Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Sterilization

There are currently three methods of permanent contraception. These methods are vasectomy, tubal sterilization, and hysteroscopic sterilization. Hysterectomy of course will also result in permanent sterilization but is not performed for this reason alone. Vasectomy is a procedure performed on men during which the tubes that carry sperm from the testicles are cut. This procedure is done under local anesthesia. It is the most safe and cost effective form of birth control. The failure rate is about 1%. Complications are uncommon. Sperm checks performed for 6-8 weeks after the procedure are used to confirm that the tubes have been completely occluded and that no sperm is released.

Tubal sterilization in women involves the occlusion of the Fallopian tubes which are the tubes that allow the passage of the egg to the uterus. These tubes are also where fertilization usually occurs. The tubes may be occluded by cutting, burning, or placement of a device such as a clip or band. Tubal sterilization can be performed at the time of cesarean delivery to prevent future pregnancy or it can be performed separately. Generally, tubal sterilization is performed laparoscopically. Laparoscopy is when a small camera is placed through an area near the belly button. Other small incisions are made as needed for the instruments used during the procedure. The procedure is performed under general anesthesia and patients may go home the same day after the procedure. The overall complication rate is less than 1%. The failure rate for tubal ligation is also about 1%.

The newest form of permanent contraception is the Essure or hysteroscopic sterilization. The Essure devices are tiny coils which are placed inside the Fallopian tubes. This procedure is performed by use of a camera placed in the uterus. The camera is introduced through the vagina and cervix and then into the uterus. The openings of the tubes are then located and the coils are placed in the openings like corks in a bottle. With time, these coils cause scar tissue to grow which then causes the tube to become blocked. The benefit of this procedure is that it can be performed under local anesthesia and it is less invasive than traditional occlusion of the tubes. It is a good choice for women who desire sterilization but who would not be good candidates for surgery because of health reasons, endometriosis, or a history of extensive abdominal surgery. The main drawback of the Essure is that it takes approximately three months for the body to form enough scar tissue to block the tube. It also cannot be used in women who have a nickel allergy as the coils contain nickel.

All of the forms of sterilization should be considered permanent. Reversal is sometimes possible but it requires major surgery that is costly and often not covered by insurance. Sexual desire and function is not affected by any of the procedures. Women who undergo sterilization will continue to have monthly cycles.