Birth control options: permanent methods

Permanent methods of birth control involve creating a surgical block or an occlusion to prevent a woman’s egg from coming in contact with a man’s sperm. Although they may be reversed in some cases, they are usually called permanent because reversal is difficult and cannot be guaranteed. These procedures do not protect against sexually transmitted infections, but a successful surgery is a 99.5 per cent effective way of preventing pregnancy. Generally, couples who choose these methods are in stable partnerships and can predict that they do not wish to have children in the future. Approximately 24 per cent of Canadian women rely on one of these procedures to avoid pregnancy.

There are three possible procedures:

1.Vasectomy

Vasectomy is a very simple surgical procedure that makes a man infertile. It can be done in about 15 minutes in a doctor’s office. About 14 per cent of Canadian women rely on this form of birth control. A successful vasectomy is 99.5 per cent effective in preventing pregnancy (if the woman has only one sexual partner!)

How it’s done
The scrotum is numbed with an injection but the man remains awake during the procedure. Two tiny incisions are made. The tubes (called vas deferens) which carry sperm from the testicles to the penis are severed and the ends are sealed.

Afterwards
Most men recover quickly although a few men experience pain and swelling for up to two weeks. Infection is possible but rare. Men are asked to avoid strenuous activity for 48 hours. It takes about three months for the procedure to be fully effective. A sperm count is done three months after the procedure to ensure that it has been successful.

A vasectomy has no negative effects on a man’s sex drive and studies have not shown an association with prostate cancer. Very rarely, small, sometimes painful, bumps can develop at the ends of the vas deferens. These bumps usually disappear on their own, but may be removed surgically if necessary.

Advantages

• one-time procedure
• very effective
• quick recovery
• no need to remember birth control method
• allows male partner to be involved in birth control decision-making
• you don’t have to interrupt sex
• no significant long-term side effects
• simplest procedure for permanent birth control

Disadvantages

• male partner must be willing
• reversal is expensive, difficult and sometimes impossible
• provides no protection against sexually transmitted infections
• psychologically difficult for some men
• birth control must be reconsidered if a woman changes (or adds) male partners

2. Tubal ligation

Tubal ligation is a surgical procedure that makes a woman infertile. It is performed in a hospital. About 10 percent of Canadian women rely on this method of birth control. There are two ways of doing the surgery.

1.  Abdominal incision
   Usually performed under general anesthetic. An incision is made just above the woman’s pubic region. The fallopian tubes, which carry the eggs from the ovaries to the uterus, are cut and sealed.
2. Laparoscopy
   Usually performed under general anesthetic. Laparoscopy only requires two tiny incisions that can be covered with Band-Aids. A thin tube carrying a camera is inserted through one incision. An instrument is placed through the second incision and used to block the fallopian tubes.

Afterwards
A woman can move around after about eight hours and resume normal activities in a few days. Physical exertion should be avoided for at least a week. Infections or bleeding are possible but rare. An anesthetic that makes a woman unconscious has more risk than a local anesthetic.

This is a simple and effective procedure. The failure rate is very low (less than 0.1 per cent) but if a tubal ligation is unsuccessful, it can increase the risk of a woman having an ectopic pregnancy. This is a dangerous condition where a fetus begins to develop in the fallopian tube instead of inside the uterus.

Some studies suggest that a woman who has a tubal ligation before age 30 has a slightly higher risk of hysterectomy in later life. Other studies suggest that this procedure has a slight protective effect against ovarian cancer and pelvic inflammatory disease (PID).

Advantages

• one-time procedure
• very effective
• no need to remember birth control method
• you don’t have to interrupt sex

Disadvantages

• reversal is expensive, difficult and sometimes impossible
• provides no protection against sexually transmitted infections
• although a tubal ligation dramatically decreases the risk of any pregnancy, if the procedure fails and a pregnancy results, there is an increased risk of it being an ectopic pregnancy

Hysteroscopic tubal occlusion (Essure)

Essure is a permanent birth control procedure. It is an alternative to traditional tubal ligation. Essure is over 99 per cent effective at preventing pregnancy. Using a scope inserted into the uterus through the cervix, small Essure coils are placed into the fallopian tubes (the tubes that carry eggs from the ovaries to the uterus). The body then builds tissue around these coils over the next few months, blocking the fallopian tubes. The Essure insert is made of materials that include a nickel-titanium alloy. The procedure requires no incisions, and does not require a general anesthetic. Another method of birth control must be used for about three months (but possibly six months) following the procedure, while the body forms enough tissue around the inserts to block the fallopian tubes.

Afterwards
Hysteroscopic tubal occlusion is a quick and simple procedure, and many women can return to their regular activities the same day. Side-effects from the procedure can include mild to moderate pain and/or cramping, bleeding or spotting, and nausea.

An X-ray or an ultrasound is performed about three months after the procedure to make sure that enough tissue has formed around the inserts to block the fallopian tubes. Until then, another form of birth control must be used.

Advantages

• one-time procedure
• very effective
• no need to remember birth control method
• no surgical incisions
• no general anesthesia required
• you don’t have to interrupt sex

Disadvantages

• cannot be reversed
• takes several months to become effective
• provides no protection against sexually transmitted infections
• patients who are allergic to nickel may have an allergic reaction to the inserts
• although tubal occlusion dramatically decreases the risk of any pregnancy, if the procedure fails and a pregnancy results, there is an increased risk of it being an ectopic pregnancy
• in rare cases, women have experienced pelvic pain, infection, or the coils causing a puncture in the uterus or fallopian tube