Family planning: Is taking the snip safer than tubal ligation?

Dear Dr G,

Malaysians will soon celebrate the Lunar New Year, and for us, it is the new dawn for our family.

In the year 2019, we are welcoming many things in life.

First of all, my wife will be giving birth to our second child in early February.

I gather the year of the pig is going to bring great prosperity to all of us.

Although being excited with the prospect of a new family member, I also find the whole issue of family planning rather daunting.

In the last visit to the clinic, we were asked about my wife having the tubal ligation at the same time as the caesarean section.

I was rather embarrassed when the doctor asked if I wanted to have the snip, which is a simpler and more straightforward procedure than tubal ligation.

The question is, who should go for the cut?

I am putting Dr G on the spot to find out what are the differences between vasectomy and tubal ligation.

Surely, meddling with the crown jewels in the sac can never be as straightforward as everyone makes out to be.

I am fully aware that I need to be a “new man” in the New Year to share the responsibility of family planning.

I just would like to know the facts, before my “act of heroism”.

Thank you in advance for your advice.

Mr Hero (in the making)

Tubal ligation is a surgical procedure intended for permanent birth control during which a woman’s fallopian tubes are intentionally clamped and sealed, preventing the eggs from reaching the uterus for pregnancy. Tubal ligation as the form of sterilisation constitutes 33% of contraception, making this modality the most common form of birth control.

Compared with vasectomy, tubal ligation is often considered a major surgery, as the patient requires undergoing anesthesia, followed by two incisions below the navel to gain access to the fallopian tubes in the pelvis. A medical review of over 200 articles in 1998 highlighted the evidence of a post-tubal sterilisation syndrome. This is a condition characterised by abnormal pain and bleeding during menses, changes in sexual behaviour and increased premenstrual distress.

The study identifies women aged 20-29, with pre-existing history of menstrual dysfunction, being more at risk. As in June 2010, there is a decline in the uptake of tubal ligation in the United States, possibly due to an improved range of oral contraceptive pills and the awareness of male sterilisation as an alternative modality of sterilisation. Concurrently, slow (but steady) rise of the uptakes of vasectomy has been observed. In fact, in New Zealand, higher levels of vasectomy than tubal ligation were recorded, with 57% of men aged 40-49 undergoing the snip.

Vasectomy is a more straightforward procedure for contraception as the vas deferens is easily accessible from the scrotum. It is typically performed in the doctor’s clinic under local anesthesia, when the tube that delivers the sperm is identified, cut and sealed with minimal complications. Ninety percent of men are reportedly satisfied with having had a vasectomy, while 7-10% of men regret their decision.

Men who are younger at the time of procedure are significantly likely to regret, as men in their 20s being 12.5 times more likely to undergo reversal later in life. In recent years, the emphasis on “shared responsibility” has been taken up in psychological research relating to family planning.

Studies have found that men consider vasectomy as “an act of heroism” of taking responsibility, and such mentality is gaining popularity. Although tubal ligation is a safe operation, vasectomy is just more straightforward.

When Dr G is put on the spot, his advice is: Share the responsibility and take the snip!

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