What is permanent contraception?
Permanent contraception methods are ways to permanently prevent pregnancy. Permanent contraception involves a minor surgical procedure by which the man or the woman is sterilized.
It is possible to reverse surgical sterilization, but the reversal procedure is technically complicated and may not be successful. Reversal of a woman’s sterilization has a better success rate than a man’s sterilization reversal.
How do permanent contraception methods work?
Permanent contraception is possible for both men and women and are among the most effective ways to prevent pregnancy. Permanent contraception procedures work by altering the reproductive anatomy of a woman or a man.
Permanent contraception in a woman blocks the passage of the egg into the fallopian tube where fertilization takes place. There are no hormonal changes in the woman’s body, and no change in egg production. The woman’s body naturally absorbs the unused eggs.
The male surgical contraception procedure blocks a man’s vas deferens, the tubes that carry sperm from the testes to the ejaculatory duct. The sperm is blocked from entering the semen and is absorbed by the body.
What are the methods of permanent contraception?
Female permanent contraception
Several methods are in use for performing permanent contraception in a woman:
- Tubal occlusion: Application of devices such as rings, clips or bands to squeeze the tube shut and obstruct the egg passage.
- Tubal ligation: The fallopian tubes are surgically severed and the ends are sutured to prevent the transit of the eggs.
- Electrocoagulation: A part of the fallopian tube is destroyed using a low-voltage bipolar electric current. The destroyed portion of the tube clots up and blocks the passage of the eggs.
- Essure system: The procedure involves the placement of a microinsert in the fallopian tubes using a tube (hysteroscope) inserted through the vagina directly into the tube. The woman has an imaging test after three months to check correct placement. The Essure contraception system was withdrawn from the US markets in December, 2018. The Essure system is undergoing further studies.
Permanent contraception can be performed immediately after childbirth (postpartum salpingectomy) with a small incision under the navel, or during a Caesarian delivery.
Permanent contraception surgery during the other period (interval partial salpingectomy) is performed under general anesthesia, using one of the following procedures:
- Laparoscopy: A minor procedure performed with tiny surgical instruments inserted into several small incisions in the abdomen, using a flexible lighted tube with a camera (laparoscope).
- Laparotomy: A conventional open surgery, not much in use.
- Colpotomy: The fallopian tubes are accessed through an incision in the posterior vaginal wall.
Efficacy
The cumulative 10-year failure rate for permanent female contraception are as follows:
- Tubal occlusion with
- Spring clip method – 3.7%
- Silicone rubber bands – 2%
- Tubal ligation
- Postpartum salpingectomy – 0.8%
- Interval partial salpingectomy – 2%
- Electrocoagulation – 2.5%
- Preliminary two-year follow up clinical testing indicated that the Essure system was 99.8% effective, but 1 out of 7 women did not achieve correct placement and had to undergo a second placement procedure.
Advantages
- One-day procedure
- Does not involve hormones
- No change in
- Libido
- Menstrual cycle
- Lactation
Disadvantages
- Involves general or regional anesthesia and risks of surgery.
- Possibility of regret, especially by young patients; reversal may not be successful.
- Does not protect from sexually transmitted diseases (STDs).
Male permanent contraception (Vasectomy)
Vasectomy is a simple procedure performed under local anesthesia, with a small incision in the scrotal sac. The doctor severs the vas deferens and closes the severed ends with sutures or using heat from low voltage electric current.
After sterilization there may be remnant sperm in the ejaculatory duct. It requires 15-20 ejaculations after sterilization procedure for the semen to be completely free of sperm presence, which can be confirmed with a semen analysis.
Efficacy
Failure rate is approximately 0.1%.
Advantages
- Doesn’t involve hormones
- A quick outpatient procedure with minimal risks
Disadvantages
- Does not protect against STDs
- Requirement of alternate contraception methods until the semen is clear of sperm
- Possibility of regret after the procedure
- Short-term discomfort after the procedure
- Potential complications such as