What Are My Options For Permanent Birth Control? ASK AN OBGYN

Dear SuzyKnew!, I’m 35 years old and am ready to go from “temp-to-perm” with my birth control. But, the recent reports on some of these methods can really scare a Sista’.  Please give me the lo-down on different permanent birth control methods!


Dear Reader,

There are several options for permanent birth control.  First, let’s talk about the  “permanent” part.   According to a review article on the subject, between 2% and 20% percent of women regret their decision to undergo sterilization- which is permanent. The younger a woman is when she has a sterilization procedure, the more likely she is to regret that decision. Relationship problems at the time of the procedure, stress due to recent pregnancy complications, and being in a new relationship after sterilization can contribute to regret.  So, you really need to be sure this is the right move for you.  In the U.S., spousal consent is not required, but I would encourage you to discuss this as a couple, if in fact, you are in a long-term relationship.

The second word I will focus on is “birth control”, because sterilization is just that- it will stop you from getting pregnant.  You will still need to consider how you will protect yourself from sexually transmitted infections, such as herpes, gonorrhea, and HIV.  For protection from STIs, the condom is still the best bet.

If you are not ready for sterilization, but are looking to get away from years of condom or pill use, there are some long-acting birth control methods to consider, such as the IUD (which can last up to 10 years) and the implant (which can last up to three years).  Both methods are highly effective and are reversible. Click here for a great description of both methods from the American College of OBGYNs.

If you do chose to go permanent, you are among the 345,000 American women who choose this every year.  In fact, sterilization is the second most common birth control method used in the U.S.  Your choice of Permanent Methods are tubal ligation, the Essure coil, and hysterectomy.   And let’s not forget that men can pay to play and have a vasectomy.

Tubal Ligation-   The most common surgical sterilization procedure for women is called a tubal ligation.  You may have heard women say they have had their “tubes tied”.  In a tubal ligation, the fallopian tubes are cut or sealed in order to prevent an egg from traveling from the ovaries to the uterus.  If this passage is blocked, the egg and sperm cannot meet up, thus preventing a pregnancy.  Tubal ligation is a surgery done under anesthesia.  It can be done after childbirth in the hospital or at other times, generally as an outpatient procedure.  This surgery typically uses laparoscopic technique, and is considered minimally invasive.

Essure- In 2002,  Essure came on the market as a less invasive alternative to tubal ligation. The Essure device is a small coil placed into each fallopian tube to prevent fertilization.  The device offers some advantages over the other permanent methods and as a result has been very popular.  Among the advantages: it can be implanted in a doctor’s office much like an IUD insertion; it is not a surgery and there are no incisions or abdominal entry, like the tubal ligation; and there is no need for general anesthesia.

However, there is a cautionary note about Essure.  As recently as this month, the FDA conducted a review panel of the device in response to adverse events, patient complaints and reviews of the initial clinical studies that brought the device to market.  Awaiting a full review, the FDA has recommended the following:  1) the manufacturer should create a registry of patients to better track adverse events; 2) doctors should carefully select patients and those that have an allergy to nickel, chronic pelvic pain or prior uterine surgery are not good candidates; 3) there should be more enhanced patient counseling about the potential risks and benefits; and 4) more doctors need to be trained in the use of the device, particularly in device removal.

Hysterectomy- This is the removal of the uterus, and is considered major surgery. With new methods such as tubal ligation and Essure, the hysterectomy is no longer used for sterilization.  If the ovaries are removed during a hysterectomy, you will be looking at hormone replacement therapy as well.  A hysterectomy may help chronic medical problems such as uterine fibroids, excessive menstrual bleeding, or certain cancers, but should not be used as contraception.

Vasectomy- A vasectomy is male birth control method.  Each year in the U.S., about 500,000 men get a vasectomy, with higher rates among more educated and higher-income men.  It’s a minor surgery done in the doctor’s office, while the man is awake.  Similar to tubal ligation in women, in a vasectomy, a man’s tubes are tied.  His tubes, the vas deferens, carry sperm into the semen.  They are cut apart and then tied off or cauterized (burned or seared).  A man will continue to ejaculate, but it will only carry semen, without the sperm.  There are two website I will share for information about this low risk birth control option- Planned Parenthood has a great site with videos; and WebMD also has a very clear description of the procedure.

I hope that this helps you as you weigh your options.

Take Care.

Ask your intimate question to ASK AN OBGYN. Email: SuzyKnew@suzyknew.com