Dear Dr. G,

In conjunction with the theme of contraception this month, I am hoping to put Dr. G

on the spot about the conundrum in my life.

Both my wife and I are happily married in our late thirties and have two beautiful kids. We both agree that we have completed our family.

However, we cannot agree on who to shoulder the responsibility for sterilization; we went to a doctor for an opinion, which I reckon was biased as she only highlighted the drawbacks for women to undergo surgery to tie the tubes as this must be done under general anesthesia and this comes with higher risks.

I accept doing a vasectomy under local anesthesia is generally straightforward, but I cannot accept that the procedure itself is completely risk free.

I read somewhere the failure rate of vasectomy is also high, as many report pregnancies despite the snip.

The battle of the sexes in sterilization is ongoing and we are putting Dr. G on the spot to compare the risks and benefits.

First, can you explain what female tubal ligation is and why it is risky?

Can you also enlighten us about the vasectomy procedure and why is it risk-free?

Are both procedures effective contraception? What is the long-term failure rate and are they both reversible?

What is the longest interval of failure after the snip? Hope to hear from you soon.

Yours truly,

Sterilisation Steven

Sterilisation is a surgical procedure that permanently prevents an individual from reproducing. The two most common methods of sterilisation are male sterilisation (vasectomy) and female sterilisation (tubal ligation). While tubal ligation remains the most common form of permanent contraception, more men are coming forward to share the responsibility of sterilization with a vasectomy.

While both methods are effective in preventing pregnancy, they differ in their invasiveness, effectiveness, reversibility and recovery time.

Male sterilisation is a relatively simple procedure that involves cutting or blocking the vas deferens, the tube that carries sperm from the testicles to the urethra. The procedure is usually performed under local anaesthesia and can be completed in around 20 minutes. The recovery time is usually quick, with most men able to resume their normal activities within a few days. A vasectomy is highly effective, with a success rate of over 99%, and it does not affect male hormones or sexual function.

In the procedure the vas deferens of both testicles are segmentally cut and tied to prevent the flow of sperm mixing with the seminal fluid. As most of the ejaculated semen is derived from the secretions of the prostate, the snip will result in a “normal” ejaculation, without any alteration to the climatic sensation, amount, color, odour, or texture of the semen.

On the other hand, female sterilisation involves blocking or cutting the fallopian tubes, which prevent the egg from travelling from the ovary to the uterus. This procedure can be performed laparoscopically or through a small incision near the navel. The recovery time is longer than male sterilisation, as women may experience discomfort and swelling for several days after the procedure. Female sterilisation is also very effective, with a success rate of over 99%. However, tubal ligation is more invasive than vasectomy, and there is a small risk of complications such as infection, bleeding, or damage to nearby organs. The most complicated issue that can arise is damage to the urethra as it is crucial for urine delivery.

Which modality of sterilization is superior ultimately depends on the individual’s preferences and circumstances. Male sterilisation is less invasive, has a quicker recovery time, and does not affect sexual function, making it a preferable option for many men. On the other hand, female sterilisation may be a better choice for women who need surgery for other reasons, such as a caesarean section or hysterectomy as the procedure can be performed at the same time.

Additionally, female sterilisation is a more permanent solution since vasectomy can often be reversed, while tubal ligation is generally considered irreversible.

Although the failure rate of tubal ligation is exceedingly rare, the late failure of vasectomy is also uncommon. This is generally related to postoperative infections, abscess and the removal of a short segment of the vas deferens. The Royal College of Obstetricians and Gynecologists states that the vasectomy failure rate in the late stages is about one in 2000 vasectomies. This is based on one review in 2005 revealing a total failure rate of 183 out of a total of 43,642 vasectomies (0.4%). Another publication reported that sixty pregnancies were also reported after a review of 92,184 vasectomies, which translates to a total failure rate of 0.07%.

As such, the vasectomy is a mode of sterilization that is easily performed and has virtually no long-term impact on the sexual pleasure of men, and the acceptance of such contraception is gaining popularity amongst men who will not have more children. In North America and European countries, vasectomy acceptance is around 10%. Even in conservative Asian countries like South Korea, the vasectomy rate is reported to be as high as 21% as a form of permanent contraception. Worldwide, New Zealand has the highest levels of vasectomy at 25% of all married men.

With so many men putting their trust in vasectomy as a mode through which to enjoy the pleasure of unprotected sex without pregnancy as a consequence, Dr. G is often perplexed why he is still put on the spot to justify this modality of sterilization. With a success rate of more than 99%, there is really no excuse for the 1% who are running away from a vasectomy.

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