Vasectomy vs female sterilisation

Having the snip or having a vasectomy is the source of many jokes and female sterilisation similarly seems to be a topic to be laughed about, rather than discussed properly.

But it is of course a deadly serious subject. Over 40,000 men have a vasectomy and around 90,000 women are sterilised every year.

The main reason for people choosing to have a vasectomy or sterilisation is so that they know there's no chance of pregnancy and they can enjoy a sex life without the worry of an unplanned pregnancy.

So if you're considering either a vasectomy or female sterilisation, or you just want to know more, we have the pros and cons and the facts on what actually happens.

What is a vasectomy?

It's a small operation to cut a part of the penis, the vas deferens, so that sperm doesn't travel into the semen and make a woman pregnant.

It's a simple operation done under local anaesthetic (your scrotum and testicles will be numb) - but if you are allergic to local anaesthetic or faint easily you might have a general anaesthetic.

What actually happens?

First you have a chat with your GP. He or she will ask you a number of questions to check that there are no health reasons why you might not be able to have a vasectomy and that it's a decision that you and your partner have made together.

It's very important that you, your partner and your GP are absolutely sure that this is the right thing to do and that you don't want children. Although a vasectomy can be reversed it's often unsuccessful.

You can have the procedure at a hospital, clinic or at your doctor's surgery. There are two types of procedure:

Conventional vasectomy After anaesthetic two small incisions are made on each side of the scrotum so that the surgeon can cut the two tubes that carry sperm to the penis (vas deferens). The ends of the cut tubes are sealed either by surgical tie or using a special instrument that uses heat to close the tubes.

The incisions are sewn up with dissolvable stitches.

No-scalpel vasectomy This is a procedure usually done in a private clinic.

The surgeon finds the vas deferens with his hands and then holds in it place using a special clip. Then a special tool is used to make a tiny hole in the skin where the surgeon can cut the tubes and seal them. Research suggests that the no-scalpel procedure is less painful and less likely to cause complications.

How do you know if you really want a vasectomy?

Having a vasectomy is a decision you can't make lightly. Once you have had a vasectomy you cannot be a biological father again. And although vasectomies are reversible many are unsuccessful and aren't available on the NHS.

Because it's a big decision it needs to be discussed with your partner, if you have one, friends or family members and your doctor, you might even want counselling - your doctor can refer you to someone.

The pros of a vasectomy

• A vasectomy (either procedure) only takes between 15-30 minutes
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• It carries much less risk than female sterilisation
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• Pain is minimal and complications are rare
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• You can go home the same day
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• It's a very successful operation for most men
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• If you want a male doctor you can request one
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• Recovery is quick, just a few days. You'll probably only experience a little discomfort such as swelling and bruising.

The cons of a vasectomy

• The procedure is free on the NHS but the waiting list can be long so you might prefer to go to a private clinic, which you'll have to pay for.
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• You can't have sex straight away. You need to have two check-ups after the procedure because there may be some sperm in your semen.
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• Until the tests for sperm are clear you'll have to use some form of contraceptive
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• A vasectomy doesn't stop the spread of STIs so if you have an infection or you have a new partner you must use a condom.
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• A reversal is possible but most are unsuccessful and are not available on the NHS
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• It's rare for a doctor to agree for a man under the age of 30 to have a vasectomy as research shows that they often regret having the operation.

Complications

A vasectomy is a very safe and successful procedure, however, in a small number of cases there are complications:.

1. Fertility - in rare cases the tube that has been cut rejoins and makes you fertile again so you could make a woman pregnant.

2. Full-feeling testicles - sometimes a man develops a 'full' feeling in his testicles, as if they feel fuller than normal.. This might sound strange but it is quite normal and will naturally disappear after a few weeks, however if this sensation goes on for a while it's worth seeing your GP just to put your mind at rest.

3. Pain - occasionally, after a vasectomy some men feel a dull ache or sharp pain in the testicles. This is usually due to a pinched nerve or scarring. You might need further surgery to correct the problem - your GP will be able to advise.

4. Infection - As with any minor or major surgery infection is a risk and this is due to bacteria entering the body via the cut made during the op. It's important to keep your genital area clean and dry and to seek the advice of your doctor.

A doctor has the right to refuse to carry out the procedure if he or she believes it's not in your best interests.

What is female sterilisation?

Female sterilisation is where the fallopian tubes are cut or blocked to prevent the egg meeting the sperm and becoming fertilised, so this prevents you from becoming pregnant.

The operation is performed under general anaesthetic and recovery takes a few days.

What actually happens?

After a discussion with your doctor and possibly counselling too you'll be referred for a sterilisation.

There are various methods of sterilisation:

Laparoscopy A small cut is made in the abdominal wall and then a tube with a tiny camera attached is inserted. This is so the surgeon can clearly see the fallopian tubes and seal them with one of four methods: The tubes are sealed with either clips made of titanium or plastic, silicone rings which clamp the tubes shut. Or the tubes are tied closed or sealed using an electric current.

Mini-laparotomy A slightly less invasive procedure is the mini-laparotomy. A small cut is made just above the pubic hairline and the fallopian tubes are pulled out and then sealed with one of the four ways mentioned above, then put back into place. This type of operation usually takes place just after a women has had a baby.

How do you know you really want a sterilisation?

It's a big decision to make - once you have been sterilised you won't be able to have children. Reversal is either not attempted or if it is, it's more often than not, unsuccessful.

You must never rush into deciding to have a sterilisation - you need to be sure that you are certain that you won't change your mind or regret it. It's never a good idea to decide on a sterilisation if you have recently had a termination, just given birth or had a miscarriage.

If you are stressed, depressed or have just split up with your partner it's also not a good time to consider an operation.

If you are absolutely sure that a sterilisation is the right thing for you then discuss it thoroughly with your partner, friends, family, your GP and a counsellor (your GP can refer you)- then give yourself a cooling off period before you decide.

The pros of sterilisation

• The procedure is free on the NHS although you can pay to go private if you want
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• It is more than 99% effective at stopping pregnancy
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• Although it is a more complex procedure than a vasectomy it's rare for there to be any long-term health problems
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• Your sex drive and hormone levels will not be affected
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• Once you are healed you can go back to having a normal and spontaneous sex life

The cons of female sterilisation

• Getting a female sterilisation is not easy. Many doctors would rather the male partner had a vasectomy because there are more risks associated with female sterilisation
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• Reversal is usually unsuccessful - so you need to be sure that you don't want children
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• You will have to use contraception until your periods have stopped just in case there is still a risk of pregnancy
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• Sterilisation won't prevent you from catching or spreading STIs
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• Although very small, there is a risk of infection, internal bleeding and damage to other organs.
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•  It's possible for the tubes to rejoin and make you fertile again - although this is very rare
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• If you do get pregnant after the operation, there is a higher risk that there'll be complications such as an ectopic pregnancy. So if you miss a period you must take a pregnancy test immediately.
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• A doctor has the right to refuse sterilisation if he or she believes it is not in the best interests of the patient