Sterilization is a form of birth control that is intended to be permanent. The sterilization surgery for men is called a vasectomy. This is a procedure in which the tubes that transport a man’s sperm (the vasa differentia) are surgically removed, severed, or clamped shut. Such procedures are highly effective in preventing pregnancy: over 99 percent.
Following a vasectomy, a man’s testes will continue to produce millions of sperm each day. However, because the vasa differentia have been severed or blocked, the sperm have no natural way to be released. If the tubes are blocked, the pressure of backed-up sperm often causes a “blowout” of the epididymis, the tubes that hold sperm, which can be very painful. Inevitably sperm cells enter the bloodstream, where antibodies must be created to destroy them.
Post-vasectomy pain is a complaint among some men. Such pain can last for weeks or even years. Various treatments may provide relief. Some men receive another operation to remove the epididymis or testicles. Sometimes the vasectomy is reversed in order to lessen the pain. One man wrote, “I have lived the nightmare of chronic pain and autoimmune reactions since my own vasectomy in August of 1999. Nineteen surgeries and nerve blocks, 197 medications and other substances, and dozens of therapies that I have pursued in the interim have not resolved the pain I experience on a daily basis.”
Most men do not experience such severe consequences from the operation. However, men who have vasectomies may be two-and-a-half times as likely to develop kidney stones. It is not uncommon for men who have vasectomies to regret their decision. Reduced marital satisfaction and feelings of remorse often follow the operation, and sometimes last indefinitely. Thankfully, many men are able to have the operation reversed. Unfortunately, the reversal procedure is far more expensive than the vasectomy.
A woman’s sterilization surgery is more involved. Commonly referred to as having her “tubes tied,” a tubal ligation means that the woman has her fallopian tubes severed and sealed. Other methods involve clamping the tubes shut (tubal occlusion), burning them (tubal cauterization), or entirely removing them (salpingectomy). Depending upon which type of sterilization is used and how much damage has been done to the woman’s reproductive system, the procedure may or may not be reversible. Even when the operation is reversed, the woman is more likely to suffer an ectopic pregnancy in the future because of the damage to the fallopian tubes. These types of sterilizations have a very high rate of effectiveness in preventing pregnancy: over 99 percent.
Since these forms of female sterilization involve surgery, the risks are different than for other forms of birth control. For example, the woman may experience complications from the surgery, such as severe bleeding or pelvic infection. Sometimes the sterilization surgery can be fatal. According to Planned Parenthood, “the rate is about two deaths per 100,000 women who have a sterilization procedure performed.” Other resources, such as the Encyclopedia of Medicine, place the death rate at four per hundred thousand.
Female sterilization is the most common form of birth control in the world, with over a hundred million women having had the surgery. So in order for a hundred million women to be sterilized, at least two thousand have died. The number is probably higher, because the “two deaths per 100,000” statistic is based on available data from the most recent and safest procedures, which have not always been available and even now are not always offered to women in developing nations (who are more than twice as likely to resort to sterilization). These numbers also do not include deaths caused by sterilization-related ectopic pregnancies. Despite the fact that female sterilization surgeries are more expensive, invasive, and potentially dangerous than male vasectomies, sterilization procedures are between three and six times more common for women than men.
Besides the physical complications, women who undergo sterilization often suffer from the guilt and regret of mutilating their bodies. They often experience reduced marital satisfaction.
Interestingly, the more education a woman receives, the less likely she is to sterilize herself. For example, the Centers for Disease Control studied women who used contraception and were between the ages of twenty-two and forty-four. They discovered that 55 percent of the contracepting women who did not finish high school chose to be sterilized! However, among contracepting women who graduated from college, only 13 percent resorted to sterilization.
A more modern form of sterilization for women was approved by the FDA in 2002, and it is called Essure. In order to prevent future pregnancies, “microinserts” are passed through a woman’s reproductive tract and placed in her fallopian tubes. “Microinsert” is the pharmaceutical company’s polite way of describing a four-centimeter-long device that resembles a spring or coil and is made of polyester fibers, nickel-titanium, and stainless steel. Once these are in place, they expand and lodge themselves into the ends of the fallopian tubes, partially dangling into the uterus. Over a period of three months, they cause tissue growth (scarring), creating a barrier that prevents egg and sperm from joining. At the end of three months, the woman’s uterus is injected with a dye, and a specialized X-ray is used to make sure the fallopian tubes are sealed.
At times the efforts are unsuccessful. According to Essure’s patient information, about one in seven women do not achieve placement of both microinserts in the first procedure. Even when both are inserted, they may not be in the correct positions. For example, they may be too far into the fallopian tubes or may have fallen out. Sometimes they poke through the wall of the fallopian tube or uterus (perforation). Other potential side effects of the device or its insertion include pain, cramping, nausea, fainting, profuse perspiration, pelvic inflammatory disease, bloating, back pain, shakiness, headache, severe cramps, abdominal pain, heavier periods, tubal pregnancy, inflammation or infection of the fallopian tubes, or death.
If a woman using Essure decides that she wants the device removed, surgery is required to reconnect the fallopian tubes to her uterus. However, such a procedure would have a poor chance of success. According to the makers of Essure, “There are no data on the safety or effectiveness of surgery to reverse the Essure procedure. Any attempt at surgical reversal will likely require utero-tubal reimplantation. Pregnancy following such a procedure carries with it the risk of uterine rupture and serious maternal and fetal morbidity and mortality . . . and possible hysterectomy.” Therefore, any woman who uses Essure should consider it to be permanent. Not surprisingly, young women are particularly likely to experience regret following a sterilization procedure.
When the device is successfully placed, it is 99 percent effective in preventing pregnancy. However, since the product is new, data does not exist regarding its long-term effectiveness. Should a woman become pregnant while using Essure, the makers of the implant say “the risks of the Micro-insert to the patient, to the fetus, and to the continuation of a pregnancy are also unknown.” But one can suspect that a pair of coiled metallic wires hanging into the uterus would not be healthy for a developing baby.
. R.A. Kronmal, et al., “Vasectomy and Urolithiasis,” The Lancet 331 (1988), 22–23.
. Jon Knowles, “Tubal Sterilization,” Planned Parenthood (April 1, 2005).
. Mercedes Mclughlin, “Tubal Ligation,” Encyclopedia of Medicine.
. Centers for Disease Control and Prevention, “Unintended Pregnancy Prevention: Female Sterilization,” Department of Health and Human Services (April 26, 2006) ; United Nations, “World Contraceptive Use—2005.”
. United Nations, “World Contraceptive Use—2005.”
. National Institutes of Health, “Facts about Vasectomy Safety” (August 17, 2006); “World Contraceptive Use, 2005.”
. Mosher, et al., Advance Data From Vital and Health Statistics 350, (CDC) 10.
. Essure Patient Information Booklet, Conceptus (October 31, 2006), 13.
. Essure Patient Information Booklet, 12.
. Essure Prescribing Information, Conceptus (September 8, 2005).
. Essure Patient Information Booklet, 12.
. Essure Instructions for Use, Conceptus (June 12, 2002), 4