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Vasectomies Generally Safer Than Tubal Ligations

April 23, 2001|JONATHAN FIELDING and VALERIE ULENE

Sterilization is the most widely used method of birth control in the United States. In spite of its popularity, many couples are still unsure about which procedure is best: vasectomy (for men) or tubal ligation (for women). In this country, tubal ligations outnumber vasectomies by almost 2 to 1, but many experts believe those numbers might reverse themselves if all the facts about these procedures were better known.

On the surface, the two operations appear quite similar. During a vasectomy, the surgeon divides and seals off the vas deferens, the tubes leading away from the testicles, where sperm are produced. During a tubal ligation, the same thing is done to the Fallopian tubes (the tubes in which the sperm and eggs meet and fertilization takes place). In both procedures, further pregnancies are permanently prevented, because sperm and eggs can no longer come into contact with each other.

Success rates for both procedures are excellent--more than 99%. Vasectomies, however, are not immediately effective, so pregnancy rates can be quite high in the weeks following the procedure unless alternative forms of birth control are used. Sperm can typically be found in the semen of the first 15 to 20 post-procedure ejaculations; a semen analysis is performed several weeks after the procedure to check if any sperm remain.

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With both procedures, complications are quite uncommon and typically minor in nature (for example, a small amount of bleeding may cause a hematoma or blood clot under the skin, or a mild infection may occur at the site of the incision).

Serious complications occur more often with tubal ligation, in large part due to the location of the Fallopian tubes inside the abdomen, making them more difficult for the surgeon to reach than the vas deferens. Tubal ligations are most frequently performed through small incisions made in the abdominal wall and require general anesthesia. During the procedure, the uterus or other internal organs can be injured, or serious bleeding can occur.

Vasectomies, on the other hand, are performed through a tiny incision in the scrotum, and require only a local anesthetic. And, although the risk of death associated with both procedures is extremely low, a woman undergoing a tubal ligation runs a greater risk of dying than a man having a vasectomy. (The risk for a woman is estimated to be about 4 in 100,000; the risk for a man is almost negligible.)

Cost is another factor to consider in the decision between sterilization operations: A tubal ligation is substantially more expensive, costing as much as three times more than a vasectomy. A nationwide study comparing the costs of the two procedures found that tubal ligations cost between $1,190 and $2,466; vasectomies ran between $353 and $753.

For some couples, the decision between vasectomy and tubal ligation is based largely on nonmedical issues. For example, some research suggests that the partner who feels more strongly about preventing further pregnancies is more likely to be the one to undergo sterilization.

Both tubal ligations and vasectomies are highly reliable methods of birth control and are appropriate for men and women who are certain they do not want any more children. Unfortunately, some people who undergo the procedures end up regretting their decision, and a small percentage even attempt to reverse it. Typically, this requires another operation in which the surgeon attempts to sew the severed ends of the vas deferens or Fallopian tubes back together. Pregnancy rates following such operations are modest (about 30% to 60%), but tend to be slightly higher for vasectomy reversal. Because of the relatively low success rates in reversing these procedures, no one should ever undergo sterilization without consultation with a physician and great consideration.

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Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. They can be reached by e-mail at ourhealth@dhs.co.la.ca.us. Their column appears the second and fourth Mondays of the month.

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