RESEARCH TRIANGLE PARK, NC -- Compared with other contraceptive options, male and female sterilizations are highly effective and convenient.
Yet while female sterilization is the most popular contraceptive method, both worldwide and in the United States, male sterilization (vasectomy) is widely available in only a few countries, primarily in North America, parts of Asia and the United Kingdom. Unfounded fears or incorrect beliefs about vasectomy may limit its use even in countries where it is readily available, like the United States, experts say in the fall 1997 issue of Network, a reproductive health bulletin prepared by Family Health International.
Some people believe incorrectly that vasectomy may affect a man's sexual performance, but vasectomy does not affect male hormones that control sex drive or masculine features, such as facial hair or muscle tone.
Other male and female sterilization topics in the issue include the following:
While most men and women who become sterilized are satisfied with this permanent contraceptive method, some eventually will regret their decision to end fertility. Thorough counseling can help people to choose the best method for their circumstances, thereby reducing rates of regret among those who choose sterilization. "You can identify clients who are more likely to experience regret before doing the procedure," says Dr. Ellen Elizabeth Hardy of Brazil, who is studying the impact of sterilization on women's lives as part of an FHI project. "The most important variable is age."
According to a 1994 FHI review of 21 studies examining regret among women who were sterilized, regret is higher among those women who had the procedure when they were young (under age 30). Allowing others to make the decision, such as a husband or other family members; being sterilized immediately after giving birth; a new marriage; and death of a child are also frequently mentioned as factors in the studies, which were done in the United States and 10 other countries between 1986 and 1992.
Men who choose sterilization (vasectomy) should understand that it takes weeks to become effective, since sperm remain within a man's reproductive tract long after the procedure. Men are often advised to use another method, such as condoms, for 12 weeks after being vasectomized. However, recent small studies suggest that it may take longer for some men to achieve low enough sperm counts to have dependable sterilization. Research is needed to clarify such concerns, experts say.
In addition to being exceptionally effective methods, male and female sterilization have few side effects and do not require any additional steps by the user to maintain contraception, such as taking daily pills (as oral contraceptives require), obtaining shots (injectables) or using of barrier methods (such as condoms, diaphragms or spermicides) correctly and consistently. Vasectomy is safer and easier to perform than female sterilization, which is itself a very safe and relatively easy procedure to perform. Both are typically done with local anesthesia, and injuries during the surgeries are rare.
In an article about contraception for older men and women, sterilization is described as an excellent option. In general, women who are approaching menopause have a larger range of methods suitable for their needs, compared with the number of method choices available for younger women. They are more likely to consider a permanent option like sterilization, for example. However, because a woman's fecundity declines with age, an older woman may prefer methods that she avoided in her younger years because of their higher failure rates, such as condoms and other barrier methods.
While female sterilization is considered highly effective, recent research in the United States shows that rare failures can occur years later. Scientists once thought that the risk of pregnancy virtually disappeared within a year or two after sterilization, but a study by the U.S. Centers for Disease Control and Prevention shows that the risk continues for years. When sterilized women do get pregnant, there is a high risk that pregnancies may be ectopic. Sterilized women who suspect they have become pregnant should seek medical attention promptly, since an ectopic pregnancy can be fatal.
