Contraception V: Sterilization and Withdrawal
Author: Michael Castleman, M.A.
STERILIZATION FOR MEN -- VASECTOMY
Sterilization is the most effective birth control method, but those who opt for it should consider it permanent.
Vasectomy is a minor surgical procedure which cuts the tubes that carry sperm out of the testicles.
Sperm are produced in the testicles inside the scrotum. Once mature they leave through a tube, one per testicle called the vas deferens. The two vas tubes carry the sperm up to the prostate gland, where they combine with seminal fluid to form semen. Sperm account for about 2 percent of semen by volume.
Vasectomies are 20-minute procedures performed under local anesthesia. The surgeon makes two tiny incisions in the upper scrotum, cuts the vas tubes and seals their ends. After vasectomy, men usually feel some soreness and see some scrotal discoloration.
Surgical complications develop in about one percent of cases, including wound infections, anesthesia reactions and sterilization failure.
Most vasectomies are performed on Fridays. Afterward, men should take it easy on the weekend and not do any heavy lifting. Most feel fine by the following Monday.
Couples may resume lovemaking whenever they wish, but must use another form of birth control until the man has been confirmed sterile. After vasectomy, men are not sterile. Typically hundreds of millions of live sperm remain in the vas tubes above where the surgeon cuts. It usually takes about two dozen ejaculations to eliminate them. A few weeks after vasectomy, men return for follow-up appointments. They masturbate and the physician examines their semen for live sperm. You're not sterile until the doctor says you are. Until then, continue to use another form of birth control.
After vasectomy the man's testicles continue making sperm, but they are reabsorbed into the body like other cells that outlive their usefulness.
Vasectomy is a more minor, less costly, less traumatic procedure than the woman's sterilization operation -- tubal ligation.
Recently, urologists have enjoyed increasing success reversing vasectomies. Using the latest microsurgical techniques, sperm return to semen in about 75 percent of cases and impregnation occurs about half the time. But vasectomy reversal is major surgery. Instead of a 20-minute office procedure, reversals take hours in a hospital under general anesthesia. Vasectomies cost a few hundred dollars and health insurance pays for them. Reversals cost $5,000 to $10,000, few insurers cover them and success cannot be guaranteed.
If you have completed your family and no longer care to use other contraceptives, vasectomy might be right for you. But before you have the operation, think long and hard about some difficult questions:
* Suppose you divorced or became widowed and then remarried. Would you want more children? What if your new wife wanted children? * Suppose your children were killed? Would you want to start a new family?
If you find yourself thinking, "Well, I could always get it reversed," think again. There's no guarantee that any vasectomy can be reversed and no man should have one if he thinks he might ever attempt to have it reversed. The vast majority of reversal attempts involve men who divorce, remarry and want children with the new wife.
Sterilization decisions should not be made impulsively. Studies of men's feelings after vasectomy show that those happiest with the operation thought about it for at least a year before having the surgery. If you're quite certain you want a vasectomy, contact a physician.
STERILIZATION FOR WOMEN -- TUBAL LIGATION
Sterilization is the most effective birth control method, but it's also permanent.
Tubal ligation involves blocking the fallopian tubes which connect the ovaries and the uterus. The fallopian tubes can be blocked by cutting, mechanical closure with clips or removal of the uterus. Cutting is generally considered the most effective, least costly and least physically traumatic alternative.
The standard procedure takes place under sedation and local anesthesia. An overnight hospital stay may be necessary. It involves a small incision at the top of the pubic hairline and insertion of an instrument called a laparoscope, which is used to cut the tubes.
Surgical complications develop in about one percent of cases, including wound infections, anesthesia reactions, intestinal injury and sterilization failure.
About 40 percent of tubal ligations are performed shortly after delivery of a child. In such cases, the surgeon uses a slightly different procedure which requires general anesthesia.
Tubal ligation is considered minor surgery, but it's more major -- and more costly -- than vasectomy.
If you have completed your family and no longer care to use other contraceptives, tubal ligation might be right for you. But before you have the operation, think long and hard about some difficult questions:
* Suppose you divorced or became widowed and then remarried. Would you want more children? What if your new husband wanted more children? * Suppose your children were killed? Would you want to start a new family?
If you find yourself thinking, "Well, I could always get it reversed," think again. There's no guarantee that any tubal ligation can be reversed and no woman should have one if she thinks she might ever want it reversed. If you're quite certain you want to be sterilized, contact a physician.
WITHDRAWAL
Withdrawal means that the man removes his penis from the woman's vagina before he ejaculates. Theoretically, withdrawal also known as "pulling out," makes sense. If the man doesn't ejaculate inside the vagina, the woman can't become pregnant. But in practice, things often don't work out that way. Pre-ejaculatory fluid may contain sperm. And for this method to work properly, the man must have excellent ejaculatory control, a skill many men do not have.
On the other hand, withdrawal is considerably better than nothing and after weighing the advantages and disadvantages of all the methods some couples might decide to use it.
Withdrawal is theoretically 96% effective, with an actual effectiveness of 82%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion.
Withdrawal has several advantages:
* There's nothing to buy. * There are no devices to use. * You don't have to visit a doctor or family planning clinic to use it. * It causes no side effects.
But withdrawal also has some disadvantages:
* It's not very effective, meaning considerable risk of pregnancy. * It limits the ways a couple can make love.
If the man accidentally ejaculates inside the vagina, the woman should immediately insert some spermicide and consult a physician or family planning clinic for a morning-after contraceptive.