Sterilization is a voluntary surgical procedure that. prevents permanently either a man fathering a child or a woman conceiving one. Sterilization for men is called vasectomy and is the operation in which a doctor cuts and seals shut the two tubes (the vasa deferentia) that convey sperm. Vasectomy does not interfere with sexual interest, erection, ejaculation, pleasure or performance. But read this!
Sterilization for women is called tubal ligation. The procedure is that a doctor cuts or seals shut the Fallopian tubes, preventing eggs from moving through them and stopping sperm from reaching the eggs, which stay permanently in the other portion of the sealed tube. Tubal ligation does not interfere with sexual interest, pleasure or performance. Voluntary sterilization has become a very common method of birth control in the United States and Europe. In the United States sterilization is the most popular method of birth control among married couples aged 30 and over.
Because sterilization is usually irreversible, no-one should decide to be sterilized without giving it exceptionally careful thought. The issues are emotional, social and physical, and each of them needs to be considered in depth and discussed between partners: sterilization is final and permanent; reversing the surgery and retying the tubes rarely works, either in women or in men. The decision to be sterilized must be made freely, without pressure from family or friends. Agreeing to a vasectomy or tubal ligation under pressure from your partner frequently causes resentment and bitterness; it can have a serious negative effect on the relationship.
Will your current relationship suffer in any way because of childlessness? Is it likely that a future relationship will be damaged by childlessness? Marriages are ending in divorce more than ever before, and on remarriage the desire to have a child with a new partner is very common. What position has your religion taken on sterilization, and will you feel guilty if you go against it? Will the inability to reproduce affect your concept of being a complete woman or man? Are you fully aware of the surgical procedure for sterilization? Might it be unsafe for you or have undesirable side effects? Have you talked with your partner about which of you should be sterilized? All things being equal, sterilization is easier for the man.
Myths about sterilization, and what it does to women and men, are legion. Here are some of them:
FEELINGS Typical responses that men and women have to their sterilizations are:
As you can see. some are positive, some are negative. Fortunately, most people's response is positive, like the first two quoted. They are the people who took the decision to be sterilized in a positive way, as a means of improving the quality of life of their existing family. They are the people who felt positive about themselves and their relationships, people who felt secure about their own femininity or masculinity. The negative responses come from people who either should not have been sterilized or who should have waited until they had resolved the sues. They may be people who felt uncertain about or unfulfilled in their masculinity or femininity. Maybe they were using sterilization to cover up basic flaws in their relationships or maybe they had not resolved religious or social conflicts.
The feelings of people who have been sterilized show up two things: for a great many people it is a life-enhancing experience; for a minority it is a disadvantage. Everyone therefore who is considering sterilization needs to give it the closest possible thought and would be well advised to get and need professional counseling.
RELATIONSHIPS
The overwhelming majority of couples in which one
partner has been sterilized report that their
general relationship has improved
and that their sex lives have
shown a particular improvement - especially when using
the best sex positions for
orgasm.
Many couples feel more relaxed and spontaneous when the fear of pregnancy has
been removed, because the element of anxiety caused by an unwanted pregnancy
often interferes with a man's or woman's sexual functioning. In the certain
knowledge that there will be no more children, couples find they can pay fuller
attention to their existing family with reduced anxieties about further
financial pressures of parenthood.
In fact, the couple should be counseled out of a sterilization until they have worked through any relationship difficulty. Sterilization can lead to relationship difficulties. If the partner who is sterilized has problems of low self-esteem, he or she may withdraw and / or blame the other partner for pressuring him or her to be sterilized. It is clear that if a relationship is sound and healthy, sterilization is likely, if anything, to improve it. If the relationship is unsound, sterilization should be avoided until the couple have worked through their problems.
RELIGION The official positions of religions on sterilization vary from belief to belief.
The Roman Catholic Church and Orthodox Judaism are opposed to sterilization because they oppose any form of birth control except natural methods. The only exception made is when pregnancy and/or the birth of a child is a real threat to the health of the woman. However, there is evidence that Catholics, Jews and others from religious groups with similar views on sterilization do choose it as a way to stabilize family size and avoid the risk of unintended pregnancies and possible abortions. In these cases, the individuals have formed their consciences in a fashion that does not exclude them from continuing their religious practice, even though their judgment about sterilization is contrary to the current official teaching of their belief. Many of the Protestant churches see sterilization as a responsible act that fulfills, not violates, the will of God regarding family and the quality of life. Sterilization is a deeply personal issue of great complexity for anyone, but if you belong to a religion that forbids sterilization or frowns on it, your problem is more complex still. It is very important that you should resolve your conscience before being sterilized, otherwise there may be conflict and guilt. It can be helpful to discuss your feelings about sterilization with your religious adviser. The official position of the Roman Catholic Church on voluntary sterilization for a woman or a man is clear - it is prohibited. The only time a Roman Catholic may be sterilized is if a disease is present that can be treated in no other way. Sterilization may not, of course, be used as a contraceptive method. However, the majority of practicing Roman Catholics and many contemporary theologians have opinions that differ from the teaching of the Vatican. Most Catholics believe that sterilization is a matter of individual conscience. As long as the matter has been carefully thought through and the personal and relationship issues have been considered, ma y Catholics today would accept sterilization as a valid moral act. So if Catholic couples believe that their conjugal love and their parental responsibility would be weakened by another child, for whatever reason, emotional, physical, age, family or social - they may find sterilization proper in the context of their belief. Sterilization is never to be undertaken lightly, and for Catholics it can important, therefore, for Catholic couples to discuss their views with a religious counselor. It is a very serious moral decision that strikes at the center of real religious beliefs. It is not a simple decision. It is one that requires a couple honestly to search their consciences about why they no longer want children, and why they believe they will never change their minds. In addition, they must feel sure they are acting properly for themselves and for their relationship. This is no snap decision; if it is, the chances are they need to go back and rethink their reasons and intentions.
Judaism. In the Torah, it is stated that it is forbidden to give a man anything to cause sterility. However, references in the Talmud suggest that a woman may be permitted to sterilize herself. The wife of a famous Rabbi, it is said, "drank a cup" so that she would not be able to bear children any longer and end her great suffering in childbearing. Ancient law also permitted women permanently to avoid pregnancy if they had previously borne diseased or delinquent children. This shows the early Jewish consciousness of eugenics and the inadvisability of bearing children if previous ones showed undesirable physical, mental or spiritual traits. Contemporary Judaism, except for strict Orthodox believers, is very clear in its acknowledgment of voluntary sterilization as a valuable method of permanent birth control once the two people are certain they have completed their family.
Protestant churches up to the early 1930s were in general opposed to birth control and sterilization. Today, however, many of the major Protestant sects around the world acknowledge that voluntary sterilization is a valuable means of promoting family stability and enhancing the quality of family life. The United Presbyterian Church, for example, takes the view that if a couple chooses sterilization for themselves it should be done with the full knowledge of the irreversibility of the procedure and with thorough counseling, but the Presbyterians, like the United Methodist Church, and others find no intrinsic conflict between responsible voluntary sterilization and their religious values.
Sterilization for women is done by cutting, clamping or heat-sealing a piece of each Fallopian tube. This prevents the egg from passing from the ovary to the uterus. It is commonly known as "cutting the tubes" or "tying the tubes." Until recently, abdominal tubal ligation was the chief method used for sterilization of women. Today there are several other ways of cutting. These newer methods are just as permanent and irreversible, are virtually 100 percent effective, are making sterilization much safer and providing women with more options about which procedure is best for them. It is not advisable to have tubal ligation:
All of these issues will be discussed by your doctor when she/he does a medical history and evaluation. Tubal ligations of any kind are considered permanent. Although microsurgery techniques may in the future make the surgery reversible, women and couples who choose tubal ligation should be certain they do not wish to have children in the future.
Sexual interest, desire and performance or the ability to give or receive pleasure are not affected by any sterilization method. Female sex hormones are not affected, and tubal ligation of any kind does not interfere with menstruation or cause menopause. After a tubal ligation many women have reported an increase in their sexual interest and activity due to their ability to relax, be more spontaneous, and not to have to worry about pregnancy. The following is a brief description of the different female sterilization methods, all of which achieve the same purpose. Your doctor will discuss with you the merits of each method to help you make your decision.
In this procedure an incision about five inches long is made in the abdomen to expose the uterus and Fallopian tubes. The tubes are then tied and a piece is cut out of each tube. This is major surgery with all the risks and complications that implies, and requires general anesthesia, usually five days of hospitalization and several weeks of recovery time at home. It can be done at any time but is frequently performed after the birth of a child, after a D&C or after a pregnancy termination.
In this procedure, a small incision is made just below the navel. Then through the incision the doctor inserts a laparoscope, an instrument that permits outside light to illuminate the internal organs. Inserted along with the laparoscope, or through a second small incision just above the pubic hair line, soem doctors seal the tubes with spring-loaded clips, and others cut a piece out of the tubes and then heatseal the free ends. The surgeon then withdraws the instruments, allows the as to leave the body, closes the incision(s) with a stitch or two. This procedure can be performed in a health clinic, surgical ambulatory care center, or hospital using local anesthesia and minor relaxants, though occasionally it is done under general anesthetic. Most women go home the same day - a few leave after they have had a day's rest. Recovery is rapid after a laparoscopic tubal ligation and intercourse an be resumed as soon as the woman is feeling well.
In this tubal ligation method, a small incision, about an inch or two in length, is made just above the pubic hair line. An instrument is inserted in the vagina that elevates the uterus towards the incision. Through the incision the surgeon locates the Fallopian tubes and cuts them off or places bands or rings around each tube to seal them off. The incision is then stitched. The "mini-lap" takes less than 30 minutes and is usually performed under local anesthetic. The woman can return home after several hours.
In this procedure the surgeon makes a small incision in the rear of the vagina, near the cervix, to reach both Fallopian tubes. He or she pulls both of them through the incision at the same time, cuts and ties a piece of each and returns them to their usual place in the abdomen. General or local anesthesia can be used in this procedure. Some women return home the same day, some need a day or two of rest and observation. Recovery is generally rapid, with all activities being quickly resumed except intercourse, which must be avoided for four weeks to allow for proper healing of the incision. A major disadvantage of vaginal tubal ligation is the possibility of infection if some of the bacteria that are normally in the vagina, where they are beneficial, get transferred to the tubes, where they are not. Also failure rates are higher for vaginal tubal ligation by comparison with the rates for other methods of female sterilization.
Q. "Is female sterilization very effective?"
A: "Yes. When properly done by a qualified doctor, tubal ligation of any kind is virtually 100 percent effective."
Q. "Do women have to go back to be sure they have really been sterilized?"
A: "No. If women do go back to their doctor, it usually is to check the incision is healing well."
After a tubal ligation you will still have your period and you will still ovulate. No matter which method is used, the effect is always to seal off the Fallopian tubes so that sperm coming up the tubes cannot meet ova on their way down from the ovaries.
Q. "Is it true that tubal ligation is reversible?"
A: "Improvements in sterilization procedures will result in less damage to the Fallopian tubes (the spring-loaded clip is a promising advance in this respect), and improved microsurgery techniques will also help to achieve more successful reversals. One potential problem with reversing tubal ligation is that ectopic pregnancies occur ten times more often in women who have had a tubal ligation reversed."
The standard way in which men are sterilized is by an operation called vasectomy, in which the vas deferens, the two tubes that convey sperm from the testicles to the penis, are cut and sealed off. There are two very important points to note: first, it is unlikely that a vasectomy can be reversed - once it has been done, the man will be sterile for life. Second that having a vasectomy will n your sex life at all. You will get erections as before, you will ejaculate s before, you will feel all you felt before. Desire and performance are in o way reduced. The only difference is that you cannot cause a pregnancy because your semen no longer contains sperm.
Some men worry that because sperm can no longer get out it will build up in the testicles and cause them to swell. This will not happen: sperm is absorbed just as it is if you do not ejaculate for a while. There will be no discomfort or swelling; you will feel just the same. Vasectomy is virtually 100 percent effective and entirely without physical risk if it is performed correctly. What has to be done is this: the two tubes, the vasa deferentia, that carry sperm from the testicles up toward the penis have to be cut and sealed off so that sperm cannot reach the penis. Vasectomies are normally done in the doctor's office, unless a special medical condition requires hospitalization.
The doctor first locates the vas on one side of the scrotum and gives the man a small local anesthetic on that side. The anesthetic takes effect quickly. The doctor then makes a small incision in the scrotum, lifts the vas through and cuts out between half an inch and an inch of it. The ends are then tied off or cauterized (heat sealed) and replaced in the scrotum. The same procedure is followed on the other side of the scrotum: the other vas is cut through and the ends sealed off. The operation usually takes no more than 30 minutes and generally produces only minor discomfort.
If both vasa have been properly sealed off, they will not open or grow together again; this means that vasectomy is virtually 100 percent certain as a method of sterilization. The skin of the scrotum is so wrinkled that the two small incisions will not be noticeable once they have healed. There are a few medical situations in which it is unwise to have a vasectomy. A hernia or an undescended testicle may make it undesirable, though sometimes the operation can be performed after such a condition has been corrected. Men who suffer from abnormal blood clotting, very high blood pressure or heart disease will probably be advised that they should not have a vasectomy, as any kind of surgery could be harmful.
The development of microsurgery techniques means that reversal rates may be higher in the future. A number of men have already sought reversal after the death of a child, or after marrying when they never thought they would or after their career or financial circumstances have changed so that they felt able to have a child. Some have been lucky and the operation has worked; many have been disappointed.
Q. "But how can you still come if there is no sperm?"
A: "Sperm makes up a very small part (about one percent of ejaculate. The other 99 percent is fluids from the seminal vesicle and prostate gland, which are unaffected by the vasectomy. They keep producing their fluid and that is what continues to leave your penis when you come. Incidentally, only examination of your semen under a microscope would reveal that you had had a vasectomy. The color, amount and consistency remain as before."
Q. "After my vasectomy when can I have intercourse?"
A: "Your doctor will advise you. Usually, doctors suggest that intercourse can begin as soon as it is comfortable for you. Although the surgery was minor, the tissue on the scrotum was cut and bruised and needs to heal, so vigorous intercourse may need to be delayed a bit. Whenever you resume sex, remember: vasectomy does not provide you with immediate pregnancy protection. Sperm are still alive and present in the seminal vesicle, prostate and Cowper's glands, all structures beyond the point of the surgery. All of this sperm must be ejaculated before your entire reproductive system is free from sperm. Therefore you or your partner must use a method of birth control until you no longer ejaculate sperm. After that time the vasectomy is virtually 100 percent effective."
Q: "How do I know when that happens?"
A: "Your doctor will require you to have a sperm count after you have resumed sexual activity. The sperm count will reveal the presence or absence of sperm in your semen and will indicate whether birth control needs to be continued. It is important to remember that it is not how long you wait after your vasectomy to have unprotected intercourse that is decisive but how many times you have ejaculated to clear your reproductive system of sperm."
Q: "I understand the facts about vasectomy, but I find it very hard to believe that it isn't going to have some effect on my sex life."
A: "You are partly right. If vasectomy has any effect on your sex life, it will be to improve it. Research has shown that some men find that their interest in sex increases and that they have intercourse more often after a vasectomy. This is probably because they can relax entirely and be more spontaneous as there is no chance at all of causing a pregnancy. But only a minority of men are affected in this way, so don't count on it!"
Q. "I heard that vasectomy makes you feel less like a man. Does that happen?"
A: "No. What makes you feel like a man should have little to do with whether your vasa deferentia are closed or open. But if it does make a difference, then vasectomy is not for you! Vasectomy does not change your appearance or your identity, nor does it interfere with your sexual desire, arousal, performance or your ability to enjoy and provide enjoyment for another. Therefore, if you felt like a man before a vasectomy you will feel like one after a vasectomy."
Q. "Can I use a sperm bank before a vasectomy?"
A: "Yes. Sperm banks offer you the opportunity to store your sperm in a medical freezing unit before your vasectomy. Afterwards, if you wish to have another child, the sperm can be artificially inseminated in your partner. However, there can be problems. Some of the freezing techniques used have destroyed sperm, and anyway cases have revealed that sperm seem to lose their mobility after being stored for a long period of time."
General Issues Around Contraception