Permanent Methods of Birth Control
The most common form of male contraception is vasectomy. It is less complex and safer than female sterilization and many couples choose vasectomy for permanent sterilization.
Sterilization is a permanent means of contraception. Tubal ligation (also known as tubal sterilization) has been the predominant method of female sterilization in industrialized countries since the late 1880s. A procedure called hysteroscopic sterilization is another method of permanent female sterilization.
Tubal ligation involves closing off the fallopian tubes to prevent the egg from reaching the uterus, where it can be fertilized. The ends of the fallopian tubes are closed off by burning them (using electrocauterization or electrocoagulation) with a laser, or by putting clips or bands around them.
In the past, tubal ligations were done through the vagina (vaginal tubal ligation). But vaginal tubal sterilization is no longer performed in the United States because it can cause infections and pelvic abscesses (destructive collections of pus that result from infection) and because it has a high failure rate. Vaginal tubal ligations have been replaced with safer, simpler procedures that have a failure rate of about 0.14% (i.e., 14 out of 1000 women).
Pregnancies reported after the tubes have been closed off usually occurred before sterilization. In rare cases, the clips that are used to tie the tubes open up, or there is an abnormal opening in the tubes that allows the sperm and egg to have contact.
There are 3 methods of tubal ligation; the most common are the minilaparotomy and laparascopy:
- A minilaparotomy involves making a small incision in the abdomen, locating the tubes, and cutting and closing them off. A postpartum minilaparotomy is done within 48 hours after a vaginal delivery, when the position of the uterus makes it easier to locate the tubes. The procedure takes about 1020 minutes and can be done on an outpatient basis.
- A laparoscopic tubal ligation involves inflating the abdomen with carbon dioxide or nitrous oxide gas, making a small incision in the abdominal wall, and inserting a fiberoptic light and an instrument that coagulates the tubes with an electric current or puts a clip or plastic band around the end of each tube. The procedure takes about 5 to 10 minutes. Laparascopy requires a smaller incision than a minilaparatomy, is less painful, results in fewer complications and a shorter recovery time, and leaves a smaller scar. However, it requires more sophisticated equipment and specially trained surgeons.
- Tubal sterilization can be done during a laparotomy (abdominal operation) for a cesarean section (delivery of a fetus through an incision into the uterus) or other abdominal procedure. The surgeon has access to the fallopian tubes, even in cases where scar tissue is present (i.e., from previous surgery or infection). The failure rate for a ligation done during a laparotomy is slightly higher than 0.14%.
Tubal sterilization is reversible. With microsurgical techniques, the success rate of reversal surgery is about 7585% in women who are able to undergo reversal surgery. Many women are not considered candidates for reversal surgery for a variety of health reasons. Thus, despite the fact that it is reversible, female sterilization is considered a permanent method of birth control.
Essure® is a method of hysteroscopic sterilization that was approved by the U.S. Food and Drug Administration (FDA) in 2002. In this procedure, a thin, telescopic instrument (called a hysteroscope) is inserted through the vagina and cervix and into the uterus and is used to insert a tiny device into the opening of each of the fallopian tubes. These devices block the tubes and prevent pregnancy.
Hysteroscopic sterilization can be performed in a physician's office using local anesthesia, does not require an incision, and takes less than 20 minutes. After undergoing the procedure, most women are able to return to regular activities by the following day. Side effects may include mild cramping and irregular spotting (minor vaginal bleeding).
About 3 months after the procedure, special x-ray images of the uterus and fallopian tubes (called hysterosalpingograms) are used to check the position of the devices and make sure that the fallopian tubes are completely blocked. Hysterosalpingography involves injection of a contrast agent (dye) that allows the reproductive tract to be visualized upon x-ray. Women should use an alternate method of birth control until sterility is confirmed using this procedure.