Sterilization for Women and Men

Sterilization is a permanent method of a birth control. Sterilization procedures for women are called tubal sterilization or female sterilization. The procedure for men is called vasectomy. Sterilization is considered a safe procedure with few complications.

Sterilization does not protect against sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). A latex or polyurethane condom should be used to protect against these infections if you are at risk of getting an STI (read How to Prevent Sexually Transmitted Infections).

Tubal sterilization closes off or removes the fallopian tubes. This prevents the egg from moving down the fallopian tube and keeps the sperm from reaching the egg.

Sterilization is a highly effective way to prevent pregnancy. Fewer than 1 in 100 women get pregnant within 1 year of having the surgery.

In the rare chance pregnancy does occur after tubal sterilization, there is an increased risk that it will be an ectopic pregnancy. But the risk of ectopic pregnancy occurring in women after tubal sterilization is lower than in women who do not use any birth control. Other risks are specific to the type of procedure.

Yes, you will still have menstrual periods after sterilization.

There are two ways that sterilization for women can be done: minilaparotomy and laparoscopy.

• Minilaparotomy—A small incision (cut) is made in the abdomen. The fallopian tubes are brought up through the incision. A small section of each tube is removed, or both tubes can be removed completely. When the fallopian tubes are removed, it is called a salpingectomy. Less often, clips are used to close off the tubes. Minilaparotomy is often used for postpartum sterilization. Read Postpartum Sterilization to learn more.

• Laparoscopy—A device called a laparoscope is inserted through a small incision made in or near the belly button. The laparoscope allows the pelvic organs to be seen. The fallopian tubes can be closed off or removed using instruments passed through the laparoscope or with another instrument inserted through additional small incisions. Read Sterilization by Laparoscopy to learn more.

Minilaparotomy is usually done under general anesthesia or regional anesthesia. Laparoscopy is typically done with general anesthesia.

Benefits: It is effective right away. You do not need to use a backup method of birth control.

Risks: As with any type of surgery, there is a risk of bleeding, problems with wound healing, infection, and complications from the anesthesia used. Other organs in the pelvis can be injured during the surgery. Your risk of these complications is increased if you also have a serious health condition. Health conditions may include diabetes mellitus, obesity, or a previous abdominal or pelvic surgery.

Benefits: In general, recovery time for laparoscopic sterilization is short. It is usually done as outpatient surgery, so you can go home the same day if there are no problems. It is effective right away.

Risks: Laparoscopy has the same surgical risks as minilaparotomy, but there is an additional risk of injury to other organs with the instruments used.

The vas deferens is one of two tubes that carry sperm from the testicles. Sperm becomes part of a man's semen. In a vasectomy, the vas deferens tubes are tied, cut, clipped, or sealed to prevent the release of sperm into the semen. This prevents a woman's egg from being fertilized with the man's sperm.

After a vasectomy, a man's sexual function does not change. Because sperm normally make only 5 percent of semen, there will be little change in the amount of fluid that is released.

The effectiveness of vasectomy in preventing pregnancy after 1 year is slightly higher than that of female sterilization. As with female sterilization, vasectomy does not protect against STIs.

One or two small openings are made in the skin of the scrotum. Each vas deferens is pulled through the opening until it forms a loop. A small section is cut out of the loop and removed. The two ends are tied and may be sealed with heat. This causes scar tissue to grow and block the tubes. Each vas deferens is then placed back into the scrotum.

There also is a "no-scalpel" technique that does not require incisions in the skin. In this procedure, the vas deferens is cut the same way, but instead of making an incision, a special tool is used to puncture the scrotum in one place. No stitches are needed after the procedure. There is less pain afterward, and recovery time is shortened.

Both techniques can be done with local anesthesia in a health care professional's office.

A vasectomy is not effective right away because some sperm may still be in the tubes at the time of the procedure. It takes about 2 to 4 months for the semen to become totally free of sperm.

A couple must use another method of birth control or avoid sexual intercourse until a sperm count confirms that no sperm are present. In this test, the number of sperm in a semen sample is counted.

Benefits: Vasectomy is generally considered to be safer than female sterilization and requires only local anesthesia. Also, there is no increased risk of ectopic pregnancy if the vasectomy fails.

Risks: Risks of vasectomy include minor bleeding and infection. Major complications are rare.

Sterilization is permanent birth control. It is not meant to be reversible. Before having the procedure, you (and your partner, if appropriate) must be certain that you do not want children in the future.

If you have a sterilization procedure and you change your mind after the operation, you can have surgery to try to reverse it. You can also try assisted reproductive technology (ART) to attempt pregnancy. These procedures are expensive and may not be covered by insurance. There is also no guarantee that you will be able to get pregnant afterward.

Choosing to have sterilization is a major decision. You should avoid making this choice during times of stress, such as during a divorce or after losing a pregnancy. You should also not make this choice under pressure from a partner or others.

Most women who choose sterilization do not regret their decision. But research shows that women younger than age 30 are more likely than older women to regret having the surgery.

If you are not sure you want to have sterilization, there are long-acting methods of birth control that allow you to get pregnant when you stop using them. For example, the intrauterine device (IUD) and the birth control implant are birth control methods that

• are as effective at preventing pregnancy as female sterilization

• are safer than sterilization

• last for several years

• can be removed at any time if you wish to get pregnant

Read Long-Acting Reversible Contraception (LARC) to learn more.

Sometimes previous surgery, obesity, or other conditions affect which methods can be used. You should be aware of the risks and benefits of all options before making a choice. If you have a male partner, you may want to discuss vasectomy. Vasectomy is generally considered to be safer than female sterilization.

You can also think about when to have sterilization:

• Postpartum sterilization can be convenient because it can be done when you are already in the hospital after giving birth. If you have a cesarean birth, sterilization can be done using the same incision. If you have a vaginal delivery, you will need a minilaparotomy.

• Female sterilization with minilaparotomy or laparoscopy can be done immediately after an abortion if there are no complications.

• Vasectomy can be done at any time.

• Check whether your health insurance covers sterilization procedures.

• Ask if there is a waiting period after consent forms are signed.

• A few months in advance, make sure that sterilization procedures are offered at the hospital where you are planning to give birth. Not all hospitals offer postpartum sterilization.

Read Postpartum Sterilization to learn more.

Assisted Reproductive Technology (ART): Treatments or procedures that are done to start a pregnancy. This may include handling eggs and sperm or embryos.

Birth Control: Devices or medications used to prevent pregnancy.

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm. The implant releases a hormone to prevent pregnancy.

Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman's abdomen.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Ectopic Pregnancy: A pregnancy in a place other than the uterus, usually in one of the fallopian tubes.

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that create a sleep-like state to prevent pain during surgery.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body's immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Laparoscope: A thin, lighted telescope that is inserted through a small incision (cut) in the abdomen to view internal organs or to perform surgery.

Laparoscopy: A surgical procedure in which a thin, lighted telescope called a laparoscope is inserted through a small incision (cut) in the abdomen. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Local Anesthesia: The drugs that stop pain in a part of the body.

Minilaparotomy: A small abdominal cut used for a surgery in which the fallopian tubes are closed off as a form of permanent birth control.

Postpartum Sterilization: A permanent procedure that prevents a woman from becoming pregnant, done soon after the birth of a child.

Regional Anesthesia: The use of drugs to block sensation in a region of the body.

Salpingectomy: Surgery to remove one or both of the fallopian tubes.

Scrotum: The external genital sac in the male that contains the testicles.

Semen: The fluid made by male sex glands that contains sperm.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Sperm: A cell made in the male testes that can fertilize a female egg.

Sterilization: A permanent method of birth control.

Testicles: Paired male organs that make sperm and the male sex hormone testosterone. Also called the testes.

Tubal Sterilization: A method of sterilization for women. The fallopian tubes are tied, banded, clipped, or sealed with electric current. The tubes also can be removed.

Vas Deferens: One of two small tubes that carries sperm from each male testicle to the prostate gland.

Vasectomy: A permanent birth control method for men. In this procedure, a portion of the tube that carries sperm is removed.