man still ejaculates but the semen does not contain sperm.
The man is usually advised to rest in bed for 24 hours. Complications from vasectomy are rare (fewer than 5 per- cent of cases); the most common com- plications are bleeding and swelling of the scrotum. Most men return to work within a few days. Some doctors advise wearing tight-ﬁtting underwear or a jock strap for 4 to 6 weeks to prevent swelling and pain in the scrotum.
It is important to remember that viable sperm may still be present in the seminal vesicles (the small sacs that store semen) after a vasectomy. For this reason, a man or his partner should con- tinue to use some other form of contra- ception until those sperm are either ejaculated or die. The man is considered sterile only after a laboratory test con- ﬁrms that two successive samples of ejaculate, collected 2 to 4 months after the procedure, are free of sperm.
Contrary to what some men believe, vasectomy does not interfere with ejacu- lation, orgasm, or sex drive. In fact, several studies have shown that many men who have this procedure experience an increase in sexual desire. Vasectomy has been known occasionally to be associated with psychological problems or regrets about having the procedure. When these problems affect sexual perform- ance, counseling is advised.
Women are sterilized by tubal ligation—the cutting and tying of the fallopian tubes, which carry the egg from the ovaries to the uterus. A variety of procedures are currently being used in the United States: abdominal tubal ligation, tubal coagulation by laparoscopy, and minilaparotomy. The ﬁrst two methods require hospitalization and usually are performed under general anesthesia; the third can be performed on an outpatient basis.
Currently, the trend is for more tubal ligations done by laparoscopy. A thin tube (laparoscope) is inserted through a small incision in the woman’s abdomen (usually through the navel). The doctor cuts the fallopian tubes and ties off the ends. (The ends of the tubes also may be cauterized.) The woman usually goes home the same day. Complication rates for this procedure are very low.
About a third of all married couples in the United States who use family plan- ning methods choose sterilization of either partner. It is the method most often chosen by couples in which the woman is more than 30 years old. Vasectomy is more common than tubal ligation because it is simpler, just as effective, less expensive, and has fewer potential complications.
For couples who know that they do not want more children, sterilization is the most effective way to prevent pregnancy. Because the surgical procedures to reverse either vasectomy or tubal ligation are complicated and expensive, the results should be considered permanent. Although researchers are studying ways to easily reverse these procedures, they are not yet available.
If you have questions about any contraceptive method, ask your primary care doctor, a urologist (a physician who specializes in treating disorders of the uri- nary tract), or a gynecologist (a physician who specializes in treating disorders of the female reproductive system).