In this post, we look at some key differences between male and female sterilisation. This can help any couple wishing to decide which method would be safer and most effective for their needs. But, of course, the choice will also be based on the individual health of both partners; (and any previous contraception experience).

What is Male Sterilisation

Male sterilisation is also known as vasectomy.

Vasectomy is presently the most efficient method for men’s sterilisation. It is also the safest form of permanent sterilisation.

Methods of Male Sterilisation

Vasectomy involves surgery to the man’s reproductive organs and must be performed by an experienced clinician.

Sperm made in the testes is transported in the semen into the penis. 

A small tube connects the organ where your body makes sperm to the urinary tract in the penis, (the vas deferens).

The most common method involves cutting and removing a small piece (10-15mm) of the vas deferens through the scrotum on both sides. 

Doing this will stop the sperm from flowing to the penis in the ejaculate.

Top Tips for Recovery after Male Sterilisation

Pain control: Commonly, it appears that the actual pain you experience is a lot lower than what you may anticipate.

Using a dressing and scrotal support can also help with the pain. We recommend you leave this in place for at least 48 hours.

Any serious post-procedure pain happens in up to 30% of people after surgery – but it usually resolves itself.

Other helpful pain control measures:

• Using paracetamol or Ibuprofen
• An ice pack intermittently applied to the scrotum for 48 hours can help with swelling and ease the pain.

What To Expect following your Procedure

You can expect mild pain, swelling and bruising for the first 2-3 days.

If you experience:

• worsening pain
• bleeding from the operation site
• fever
• significant scrotal swelling,

you must seek urgent medical advice.

What types of Activity can you perform after Vasectomy

During the first 24 hours following a vasectomy, we recommend bed rest or quiet activity.

If your recovery progresses smoothly, you may return to light activity in 2-3 days after surgery.

You should avoid heavy work, sports, or lifting for 7 days at least.

It’s important to go without sexual activity for 1 week after your procedure.

When you do resume sexual activity, you must use an alternative form of contraception. An alternative method like condom or female contraception must continue until a semen analysis has shown no sperm in the ejaculate.

How soon do you become Sterile after Vasectomy?

An important fact you should know about this procedure: Sterilisation is not immediate. 

Studies suggest:

• the more frequently you ejaculate following the proceedure, the faster you can achieve sterility.
• And the older you are, the longer it takes to achieve sterility.

Most men (up to 80%) have no sperm in their semen by the third month from surgery and after 20 ejaculations.

 (A semen analysis usually confirms this).

At your 3-month follow up, if there are live and moving (motile) sperm, you will have a repeat test after 1-2 months. 

If motile sperm are still present, after the second test, the procedure has failed.

At this point, the options include: repeat the sterilisation procedure or use alternative contraception.

Finally, a note on reversal. Vasectomy reversal is possible, but success rates are not very high. There is no guarantee that fertility will return. 

What is Female Sterilisation

Female sterilisation is the same as tubal ligation.

It is when you achieve permanent pregnancy prevention by blocking the fallopian tubes.

Female sterilisation is the most common contraceptive method worldwide, used by 19 per cent of all women ages 15 to 49 years. 

Worldwide, the female-to-male sterilisation ratio is 3 to 1 (2017).

So many people/couples rely on female sterilisation probably because it does not have the common side effects associated with other contraception methods. Another reason is if a previous method is not effective. In addition to its permanent nature, it also has the advantage of convenience and reliability.

Types of Female Sterilisation

Women can have the sterilisation proceedure in different instances.

Postpartum sterilisation – this usually happens at the time of a C-section. However, you can have the operation within the first 24–48 hours after vaginal delivery.

This method is suitable when you express a desire to have sterilisation before or during your pregnancy.

Sterilisation is also possible after an abortion (post-abortion sterilisation). This is what happens if you have an early pregnancy failure or an unwanted pregnancy. 

Interval Sterilisation: Having your operation at least 6 weeks after pregnancy is Interval Sterilisation and is also the option for non-pregnant women.

In this instance, you can have a tubal ligation via laparoscopy or hysteroscopy (where surgical equipment allows doctors to look inside the abdomen and womb, respectively). 

For these cases, there are no significant abdominal cuts.

You may also have sterilisation via a laparotomy or hysterectomy (if there are other conditions like abnormal bleeding or pelvic pain). In this case, you will have major cuts or incisions to your abdomen to reach the organs.

The laparoscopic method has a further edge:

• it is successful at the first attempt in 99% of cases, 
• immediately effective, so there is no need for additional contraception or confirmative imaging after 3 months. 
• it is also safe to perform at the time of an abortion. 
• Reversal is possible, with high success rates.

Methods of Female Sterilisation

Tubal Ligation. There are different ways to achieve tubal ligation (closing or ‘tying’ the tubes).

These female sterilisation options are:

1. Removing a portion of the fallopian tube along its middle via laparotomy (a surgical cut into the abdomen). Known as partial salpingectomy, this is a highly effective method.
2. Using Filshie clips (or Falope rings) is another effective method. Filshie clips are preferred to the rings. Still, the failure rates with clips are reportedly higher than partial salpingectomy (0-8.4%). 
3. More commonly performed these days is complete bilateral salpingectomy. This procedure involves removing the entire fallopian tube on both sides. It is not common in women after childbirth due to concerns over additional bleeding after delivery. 

Changes You Can Expect After Tubal Ligation

• Improved menses (reduced flow volume, duration of menstrual bleeding, and less menstrual pain). However, the cycle may become more irregular. (studies suggest these menstrual changes may also be from stopping a previous hormonal method or growing older)
• No significant changes in female hormone levels happen after sterilisation. Therefore, it is not thought to cause early menopause.
• There is a possibility of persistent pelvic pain – for instance, after some types of hysteroscopy. Women with pre-existing chronic pain conditions may be more likely to have more pain after the procedure.
• There is either no change or improvement in sexual desire or function after female sterilisation.
•  You may be more likely to undergo hysterectomy within 5 years following sterilisation than women who were not sterilised (or whose partners had a vasectomy).
• There is no evidence of a greater risk of breast cancer after sterilisation. 
• However, the risk of ovarian and endometrial cancer is lower in women who have been sterilised.

Top Tips for Recovery After Tubal Ligation

• You should not drive for 48 hours afterwards if you’ve had a general anaesthetic (GA). This is because despite feeling ‘well’, your reaction times and judgement may not be back to normal.
  • You might feel a little uncomfortable following a GA which is not unusual, so you should rest for a few days.
• Most women can return to work around 5 days after tubal occlusion (depending on your general health and job)
  • Depending on your general health and job, you can typically return to work 5 days after tubal occlusion – but avoid heavy lifting for about a week.
• You can expect slight vaginal bleeding and some period pain.
  • For bleeding, you can use a sanitary towel rather than a tampon till it settles. Simple painkillers like paracetamol or Ibuprofen can help with this. 
• To care for your wound, the following are essential:
  • Keep your wound clean. If there is a dressing over your wound, you can typically remove this the day after the operation. 
  • The stitches would need to be removed at a follow-up appointment unless dissolvable ones were used.
• You can have sex as soon as it’s comfortable to do so after your operation.
  • If you had tubal occlusion, use additional contraception until your first period to protect yourself from pregnancy.
  • You should also remember you may need to use condoms because STIs are not prevented by sterilisation.

Although female sterilisation can be reversed, it is a challenging process (removing the blocked part of the fallopian tube and rejoining the ends). In addition, there is no guarantee that the patient would become fertile again. Therefore, female sterilisation reversal success rates depend on age factors and the method used in the original operation. 

Male Sterilisation Disadvantages

• Postoperative complications like – bleeding after the procedure, pain, infection, trauma to the nearby structures like the urethra
• Vasectomy failure
• Can be reversed but the reversal process can be expensive and fertility is not a guarantee

Compared with tubal ligation, vasectomy is safer, less costly, and significantly shorter post-procedure recovery time. 

In fact, vasectomy is the most cost-effective method of permanent contraception.

Female Sterilisation Disadvantages

• Immediate complications from laparoscopic sterilisation may include bleeding, infection or injury to nearby structures.
• You may start off with a laparoscopic method. Still, due to complications from the technique, you may need to convert to a laparotomy.  
• Postoperative pain can happen, which is more with the tubal ring than with electrosurgery and the clip. 
• Delayed complications are Ectopic pregnancy: if you get pregnant after the operation, there’s an increased risk of ectopic pregnancy. This is less common with Filshie clip and postpartum partial salpingectomy.
• Devices like the clip may move out of position (migrate) or be pushed out (expelled) via the urethra, bladder, vagina, or rectum, but these do not happen commonly. 
• Failed sterilisation
• Risk of regret of having sterilisation
• Female sterilisation cannot be easily reversed. Reversal operations can be expensive.
• The procedure can fail depending on the method – the fallopian tubes can rejoin and make you fertile again, although this is rare.

Key Comparisons between Male and Female Sterilisation

1. Post-operation Pain – Both forms of sterilisation can cause pain. Still, post-op pain happens considerably less in Male Sterilisation (except complicated with bleeding or other problems). Mostly pain after surgery is treated with simple pain relief like Paracetamol or Ibuprofen.
2. Is It Reversible – Both male and female sterilisation can be reversed. However, reversal is a lot harder with female sterilisation and can be pretty expensive with no guarantee of fertility returning. A vasectomy can be reversed, but success rates are not very high – again, there is no guarantee that fertility will return.
3. How Soon It Works – Male sterilisation and some forms of female sterilisation are not immediately effective. The semen needs to be free of sperm first, which can sometimes take up to 3 months. After tubal occlusion, you will need additional contraception until your first period.
4. Effectiveness – Female sterilisation is more than 99% effective at preventing pregnancy. Vasectomy also has a <0.15% failure rate and is the most effective available mode of male contraception. 
5. Post Operation Complications/Problems – Initial post-op complications like pain, bleeding, an infection can happen in either. Female sterilisation has more long term complications like ectopic pregnancy. The regret of having sterilisation is also more common after female sterilisation.
6. Resuming Activity – Men should avoid heavy work, sports, or lifting for 7 days at least. Women can typically return to work 5 days after surgery – but avoid heavy lifting for about a week. While women can have sex as soon as it’s comfortable after surgery, men are advised to wait 1 week before doing so.

Decision Making

Making a decision on which method to use should involve discussion between both partners and should reflect the individual choice and medical backgrounds, too.

Counselling before any type of sterilisation is recommended to be sure that couples are aware of all options available and any problems that can happen whichever method is chosen.

Would you like to discuss any of these methods further? You can schedule a friendly one to one chat with one of our clinicians here.

More Reading:

• Semen Analysis in Male Infertility – Pt 3:
• Male Infertility and its Causes – Part 1
• ALL about Symptoms of Ectopic Pregnancy
• Emergency Pill Wahala! Why’s My Period All Over The Place?
• Horrors of Female Genital Mutilation

References

• Female Sterilisation – NHS Contraception Guide
• Reversal of Male and Female Sterilisation (Local Policy Guide)
• ESC Female and Male Sterilisation Lecture

Editing by AskAwayHealth Team

Disclaimer

All AskAwayHealth articles are written by practising  Medical Practitioners on a wide range of health care conditions to provide evidence-based guidance and to help promote quality health care. The advice in our material is not meant to replace the management of your specific condition by a qualified health care practitioner.
To discuss your condition, please contact a health practitioner or reach us directly through info@askawayhealth.org

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