Are you done with the traditional birth control methods – condoms, spermicides, diaphragms, hormones, etc.? If so, we recommend moving forward with a permanent birth control option. Some are more invasive than others, and all come with their own set of pros and cons. 

Setting an appointment with your OB/GYN is the first step in determining which permanent birth control method feels right for you when taking your complete medical, family, and reproductive history into the picture.

Most Common Types of Permanent Birth Control

Let’s review the most common forms of permanent birth control, exploring what works and what may not be so ideal, depending on your situation.

Are you 100% sure?

First and foremost, it’s essential that you feel 100% sure that you don’t want any more children. This decision shouldn’t be made until your youngest child is at least two years old, as hasty decisions are often made during the postpartum period. 

Questions to ask and process include:
● Are you and your partner entirely on the same page? If not, it can cause serious issues down the road.
● Are you only doing it for yourself? Or are you doing it because your partner wants it?
● If there were any unexpected life changes down the road (divorce, death of a partner or children, etc.), would you still feel 100% sure permanent birth control was the right choice?
● Do you have any underlying medical issues you need to consider?
● Have you discussed the options with your doctor and sat with the decision for at least a month or so?

Yes, most types of “permanent birth control” have a possibility of being reversed. However, it’s only a possibility. There is never a guarantee. So, it’s much better that you feel completely clear you are through having children before choosing any of the methods discussed below.

Note: Most doctors will refuse to perform permanent birth control procedures if you are 30 years old or younger and/or you don’t have children to the high rates of future regret in these brackets.

1. Vasectomy

If you have a male partner who is on board for permanent birth control, a vasectomy is the best way to go. Vasectomies are outpatient office procedures requiring 20 to 30 minutes at most. They are very simple. 

Once the scrotum and immediate tissues are numbed via local anesthetic, the urologist makes a small incision on the upper portion of the scrotum. S/he then cuts and ties off the two vas deferens (the tubes that carry the sperm). The incision is then closed with a few stitches.

Things to know:
● Once healed from a vasectomy (one week), a man has to ejaculate at least 20 times to ensure no sperm are in the system. You should use condoms or other forms of birth control during this window of time.
● Vasectomies do not negatively impact a man’s sensations during sex nor affect ejaculation.
● After the one-week healing period, men can go about their lives as usual – no need for hormone replacement or anything else.
● Does not stop the risk of STDs (always use a condom if you’re in a non-monogamous relationship)

Again, we firmly believe vasectomies are the answer to the permanent birth control question in any partnership (unless you have multiple partners) because there is zero health risk and no need for future hormone balancing or monitoring. 

2. Tubal Ligation

If you are single or your partner refuses to have a vasectomy, tubal ligation is one possible solution. Often referred to as “having your tubes tied,” tubal ligations are full surgeries requiring anesthesia. By disrupting the tube’s path via cutting or tying it off, tubal ligations prevent the egg from traveling down the fallopian tube while simultaneously blocking a sperm’s path into the tube.

As mentioned, the procedure occurs in an outpatient office or surgery clinic. After you are fully anesthetized, the surgeon makes small incisions in the abdomen. Then, s/he either cuts, clips, or cauterizes the tubes – depending on the chosen method. 

If you are scheduled to have your tubal ligation after delivering a baby, your doctor will perform a mini-laparotomy. The process is similar but requires smaller incisions due to the more ready access to the fallopian tubes.

Things to know:
● Anesthesia brings greater risks
● Greater risk of infection or post-surgical risks (damage to other organs, internal bleeding, etc.) when compared with vasectomy
● Increased risk of an ectopic pregnancy associated with tubal ligations if the tubes make their way back together or an opening occurs near the tube
● Very minor risk of hormone disruption due to declines in estrogen/progesterone
● Does not stop the risk of STDs (always use a condom if you’re in a non-monogamous relationship)

As with any surgery, it’s important to weigh the pros and cons with your OB/GYN.

3. Essure (Non-Surgical tube implant)

Prior to 2018, Essure (manufactured by Bayer) offered a non-surgical route to permanent female sterilization. The Essure devices were implanted into the fallopian tubes in an OB’s office via the vagina and cervix. While effective, there was a high rate of post-procedure pain and discomfort. So, Bayer pulled Essure from the market, and as of 2019, this procedure is no longer available.

4. Bilateral salpingectomy (removal of fallopian tubes)

In the past, removing fallopian tubes was only recommended in certain cases, such as severe ectopic pregnancy, certain reproductive cancers, severe endometriosis, or significant fallopian tube blockages.

Today, some patients choose bilateral salpingectomy instead of tubal ligation to eliminate the risk of ectopic pregnancy. Also, data shows that women with both tubes removed have a marked reduction in ovarian cancer risk. 

Things to know:
● Overall risks are largely the same as with a tubal ligation, other than you won’t have the risk of ectopic pregnancy
● Longer procedure time (by about 20 minutes or so)
● Can trigger early menopause (something worth considering if you’re in the 30 to 40 age group)
● May cause you to need hormone replacement therapy of some type

Learn More About Which Permanent Birth Control is Right For You

Are you having difficulty deciding which form of permanent birth control is best for you? Schedule an appointment here at Women’s Health Associates. We can even meet with you online as we help you to weigh the pros and cons.