What you should know about permanent contraception

What is permanent contraception?

Permanent contraception is a form of contraception that, as the name suggests, lasts for the rest of your life. Methods are available for both men and women, and it involves permanently altering the reproductive organs. It requires a simple procedure. For men, the procedure is known as a vasectomy, whilst for women it is known as female sterilisation.

What is a vasectomy?

A vasectomy is the name for male sterilisation. It’s a minor surgical procedure that involves cutting, blocking or sealing the vas deferens tube. This tube typically carries sperm from the testicles and out of the body through ejaculation. By sealing this tube, the semen will contain no sperm which means a woman’s egg cannot be fertilised

What does a vasectomy involve?

There are two main types of vasectomy.

While both types are safe and suitable for most men, your doctor may recommend you one type over the other.

Are there any complications with a vasectomy?

The risk of complications with a vasectomy is low and most men will make a full recovery in a week or two.

Some common side effects after a vasectomy include:

• mild discomfort
• swelling and bruising of the scrotum
• blood in your semen for the first few ejaculations

Taking over-the-counter painkillers and wearing tight underwear to support the scrotum will alleviate some discomfort. However, men should avoid having sex, exercise or any heavy lifting for at least a week after the procedure.

How effective is a vasectomy?

12 weeks after a procedure, the man will have to have your semen tested for sperm count. This is to confirm that the semen is sperm-free.

A small percentage of men will continue to have traces of sperm in their semen, but these sperm are more immobile and therefore less likely to fertilise an egg.

Men will need to use an alternative form of contraception (e.g barrier contraception) until you know your sperm count is low, as it takes a while for semen to be completely sperm-free.

In rare cases, the tubes may naturally rejoin themselves. However, the overall failure rate of vasectomies is extremely low, as low as less than 1% Trusted source National Center for Biotechnology Information (NCBI) Government Source Biomedical Research and Literature Go to source .

What is female sterilisation?

Surgical female sterilisation is the equivalent of vasectomy but for women. Like the vasectomy, it requires a simple procedure which involves blocking the fallopian tubes, the tube that links the uterus (womb) and the ovaries. This is a procedure known as tubal occlusion or tubal ligation.

What this does is it prevents the egg from travelling down the fallopian tubes and into the uterus. The ovaries will continue to produce eggs, but they will naturally be absorbed into the body.

There used to be an additional type of sterilisation available known as hysteroscopic sterilisation, in which a small implant was inserted into the fallopian tubes sold under the brand name Essure. However, the device used for this procedure has since been discontinued.

What does the procedure involve?

Tubal occlusion can be done in two ways. Which one a woman has will depend on their medical history, but both procedures are similar.

The most common way is a laparoscopy, where a small cut is made near the belly button. However, certain women cannot have this procedure due to risk of complications, such as women who are overweight, have recently had abdominal surgery or have a history of PID (pelvic inflammatory disease). These women will instead have a mini-laparotomy, where a cut is made above the pubic hairline.

In both procedures, a surgeon then inserts a small camera (a laparoscope) so they can clearly see your fallopian tubes.

The fallopian tubes are are then sealed in one of several ways, including by:

• applying titanium or plastic clips that close over the tubes
• applying rings - a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut
• tying, cutting and removing a small piece of the fallopian tube

Do you still have periods after being sterilised?

As sterilisation does not affect your hormone levels or your menstrual cycle like other birth control options, you will still get your period each month. It shouldn’t change your periods in any way, but if you do notice any differences, you should consult your healthcare provider.

Are there any complications with female sterilisation?

Most women who have the surgery can go home the same day, once they have recovered from the anaesthesia. Even still, It’s normal to feel some discomfort for a few days.

Some common side effects include:

• feeling unwell or uncomfortable
• stomach cramps (may feel like period pain)
• slight vaginal bleeding

If your symptoms persist or get worse, you should consult the specialist who performed the surgery.

A rare but serious complication of sterilisation is an ectopic pregnancy. An ectopic pregnancy is where a fertilised egg implants in the fallopian tube instead of the womb. The most common cause of ectopic pregnancy after sterilisation is if the tubes grow back together over time.

If you notice that you miss a period, have sharp pains in the pelvis or have any irregular vaginal bleeding, consult your doctor.

How effective is female sterilisation?

Like a vasectomy, laparoscopic tubal occlusion has a very low failure rate. It is estimated that the failure rate is as low as 0.5% Trusted source Clinical Knowledge Summaries (CKS) Government Source Go to source , and certain sealing methods may have an even lower failure rate.

In the rare case where the procedure doesn’t work, the fallopian tubes may need to be removed completely. This is a procedure known as salpingectomy. This procedure may also be used if you experience any complications from sterilisation.

Is sterilisation reversible?

Both male and female sterilisation should be considered as a permanent birth control method. While both procedures can technically be reversed, it’s not an easy procedure and it’s not always successful.

If reversal is unsuccessful, you can always try fertility treatments such as IVF. However, like sterilisation reversal, there’s no guarantee it will be successful.

Sterilisation reversal…

• is rarely funded by the NHS
• requires a difficult procedure
• doesn’t guarantee you will be fertile after reversal

Who can get sterilised?

You can be sterilised at any age and your doctor will refer you for the procedure if they believe it is in your best interests.

However, given the irreversible nature of the procedure, if you are under 30 and don’t have any children, they will encourage you to consider your options seriously before opting for sterilisation. Healthcare professionals do have the right to refuse you for the procedure if they do not believe that it is in your best interests.

If you have any doubts about the procedure, it’s likely that it is not suitable for you and you should discuss alternative options with your doctor or a professional at a sexual health clinic.

What are the advantages and disadvantages of sterilisation?

What are the alternatives to sterilisation?

If you’re not looking for a long-lasting method of birth control but not something permanent, there are alternatives. The best option for you are a group of contraceptives called long-acting reversible contraceptives (LARC). They can last for years in some cases, but can be removed or changed at any time.

Long-acting reversible contraceptives
IUD (intrauterine device) Also known as the “copper coil”, the IUD is a small T-shaped device that releases copper into the womb. Can be left in for 5 -10 years.	IUS (intrauterine system) A hormonal version of the IUD. A small T-shaped device that releases progesterone into the womb. Can be left in for 3 - 5 years.
The injection An injection that releases progesterone into the bloodstream. Lasts for 8 - 13 weeks.	The implant Small plastic rod that is inserted under the skin in your arm and releases progesterone. Lasts for 3 years.

Final thoughts

Permanent methods are available and are highly effective. They’re a great option if that’s what you want. However, the decision should not be made lightly. The procedures are irreversible and could significantly impact your life and mental health if you change your mind. If you’re not sure, consider a non-permanent and long-lasting method like LARC instead.