Getting the snip: Should it be me or my partner?

Sterilization is a big decision. Consider this info when you’re contemplating the procedure.

Done having kids or sure you never want any? If you answer yes, you might be thinking about permanent birth control, also called sterilization. Sterilization can be done for women or men. For women, it is often called “getting your tubes tied” or “tubal ligation.” For men, it is called a vasectomy. Sterilization is a very common type of birth control. In fact, in the United States, sterilization is the most common form of birth control with 23% of all couples relying on it.

If you’re thinking about sterilization, how do you decide who gets it done—you or your partner? To make this decision, you can both consider the safety, effectiveness, reversibility, and cost of each method.

How safe is it?

Both sterilization methods are extremely safe. A small number of people complain after the procedure about a bit of bleeding or a minor local infection; in general, these issues are quickly resolved. Most female sterilization techniques require general anesthesia and surgery with about four stitches. Vasectomy can be done under local anesthesia through an incision so small it sometimes doesn’t even need stitches. Although serious complications are rare, they’re more likely to happen after a female sterilization operation than a vasectomy.

How effective is it?

Both types of sterilization are very effective. A large study called the Collaborative Review of Sterilization (CREST) examined failure rates for female and male sterilization and found that both methods were among the most effective methods of birth control. (There is a slim chance of pregnancy after sterilization—less than 1 in 100.) Health care providers consider both male and female sterilization among the best methods of birth control available.

How much will it cost?

This depends on your health insurance coverage and where you live. Most insurance plans should cover female sterilization with no out-of-pocket costs. If you do have to pay out of pocket, vasectomy is less expensive than female sterilization—usually about one-third as much as a tubal ligation.

Can I get it reversed?

Both vasectomy and tubal ligation should be considered permanent procedures. Having either type of sterilization reversed is expensive (and not usually covered by insurance) and sometimes doesn’t succeed. About half of couples report a successful pregnancy after reversing either type of sterilization, but it depends on lots of factors, including the type of surgery done, your age, and the time since sterilization.

If you’re not really certain that you don’t want (more) kids, you can consider other methods that are safe, highly effective, and can last many years, like the implant or the IUD. Some health care providers hesitate to help young patients who request sterilization, possibly because of the research showing that women under 30 who get tubal ligations are more likely to regret the decision later. This can be frustrating, but if you’re really sure sterilization is the right choice for you, look for a provider who will respect that.

Hers vs. His

How do you decide who gets the snip? Some women think that birth control is a woman’s responsibility or that their partner will not be interested. In the United States, female sterilization is much more common than male sterilization. However, in a study of men who received vasectomy, the most common reasons for men to choose vasectomy were its simplicity and safety. The men also felt it was time for them to take contraceptive responsibility.

So, if you are deciding whether or not to get sterilized, make sure you understand your options and discuss them with your partner! Remember, sterilization is permanent and you should be certain of your decision, whatever you choose.

Written by Grace Shih, MD, MAS

Grace Shih, MD, MAS, is an Assistant Professor at University of Washington. She completed her family medicine residency at Brown University and her family planning fellowship at University of California, San Francisco. When she’s not seeing patients, you can find her cooking, playing guitar, or traveling with her family.

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