Both men and women can be sterilized surgically so that they cannot produce more children. The procedure in women, tubal ligation, involves tying, cutting, cauterizing, or otherwise interrupting the fallopian tubes so that sperm cannot reach the egg. In men the procedure, called vasectomy, blocks off the vas deferens, the tube through which sperm exit the body when they are ejaculated.
Which is better, a tubal ligation or a vasectomy?
When a patient asks for a tubal ligation, we always discuss whether it is better for her to have a tubal or for her husband to have a vasectomy. Because of the possible consequences of tubal ligation, I urge husbands and wives to think about vasectomy as a safer alternative.
For several reasons vasectomy is the better choice. First, consider what happens if the procedure fails. Vasectomy and tubal ligation have roughly the same failure rate, about one in three hundred. If your partner’s vasectomy fails, then you will probably get pregnant. But if your tubal ligation fails, you will probably get pregnant — and very likely have an ectopic pregnancy. About 40 percent of pregnancies that result from failed tubal ligations are ectopic. Such a pregnancy requires invasive surgery; if untreated, it can be fatal.
Second, vasectomy is a less invasive surgical procedure than tubal ligation. It can be performed in a doctor’s office with local anesthesia. Men have “outdoor plumbing”; their anatomy is easier to work with because the vas deferens lies just under the skin away from any important organs or large blood vessels. Women have “indoor plumbing”: the fallopian tubes are buried deep in the pelvis and lie close to the bowel, the bladder, and major bloodvessels.
Are there instances when tubal ligation is a better choice?
Couples may well consider the future: what will happen if one of them dies. Some women have said that, should they die, they would like their husbands to be able to remarry and have more children. If you feel this way and are willing to undergo the risks, tubal ligation is the correct choice.
For women who do not want children (or have completed their family) and have more than one sexual partner, tubal ligation is also a good choice.
Jennifer, who has three children, comes in for her yearly checkup and requests a tubal ligation. I ask her whether she has discussed the matter with her husband. No, she says, because she has three sexual partners. Whether or not her husband has a vasectomy is not the issue, but I do point out that a tubal ligation will not protect her against sexually transmitted diseases.
Although vasectomy does not interfere with testosterone production or erections, some men refuse it because they believe the procedure will diminish their manhood. In this case tubal ligation may be the only choice.