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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 The Essure contraception system was withdrawn from the US markets in December, 2018.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
SLIDESHOW
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Barrier Methods of Birth Control
Many barrier methods of birth control are available for a man or woman, for example, the sponge, female and male condoms, diaphragm, spermicides, male condoms, female condoms, contraceptive sponge, diaphragm, and cervical cap. Side effects and efficacy (in preventing pregnancy) depend on the type of birth control used.
Birth Control Options
Birth control is available in a variety of methods and types. The method of birth control varies from person to person, and their preferences to either become pregnant or not. Examples of barrier methods include barrier methods (sponge, spermicides, condoms), hormonal methods (pill, patch), surgical sterilization (tubal ligation, vasectomy), natural methods, and the morning-after pill. Side effects and risks of each birth control option should be reviewed before using any birth control method.
Choosing Your Birth Control Method
Which birth control option is right for you? Discover birth control methods such as birth control pills, birth control shot, implant, patch and more. Learn about birth control side effects and effectiveness.
Birth Control Pill vs. Depo-Provera Shot
Birth control pills (oral contraceptives) and the Depo-Provera shot are two hormonal methods of birth control. Both methods work by changing the hormone levels in your body, which prevents pregnancy, or conception. Differences between "the pill" and "the shot." Birth control pills are available as combination pills, which contain the hormones estrogen and progestin, or mini-pills that only contain progestin. In comparison to the Depo-Provera injection, which prevents pregnancy for three consecutive months. Both methods of birth control are very effective in preventing pregnancy. Both the combination pill (if you take them as directed) and shot are up to 99% effective in preventing pregnancy. While the mini-pill is only about 95% effective in preventing pregnancy. Both methods cause weight gain, and have other similar side effects like breast pain, soreness or tenderness, headaches, and mood changes. They may lead to decreased interest in sex in some women. There are differences between the other side effects of these methods (depending upon the method) that include breakthrough bleeding or spotting, acne, depression, fatigue, and weakness. Both oral contraceptives and the Depo-Provera shot have health risks associated with them, such as, heart attack, stroke, blood clots, and cervical cancer. Birth control pills appear to increase the risk of cervical cancer. Talk with your OB/GYN or other doctor or health care professional about which birth control method is right for you.
Birth Control Quiz: Test Your Medical IQ
What is the best form of birth control? Take this quiz to find out about hormonal, surgical, barrier, and natural methods!
DVT and Birth Control Pills (Oral Contraceptives)
Deep vein thrombosis (DVT) is a blood clot that has traveled deep into the veins of the arm, pelvis, or lower extremities. Oral contraceptives or birth control pills can slightly increase a woman's risk for developing blood clots, including DVT. DVT symptoms and signs in the leg include leg or calf pain, redness, swelling, warmth, or leg cramps, and skin discoloration. If a blood clot in the leg is not treated, it can travel to the lungs, which can cause a pulmonary embolism (blood clot in the lung) or post-thrombotic syndrome, both of which can be fatal if not treated immediately. Increased risk factors for DVT and birth control pills include over 40 years of age, family history, smoking, and obesity. Other medical problems that increase the risks of blood clots, for example, lung or heart disease, or inflammatory bowel disease or IBD (Crohn's disease and ulcerative colitis (UC). Other options for preventing pregnancy include IUDs, birth control shots, condoms, diaphragms, and progestin-only oral contraceptives.
Hormonal Methods of Birth Control
There are several different hormonal methods of birth control. The hormones can be estrogen and/or progesterone. The hormones can be taken by mouth, implanted into body tissue, absorbed from a patch on the skin, injected under the skin, or placed in the vagina. Common types of hormonal birth control include: "The Pill" (oral contraceptives), injection (Depo-Provera, Lunelle), the patch (Ortho-Evra), and the vaginal ring (Nuvaring).
Hysterectomy
A hysterectomy is a surgical procedure in which the uterus is removed. There are a variety of surgical techniques for performing hysterectomies, which include vaginal hysterectomy, total hysterectomy, laparoscopy-assisted vaginal hysterectomy (LAVH), supracervical hysterectomy, laparoscopic supracervical hysterectomy, radical hysterectomy, and oophorectomy and salpingo-oophorectomy hysterectomies.
Complications include infection, pain, and bleeding. The type of hysterectomy performed is dependent on the woman and the reason for the procedure.
Hysteroscopy
Hysteroscopy is a minimally invasive surgical procedure performed to diagnose and treat women's conditions, for example, abnormal vaginal bleeding, congenital abnormalities of the female genital tract, scarring from previous procedures, and removal of uterine fibroids or tumors.
IUD (Intrauterine Device)
An IUD (intrauterine device) is a birth control method designed for a woman. The IUD is a small "T" made of molded polyethylene plastic coated with barium so that, if need be, it can be seen on X-ray. Side effects of the IUD include spotting, infection, infertility, pelvic inflammatory disease, and heavy menstrual bleeding. Risks and complications of the IUD are miscarriage, ectopic pregnancy, pelvic inflammatory disease, and increased menstrual bleeding.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
Laparoscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to guide the removal of the uterus and/or Fallopian tubes and ovaries through the vagina. During LAVH, the uterus is detached from the ligaments that attach it to other structures in the pelvis using laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.mifepristone
Mifepristone (Mifeprex) is a synthetic steroid used to terminate early pregnancy. The Korlym brand of mifepristone is a cortisol receptor blocker, used to manage and treat high blood glucose levels (hyperglycemia) in people with Cushing’s syndrome. Serious and sometimes fatal infections and bleeding occur very rarely. A failed pregnancy termination could cause birth defects. Common side effects include abdominal pain and cramping, uterine cramping, nausea, fatigue, headache, vomiting, diarrhea, dizziness, endometrial hypertrophy, low blood potassium (hypokalemia), joint pain (arthralgia), swelling of extremities (peripheral edema), and others.
Natural Methods of Birth Control
Natural methods of contraception are considered "natural" because they are non-mechanical and non-hormonal. Fertility awareness methods (FAMs) are based upon knowing when a woman ovulates each month. Natural methods of birth control include: the calendar rhythm, basal body temperature, mucus inspection, symptothermal, use of an ovulation indicator testing kit, withdrawal, lactational infertility, douching and urination, and abstinence.nonoxynol-9 vaginal
Nonoxynol-9 vaginal is a spermicide used vaginally as a gel, foam, insert, film, or sponge to prevent pregnancy, usually in combination with other modes of contraception. The rate of unintended pregnancies with the use of nonxynol-9 products is generally higher than with other methods of contraception. Common side effects of nonoxynol-9 vaginal include local reactions in the penis or vagina (burning, irritation, rash, itching) and allergic contact dermatitis. Do not use while on menstrual period or if breastfeeding.
Surgical Sterilization
Surgical sterilization is considered a permanent method of contraception. In certain cases, sterilization can be reversed, but this is not guaranteed. For this reason, sterilization is meant for men and women who do not intend to have children in the future. Types of surgical sterilization include: vasectomy, tubal ligation, STOP (selective tubal occlusion procedure), and hysterectomy.