Vasectomy or Tubal Ligation

Vasectomies do not affect testosterone levels, erections, climaxes, or sex drive.

Your Undoing

A vasectomy is a surgical birth control procedure that prevents a man from impregnating a woman. Since this male sterilization does not inhibit the spread of sexually transmitted infections, a prophylactic covering may still be necessary. Though surgical reconnections are possible, it is best to view vasectomies as irreversible.

Get Her To Do It

Comparable female sterilization is called tubal ligation. Instead of severing spermatic chords, a woman’s fallopian tubes are blocked or removed. Mothers sometimes contemplate this after giving birth to several children or if doctors warn that a pregnancy can be life-threatening. Currently, laparoscopic tubal ligation is the most popular method of female sterilization in non-pregnant women.

When people say they are having their tubes tied, we envision a neat bow on shoe laces that can easily be undone. Fallopian tubes may be banded, cauterized, or cut and tied. Keloid scar tissue can later fuse crimped passageways, making reversal problematic.

Though tube tying is quite effective, it is not a foolproof method of contraception. Less than 1 woman out of 200 will conceive, typically resulting from improperly performed procedures or a spontaneous regeneration of the fallopian tubes over time.

Get Him To Do It

Unlike a castration—where testicles are removed—men with a vasectomy can have an erection and ejaculation. The ejaculate is void of spermatozoa. Vasectomies do not affect testosterone levels, erections, climaxes, sex drive, or any other part of sex life.

The traditional method for this outpatient procedure is with a scalpel. Through a small slit in the upper part of the scrotum, two tubes called vas defrens are cut and tied off. The site is closed up with a few stitches.

A newer “knife-less surgery” or “no-scalpel” method uses needles, without requiring stitches. Within a few days of either method, pain and swelling are gone. You can have a vasectomy on Friday and return to work on Monday.

After 10–20 ejaculations following the vasectomy, your semen is tested to see if it is free of sperm. Until confirmation is received, you should continue using other birth control methods.

Don’t Count on Reversal

For optimum effectiveness, male or female tubes are preferably severed. Though it is possible to suture detached ends back together, the ability of a man’s sperm to fertilize eggs diminishes over time.

Vasectomy reversal within the first three years has about a 70 percent chance of successful pregnancy. By ten years, this drops to 30 percent. The best insurance against future regret is cryopreservation of semen.

There is a 33 percent risk of an ectopic pregnancy if conception occurs after tubal ligation reversal. This means that the egg is implanted in the fallopian tubes and cannot progress into a healthy pregnancy.

FDA Prophylactic Birth Control Guide

FDA-Approved Method	Pregnancies Per 100 Women	Frequency of Use	Side Effects
Sterilization Surgery for Women	< 1	One-time Permanent	Pain; bleeding; post-surgery infections or complications
Sterilization Implant for Women	< 1	One-time Permanent	Pain or cramping; pelvic or back discomfort; vaginal bleeding
Sterilization Surgery for Men	< 1	One-time Permanent	Pain; bleeding; infection
IUD Copper	< 1	Insert by health care provider <10 years	Cramps; heavier, longer periods; spotting between periods
IUD with Progestin	< 1	Insert by health care provider 3–5 years	Irregular bleeding; no periods (amenorrhea); abdominal or pelvic pain
Rod Implant	< 1	Insert by health care provider <3 years	Menstrual changes; weight gain; acne; mood swings; depression; headache
Injection	6	Every 3 months	Loss of bone density; irregular bleeding; bleeding between periods; weight gain; headaches; nervousness; dizziness; abdominal discomfort
Oral Contraceptives (Combined Pill)	9	Daily	Bleeding or spotting between periods; nausea; breast tenderness; headache
Oral Contraceptives (Extended-Use Combined Pill)	9	Daily	Bleeding or spotting between periods; nausea; breast tenderness; headache
Oral Contraceptives (Extended-Use Combined Mini Pill)	9	Daily	Bleeding or spotting between periods; nausea; breast tenderness; headache
Patch	9	Change weekly for 3 weeks (max 21 days).	Bleeding or spotting between periods; nausea; breast tenderness; skin irritation; abdominal pain; headache
Vaginal Contraceptive Ring	9	Personal intravaginal insertion for 3 weeks. Remove 1 week.	Vaginal discharge, discomfort, mild irritation; headache; nausea; mood changes; breast tenderness
Diaphragm with Spermicide	12	During each copulation	Irritation; allergic reactions; urinary tract infection
Sponge with Spermicide	12–24	During each copulation
Cervical Cap with Spermicide	17–23	During each copulation	Irritation; allergic reaction; abnormal Pap test
Male Condom	18	During each copulation; Protects against some STIs	Irritation; allergic reaction
Female Condom	21	During each copulation; Protects against some STIs	Discomfort or pain during insertion or sex; burning sensation; rash; itching
Spermicide Alone	28	During each copulation	Irritation; allergic reaction; urinary tract infection

For more information on the chance of getting pregnant while using a method or on the risks of a specific product, please check the product label or “Contraceptive failure in the United States,” Trussell, J. (2011), Contraception 83(5):397-404.

As you can see, when using a condom alone, a sexually active person could potentially conceive 18 times with 100 encounters, or >4 times with 25 encounters. In reality, concurrent pregnancy is not possible and conception will likely slow activity.

A male contraceptive transdermal “gel [that began October 2018 Phase 2b trial] reduces sperm count to a contraceptive level,” says Clint Dart, the Vice President, Biostatistics and Programming at Health Decisions (the CRO running the study). “Once a man’s sperm concentration is low enough (less than 1 million/mL), there is a 97 percent chance that their partner will not get pregnant.”

Religious Considerations

Some religions—notably Catholicism since the second century—forbid all methods of birth control except the rhythm method. “The Church has always taught the intrinsic evil of contraception, that is, of every marital act intentionally rendered unfruitful. This teaching is to be held as definitive and irreformable. Contraception is gravely opposed to marital chastity.” (1997, the Vatican’s Pontifical Council for the Family)

The 2008 Congregation for the Doctrine of the Faith’s instruction Dignitas Personae reiterates church opposition to contraception, mentioning new methods, notably female condoms and morning-after pills, which also “fall within the sin of abortion and are gravely immoral.”

The scriptural basis provided is Psalm 127:3–5, which extols that children are a blessing from God. The command given to Adam in the Garden of Eden and later to Noah’s family was to populate the earth. (Genesis 1:28; 9:1) Throughout the Hebrew Scriptures, childbirth was encouraged with the prospect of being within the lineage of the Messiah. —Genesis 16:9–10; Ruth 4:13.

Barren women were ridiculed. (1 Samuel 1:4–6) Though children are praised within the Christian Greek Scriptures after the arrival of the Messiah, the focus shifted to making disciples from people of the nations. (Colossians 3:11–25; Matthew 24:14; Acts 1:8) Both Hebrew and Greek Scriptures prohibit adultery and premarital sex. —Proverbs 5;16; Hebrews 13:4.

Whether or not religious views are a factor, family planning, including the decision to have a vasectomy or tubal ligation is a serious step for couples to personally decide.