American Medical Association Family Medical Guide - American Medical Association [246]
Sterilization
If you are certain that you do not want children in the future, sterilization is an almost completely safe and reliable form of birth control. Most doctors recommend male rather than female sterilization because it carries less risk and is simpler to perform. Because both sterilization procedures seal off only the tubes that carry sperm or eggs, they have no effect on the production of sex hormones. If you are a man, you will produce a sperm-free seminal fluid. If you are a woman, you will produce eggs, but they will not be able to reach the uterus. Menstrual periods are not affected in most cases.
Male Sterilization
A vasectomy is a simple procedure that usually involves no hospitalization. It is performed in a doctor’s office or in an outpatient surgical center. A vasectomy requires only a local anesthetic and takes about 20 minutes to complete. During a conventional vasectomy, the doctor makes an incision over each side of the scrotum. He or she then cuts the two vas deferens (the tubes that carry sperm from the testicles) and blocks the tubes by tying them, burning (cauterizing) them, or clipping them. He or she then stitches the incision in the scrotum. In a nonsurgical technique called the no-scalpel or no-suture vasectomy, the doctor makes only a tiny puncture in the skin to reach each vas deferens. As in a conventional vasectomy, he or she then cuts and clips the tubes to seal them. You will still be able to ejaculate after the surgery, but your semen will not contain sperm.
Vasectomy
During a conventional vasectomy, the doctor makes a small (¼” to ½”) incision in the scrotum (top) and pulls the vas deferens through the incision (center). He or she then cuts the vas deferens and ties, burns, or clips the ends to seal them off (bottom left). The incision is then closed with three or four stitches (bottom right).
Some sperm may have been stored in the seminal vesicles before the procedure, so your doctor will tell you to use some other method of contraception for the first 6 to 8 weeks after the procedure. During that time, you will have to bring in a specimen of semen at least twice. When two consecutive specimens are found to be free of sperm, you will be considered infertile. Your surgeon will tell you when it is safe to have intercourse without using a backup method of birth control. Vasectomy does not affect your ability to have an erection or an orgasm. Complications are rare but can include bleeding, bruising, and infection at the surgical site. Vasectomy is considered a permanent sterilization procedure, although surgical reversal is sometimes possible.
Female Sterilization
Female sterilization, or tubal ligation, is usually done in outpatient surgery while the woman is under general or spinal anesthesia. The operation takes less than half an hour to complete and can usually be performed through small incisions using a laparoscope (a viewing tube equipped with blades for cutting).
In the most commonly performed tubal ligation procedure, two tiny cuts that leave virtually no scars are made just below the navel. Through these cuts, the surgeon inserts the laparoscope and surgical instruments. An attachment to the laparoscope seals off the fallopian tubes, using electrocautery (application of heat using electric currents), tiny metal or plastic clips, rubber rings, or surgical cuts. Tubal ligation is often performed immediately after a vaginal delivery or as part of a cesarean section (see page 534), through the cesarean incision in the abdomen. The procedure