Battle of the sexes in sterilisation

Dear Dr G,

I hope to put Dr G on the spot to mediate our dilemma in deciding who should take on sterilisation as the final chapter of our family planning. My wife and I are in our early forties and blessed with two teenage kids.

Recently, we had a scare when my wife thought she was pregnant as her period was late. This prompted us to take contraception more seriously.

We both agree we have completed our family, but we cannot agree on who should take responsibility for sterilisation. I understand that having a vasectomy under local anaesthesia is generally straightforward; however, I cannot accept that the procedure is completely risk-free. I read somewhere that the failure rate of vasectomy is also high, with many reports of pregnancies despite the snip. The gender battle of sterilisation is ongoing, so we are putting Dr G on the spot to debate the risks and benefits.

Firstly, can you tell me how long vasectomies have been around, and is the procedure really risk-free? What are the long-term complications associated with both forms of sterilisation, and what is the failure rate?

Are they both reversible? What is the longest interval of failure after the snip? Surely that has shaken and stirred a stable relationship. I understand I will eventually be volunteered for a vasectomy anyway. I just would like to have my last plea before the snip.

Yours truly,

Vasectomy Vince

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, increasingly more men are sharing the responsibility with vasectomy. Both tubal ligations and vasectomy are effective in preventing pregnancy, but they differ in terms of 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. Vasectomy was first explored in the late 1800s.

Initial procedures were not for contraception but for therapeutic purposes, such as treating prostate disease or testicular disorders. In 1899, an American physician used vasectomy on prisoners in Indiana to control what he considered "undesirable" reproduction—a practice tied to the eugenics movement. It was used to forcibly sterilise people deemed "unfit" to reproduce. Over 60,000 people were sterilised under U.S. state laws before such practices were largely outlawed post-WWII.

By the 1950s and 1960s, vasectomy began to be used voluntarily for birth control, especially as family planning became more socially acceptable. The procedure gained popularity in countries with population control policies.

A modern vasectomy is 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.

Generally, a vasectomy is highly effective, with a success rate of over 99%, and it does not affect male hormones or sexual function. The vas deferens on 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 secretion in the prostate, the snip will result in a "normal" ejaculation, without altering the climatic sensation, amount, colour, odour, or texture of the semen, despite having no active sperm within the ejaculate.

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. There are small risks of complications, such as infection, bleeding, or damage to nearby organs, such as the ureter.

The failure rate of tubal ligation is exceedingly rare, and the late failure rate of a vasectomy is also uncommon. This is generally related to post-op infections, abscesses, and the short segment of vas that was removed. The Royal College of Obstetricians and Gynaecologists states vasectomy failure rates in the late stages are about one in 2,000 vasectomies. This is based on one review in 2005 revealing total failure rates of 183 from 43,642 vasectomies (0.4%). Another publication reported sixty pregnancies after a review of 92,184 vasectomies, which translates to a total failure rate of 0.07%.

Which modality of sterilisation 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.

Female sterilisation, on the other hand, 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 a vasectomy can often be reversed, while tubal ligation is generally considered irreversible.

The vasectomy is a mode of sterilisation that is easily performed and has virtually no long-term impact on sexual pleasure in men. 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%.

With so many men trusting in a vasectomy as a mode to enjoy the pleasure of unprotected sex with minimal complications, Dr G is often perplexed as to why he is still put on the spot to mediate the battle of the sexes in sterilisation.

With a success rate of more than 99%, there is really no excuse for the 1% running away from vasectomy!