From an effectiveness standpoint, both typically have a failure rate of less than 1%, although there is a bit of a caveat for vasectomy that we will explain later. Both are meant to be permanent procedures. Despite the availability of tubal or vasectomy reversal procedures, there is no guarantee of successful reversal or pregnancy, and these procedures are generally not covered by insurance. So, if you’re not 100% sure, then it may make sense to consider long-acting but reversible contraception options, such as implants or IUDs, that are almost equally effective in preventing pregnancy.
So, what are some advantages of tubal ligation? The main advantage of tubal ligation in comparison to vasectomy is that it is immediately effective. If done at the time of a cesarean section, then there is no additional recovery time or any significant increase in the amount of bleeding or operative time during surgery. Even as a separate procedure, the patient would go home the same day as her surgery.
What are some disadvantages of tubal ligation? If done as a separate procedure, then it would require 1 or 2 abdominal incisions to perform depending on when it is done, and it may also require general anesthesia. Also, it does involve operating near the organs in the abdominal cavity with the small possibility of trauma to those organs. That being said, a common misconception is that the procedure may affect hormonal balance or menstrual flow. In and of itself, a tubal ligation would have no effect on hormone production as it involves the tubes next to the ovaries but not the ovaries or their blood supply. Additionally, for women who do notice an increase in menstrual flow after the procedure this is typically due to either transition away from hormonal contraception (that makes menses lighter) or a small increase in perceived flow because if a portion of the menstrual flow previously drained through the fallopian tubes and into the abdomen, it now passes through the vagina.
Well, what about vasectomy? The biggest advantage is that a vasectomy may be done in the office under local anesthesia. It doesn’t involve operating in the abdominal cavity, so there is no risk to internal organs. Lastly, recovery time is generally less than for a tubal ligation.
Any disadvantages for vasectomy before I sign my partner up? The main disadvantage is that it can take several months (or longer) to become effective. Thus, pregnancy is still possible until follow-up testing confirms that there are no residual sperm in the vas deferens beyond where the vasectomy has been performed. Also, there is a very small risk of chronic testicular pain or nerve irritation. Despite a common vasectomy misconception that the procedure will take away libido or ability to perform sexually, a recent study in Europe suggests that men who had previously had vasectomy noted improved erectile function, sexual desire, orgasm and intercourse satisfaction.
In summary, both tubal ligation and vasectomy are both reasonable options for permanent sterilization. The key word, though, is permanent, and this should probably be a decision that you and your partner reach together. If there’s any doubt that another baby may be in your future, then definitely select something reversible. If you’re sure you’re sure, then make an appointment with either your ob/gyn (for you) or a urologist (for your partner). This can be a great option to take away the stress of unplanned pregnancy, and you may find that when there’s no longer worry about an unplanned surprise 9 months from now, the decreased stress = better sex!