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Sterilisation

Male and female sterilisation procedures should be viewed as permanent. Reversal of sterilisation involves complex operations that are not always effective and can be costly.

Therefore it is very important that a couple has looked at all other long term contraception options that are available before deciding on sterilisation.

If you are considering sterilisation there are many issues to think about. Can you imagine any changes in your current circumstances that might result in you wanting a future pregnancy? Most of us don’t like to think of relationship breakdown or the death of a partner or child, but these things can happen. People also develop new relationships and might want to have a child with their new partner.

Once you have decided that sterilisation is the best option, the next step is for a couple to look at who should have the operation. When considering which partner this will be, it is important to remember that while male sterilisation is a smaller procedure than female sterilisation, a man generally has many more fertile years than a woman. A man considering vasectomy should know that he can have sperm stored (cryopreservation). This service is provided by fertility clinics and does incur a cost.

Both male and female sterilisation operations are considered safe surgical procedures but, as with any operation, there is a slight risk of complications such as pain, bleeding or infection. Failure of the operation, which is possible, may result in pregnancy.

Female sterilisation

Female sterilisation most commonly involves blocking the fallopian tubes, called tubal occlusion. This prevents the sperm from reaching the egg so that fertilisation does not occur. It is important for a woman to use a reliable form of contraception up until the time of the operation.

In Australia the most popular method of tubal occlusion is via laparoscopy. This method involves passing an instrument (laparoscope) through a small incision below the navel. This enables the surgeon to see the fallopian tubes and block them using either rings or clips. These devices cause permanent closure of that part of the tube. A less common method in Australian is the laparotomy. This involves an incision just above the pubic hair line. The fallopian tubes will usually be blocked by cutting or tying. Your doctor will recommend what method will be more suitable for you.

A new method of sterilisation is now available in Australia – Essure. This method involves placing a small, flexible device called a micro-insert into each Fallopian tube to permanently block the ends of the tubes. This is done via an instrument which is passed from the vagina to the cervix, so unlike other methods of sterilisation, Essure doesn’t require surgery that cuts the skin.

After the procedure there is a three-month waiting period during which another form of contraception must be used. A woman needs to have an X-ray to check that the micro-inserts are still in place before she can rely on the Essure method for contraception.

How effective is female sterilisation?

The lifetime risk of a woman becoming pregnant after she has had a sterilisation is very small (about 0.5%).

Advantages

Female sterilisation provides effective, permanent contraception which:

  • does not interfere with natural hormone production and a woman’s natural menstrual cycle
  • is effective immediately

in the case of tubal occlusion

  • does not interfere with sexual drive.

Disadvantages

Female sterilisation:

  • involves hospital admission, and a general anaesthetic for tubal occlusion procedures
  • may cause bruising, discomfort or infection
  • is usually is not reversible
  • requires referral to hospital outpatient clinic or gynaecologist

Male sterilisation

This is usually done by vasectomy, an operation that cuts the tubes (vas deferens) which carry the sperm from the testes to the penis. A man’s ejaculate consists of sperm from the testes and fluid from the prostate gland. After vasectomy the sperm is no longer present in this fluid although the ejaculate appears the same. A vasectomy is not effective immediately and it can take up to 20 ejaculations for the sperm stored in the tubes to be cleared from the ejaculate. It is recommended that a man have a sperm count to check that the operation has been successful and that all sperm are cleared from the ejaculate before ceasing other forms of contraception.

The operation is a very simple one and can be performed in a doctor’s surgery under a local anaesthetic or, if the patient wishes in hospital, under a general anaesthetic. The operation takes about 30 minutes. It is usually carried out through a small cut in the mid line in the front of the scrotum. The tubes are cut and tied and one end is often buried in the scrotal tissue in order to minimise the risk of the tube ends joining up again.

How effective is vasectomy?

Vasectomy is a highly effective method of contraception. Most failures occur early after the procedure and are due to the man having unprotected sex before the test has shown that the ejaculate is free from sperm. Tubes can rejoin after vasectomy in approximately 1 in 1,000 cases.

Advantages

Vasectomy is an even more effective form of contraception than female sterilisation and:

  • can be done out of hospital
  • requires only 1-3 days off work (depending on the level of physical activity)
  • does not interfere with sexual drive or performance
  • does not increase a man’s risk of future illness (eg prostate cancer).

Disadvantages

A vasectomy:

  • may cause bruising, discomfort or infection around the site of the operation
  • is usually not reversible
  • can sometimes cause a lump (sperm granuloma) to develop at the lower cut end of the vas deferens (though this is rare).

Practising safe sex reduces the risk of contracting HIV and other sexually transmissible infections (STIs)

Page last updated Mon, 12 Jun 2006 15:25