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Vasectomy vs Tubal Ligation: Which is Safest?

What is a Male Vasectomy?

male vasectomy

A vasectomy is a safe and practiced method of male contraception, which may be performed under local or general anaesthesia. The tubes within your scrotum, which are responsible for carrying sperm, are either cut or blocked off. The procedure is extremely quick and patients usually return home the same day.

A vasectomy is extremely effective at preventing pregnancy with a 99%+ rate, so patients are advised to really consider their options before committing to the procedure. It is not quite 100% as there is a 1:2500 chance of spontaneous recanalisation – where tubes can re-join and begin functioning again. Other risks of surgery include bleeding, infection and slight bruising; but this only occurs in around 5% of patients and is extremely minor in most cases. Overall this is a very safe and simple procedure.

Facts on Male Vasectomy:

  • A vasectomy is almost 100% effective.
  • The procedure is considered permanent, but in some cases can be reversed despite being very difficult to do so.
  • Once complete you no longer need to use any form of contraception against pregnancy – although contraception against diseases and STIs is recommended.
  • Male sex drive and/or ability will not be affected in any way.
  • Men can still ejaculate, but the semen will not contain sperm.
  • Multiple semen tests may be carried out after operation to ensure it has been a success.
  • It is normal for the scrotum to become bruised shortly after the procedure.

What is Female Tubal Ligation?

Tubal ligation is the female form of sterilisation. In this medical procedure, a female’s fallopian tubes are sealed or blocked to prevent her eggs from travelling to the uterus and from being fertilised.

Women will still release eggs from their ovaries as normal, but they’ll be absorbed into the body. This procedure should only be considered by those who seriously do not want any more children. Once complete, this is very difficult to reverse.

Quick Facts on Tubal Ligation

  • Almost 100% effective at preventing pregnancy and is very difficult to reverse.
  • Provides a conscience-free sex life without having to worry about pregnancy.
  • Hormone levels are unaffected.
  • There is a minor risk of infection, internal bleeding and harm to other organs.
  • There’s also a risk that blocked or sealed tubes can re-join
  • If the operation fails, the chances of a fertilised egg implanting itself outside of the womb (known as ectopic pregnancy) increases significantly.

Methods and Approach

Male Vasectomy – The Scalpel Method

The scrotum is numbed with a local anaesthetic. Then 2 small cuts are made in the skin, one on each side, so that the doctor can reach the tubes that carry sperm (vas deferens). The tubes are cut and a small section is removed before the ends are closed; by either tying them or sealing them with heat. Some dissolvable stitches will take care of the tiny cuts on the scrotum.

Male Vasectomy – The No-Scalpel Method

The scrotum is numbed with a local anaesthetic. A tiny puncture hole is made in the skin of the scrotum to reach the tubes, which means there is no need for a scalpel. Everything after this is the same as above – the tubes are cut and then tied or sealed. The main difference with this approach is that there is little bleeding and no need for stitches. It’s also thought to be less painful and offers fewer complications.

Female Tubal Ligation – How it Works

A surgeon will access a woman’s fallopian tubes by creating a tiny cut near the belly button (laparoscopy) or above the pubic area (a mini-laparotomy). The former is usually faster and therefore preferable, but a mini-laparotomy is usually recommended to women who are obese and those who have recently experienced pelvic or abdominal surgery.

Once cut, the surgeon will insert a long and thin instrument with a light and camera on the end (called a laparoscope) to clearly identify the fallopian tubes. Once identified, they can be blocked using a number of different methods, including:

  • applying plastic or titanium clips
  • applying silicone rings that clamp shut
  • cutting and removing a small piece of the fallopian tube

If none of the above works successfully, the fallopian tubes may be removed completely (known as salpingectomy).

Which is the Safest?

Over 40,000 men have a vasectomy and around 90,000 women are sterilised each year. In truth, both methods are extremely safe and offer very similar minor risks. An extremely small number of people may experience a bit of bleeding or a minor local infection after the operation. If this does occur, the issues are often quickly resolved.

A lot of female sterilisation techniques require the use of a general anaesthetic and will call for some stitches in the aftermath. On the other hand, most vasectomy procedures can be performed under local anaesthetic and may not require any stitches at all.

The Risks and Drawbacks of Female Sterilisation

  • Most doctors will advise the male in a relationship to undergo a vasectomy as there are slightly more risks involved with female sterilisation.
  • Reversal is usually unsuccessful.
  • There is a small risk of infection, internal bleeding and damage to other organs.
  • Fallopian tubes may re-join and make a patient fertile again.
  • If pregnancy does occur after the operation, there is a higher risk that there’ll be complications like an ectopic pregnancy.

The Risks and Drawbacks of a Male Vasectomy

  • The NHS waiting list for male vasectomies is quite long, so you may wish to go private instead, which will of course costs money.
  • You can’t have sex straight away – at least two check-ups must be carried out after the procedure to ensure there is no sperm in your semen.
  • Reversal is possible, but it is extremely difficult.
  • Most doctors will refuse to operate on a man under the age of 30 as research shows this is a decision they often regret later in life.

Can Both Procedures Be Reversed?

Technically, yes, but it is extremely complicated and performed by specialists only. If a reversal is performed within ten years of the original vasectomy, the success rate is just above 50%. Any longer after that and the success rate drops by half to around 25%. Even if a surgeon is able to re-join the tubes, pregnancy may still not be possible.

Reversing a male vasectomy is, however, somewhat easier than reversing female tubal ligation. There are plenty of specialist surgeons out there that can help you to reverse a male vasectomy and they will be able to discuss your options in full detail.

Generally speaking though, sterilisation on both parts should only be considered by those who definitely do not want any, or any more, children.

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