Three years after they got married, Alexandra Paul and her husband, Ian, wanted better birth control. Paul was fed up with side effects of the pill, so she switched to a diaphragm. But when contraceptive jelly gave her infections, she avoided using it. That put a crimp in their lovemaking. "Not having birth control in every night limited our spontaneity," she says.
They knew they didn't want kids, so they decided to go for a permanent type of birth control -- sterilization. But for whom -- him or her? Ian appreciated how Alexandra had always taken care of birth control, and he felt like it was his turn. So he had a vasectomy.
Years later, the Los Angeles couple couldn't be happier. "We have never regretted our decision," Paul says. "Sex anywhere, anytime, without worry about pregnancy. And no more birth control chemicals."
If you're sure you don't want kids, or you have children but don't want more, permanent birth control may be for you. Your doctor can help you explore the options. Learn as much as you can about how it's done and what to expect so you can make your decision with confidence.
For Him: Vasectomy
This method blocks sperm from moving into your semen. Many couples choose it because it works. Vasectomies have a 99% success rate in preventing pregnancy.
It's also simple and safe. You can do it in a doctor's office and it only takes 15-30 minutes. The risks, like infection and bleeding, are low.
What to Expect
First, a doctor numbs your scrotum with a local anesthetic so you won't feel any pain. He makes a small opening in your skin, and then blocks or removes a tube called the vas deferens, which keeps sperm from getting into your semen. Without sperm, there's no way your partner will get pregnant. "Snip, tie, done," Paul says.
Recovery is quick. You may not need stitches, but if you do, they'll dissolve on their own. You may have discomfort or swelling for a few days. Icing the area can help. You'll probably be back at work and your usual routine in 2 days.
"Men will have normal erections and ejaculate after vasectomy," says Grace Shih, MD, acting assistant professor at University of Washington's department of family medicine. The only difference is you won't have any sperm. "Post-vasectomy, you get all juice, no seeds."
Your lovemaking may actually get a boost. "Our sex life became even less inhibited when we didn't have to think about birth control," Paul says.
There are a couple of things to keep in mind. First, it takes time for sperm to leave your system. You'll need backup birth control for about 10 weeks or 20 ejaculations.
Also, there's a steep price for changing your mind once it's done. "While some men will have successful reversals, it is costly (and also not covered by insurance) and not reliably reversed," Shih says. And the procedure to undo a vasectomy is much more intensive. It's done in a hospital and takes hours.
For Her: Tubal Ligation
In this procedure, a surgeon closes off your fallopian tubes, which carry eggs from your ovaries to your uterus. Your doctor calls it tubal ligation, but your friends may simply say "getting your tubes tied."
It works and it's safe, but there are some risks, like bleeding, infection, damage to other organs, side effects from anesthesia, and ectopic pregnancy -- when a fertilized egg stays in your fallopian tube.
On the other hand, new research suggests that removing your fallopian tubes may lower your risk of ovarian cancer.
Tubal ligation is usually done in a hospital or clinic and takes about 30 minutes. You'll probably go home the same day. Some women have it done when they deliver their last baby via C-section, while they're already being operated on.
What to Expect
First, your doctor puts you to sleep with general anesthesia, so you won't feel anything while it's done.
Next, she makes one or two tiny cuts near your belly button and puts a narrow tube with a light and camera into your belly. Then she uses long, thin instruments to grab your fallopian tubes and cut, tie, clamp, band, or seal them off. She closes the cuts with one or two stitches.
You may feel some discomfort. Pain medication can help. You can go home a few hours later and will be back to normal activities in a few days.
Other than preventing pregnancy, getting your tubes tied won't change much. Sex won't feel different.
You'll still get your period every month. Although some women say their periods changed, Dana Stone, MD, an OB/GYN at Lakeside Women's Hospital, says that's a myth. If your periods become irregular or crampier, it's because you're no longer pregnant, breastfeeding, or on birth control.
"You're not disrupting the hormones," she says. "All you've done is disrupt the pathway for the egg and sperm to meet."
For Her: Tubal Sterilization
Hysteroscopic sterilization is an option with a product called Essure. Your doctor puts a tiny, spring-like device into your fallopian tubes, which forms scar tissue to permanently plug your tubes. It only takes about 15 minutes. Instead of making a cut, your doctor inserts it through your vagina.
You may get cramping, pain, bleeding, spotting or changes in your monthly period. Some women have complications with the coils or even an allergic reaction to them and end up having surgery to remove them. If you have concerns, talk to your doctor or nurse about them before having a hysteroscopic sterilization.
The procedure is more than 99% effective, but not right away. The scars need time to form, so plan on using backup protection for about 3 months.
Making a Decision
Which birth control is best for you? It's a personal choice.
Paul says they went with vasectomy because it was a simpler procedure with fewer risks.
In the end, it may be the final result that matters most. But you've got to be 100% positive that you don't want to have kids in the future before you make your decision.