Because no method of contraception is foolproof, at some point in their reproductive lives, some men and women may elect to undergo surgical sterilization. For men, the procedure is a vasectomy; for women, the procedure is a tubal ligation (having one's tubes tied). Both procedures are relatively minor, but because they are intended to be permanent, they should not be undertaken unless you are completely certain that you do not now and will not in the future want to have any more children. Elective sterility in women can be reversed, but less than half of those who have had reversals have subsequently been successful in bearing a child. The risk for ectopic pregnancy increases after reversal. Reversing elective sterility in men is also possible, but difficult. A vasectomy involves the severing of the vas deferens, the vessel that carries sperm from the testicles to the urethra in the penis. The man still produces semen, but this fluid contains no sperm. When couples seek surgical sterilization, the vasectomy is often the procedure of choice because it tends to be less serious, with a quicker recovery time than the tubal ligation in women. A vasectomy can be performed under local anesthesia in the doctor's office in about half an hour. After injecting an anesthetic in the scrotal area, the doctor will locate the patient's vas deferens (one at each testicle) and make a small incision in the skin of the scrotal sac. Through this opening, the doctor will withdraw a small segment of the vas deferens. The doctor will then surgically remove a short length of the tube and seal either end with stitches that will dissolve in several days. The severed ends are returned to the scrotum and the outer incision is stitched closed. The procedure is then repeated on the other side. When the surgery is complete, recovery will include a short observation and recovery period in the doctor's office. Strenuous activity (lifting, exercise, etc.) should be avoided for the next couple of days. Following the procedure, it is normal to experience some pain and swelling for several days or weeks in the area of the incision for. As with any minor surgical procedure, however, if the pain worsens or if a fever develops, call the doctor immediately. Returning to work as long as it does not involve strenuous activity is acceptable. Risks include infection, bleeding and, rarely, chronic testicular pain. Approximately the first 10 to 15 ejaculations that follow surgery may still contain sperm, so it is important to use other forms of birth control for a short period of time. A semen analysis is recommended before beginning unprotected sex to be sure that sperm are completely gone. From that point on, vasectomy is quite effective as birth control, but it can have side effects. Sperm continue to be produced and though they are usually reabsorbed into the body, they can build up in the testes and create lumps or "granulomas" that may require medical attention. The tubal ligation procedure is 99 percent effective in preventing pregnancy. The tubes involved are the fallopian tubes, through which eggs travel after being released from the ovary. Tying the tube blocks eggs from making that journey and thereby prevents pregnancy. In many cases, women choose to have the procedure performed immediately after giving birth. If the delivery was by cesarean section, the procedure can be performed directly and quickly, with no additional pain or anesthesia. If the delivery was vaginal, the tubal ligation procedure will require an incision, but the recovery period is simultaneous with recovering from childbirth. When tubal ligation is not done postdelivery, it can be performed on an inpatient or outpatient basis, either under general anesthesia (you will be asleep), or under local anesthesia (which may also require the use of a tranquilizer to help you relax). The doctor will make a small incision through the wall of the woman's abdomen, near her navel. A harmless gas will be pumped slowly into the abdomen to separate the muscle wall from the organs. Using the laparoscope, a surgical tool equipped with fiber optics that enables the doctor to view the patient's internal organs without the large incisions that would once have been necessary, the doctor will identify the woman's reproductive organs. With another instrument, the doctor will clip, tie, or seal each of the fallopian tubes by cauterization. Pregnancies are rare in women who have been tubally sterilized, but if they occur they may pose certain risks. After the procedure, the woman will experience some pain from the incisions and the ligation, but it should subside in a few days. Transient side effects from the procedure can include dizziness, nausea, and feeling bloated or tired, all of which should resolve in a few days. Because tubal ligation is a more major operation than vasectomy, there is more potential for complications. It is possible to become infected, to have internal organs injured during the procedure and to experience internal bleeding. These complications are rare, but a woman should discuss them with her doctor before she decides to undergo the procedure. The woman must know how to clearly tell if she is experiencing complications before she leave the doctor's office, clinic or hospital. Fever should be reported to the doctor immediately. Last Updated: 12/17/2002
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
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