Remote Primary Health Care Manuals

Permanent contraception

Sterilisation does not protect against sexually transmitted infections (STIs)

Female sterilisation

99.5% effective

What

  • Tubal ligation — applying clips or cutting/tying/cauterising tubes
  • Tubal occlusion — blocking tubes with metal spring
    • Not commonly available — medical/specialist consult
  • Salpingectomy — removal of the fallopian tubes
    • Requires gynaecologist consult 

How it works — prevents egg reaching uterus/sperm and beginning a pregnancy. Periods continue

Timing

  • Considered permanent (although there is a risk of failure with tubal ligation)
  • Effective immediately but need reliable contraception right up to the time of the procedure

Operation

  • Tubal ligation done by specialist in hospital under general anaesthetic
    • Day surgery — laparoscopy (2–3 small incisions on the abdomen)
    • If very overweight — laparotomy (single longer cut on the abdomen), longer hospital stay
    • During caesarean section
  • Tubal occlusion done by hysteroscopy

Reversal — not widely available, specialist consultation to determine suitability, significant cost, requires further surgery, IVF may be recommended due to partner factors, reversal not an option if salpingectomy is done

Complications of operation — rare. Include anaesthetic risk, bleeding, infection, damage to adjacent structures

Preparation — negative pregnancy test, cervical screening, STI check up to date

Special issues

Talk about

Considered to be permanent form of contraception — reversal may not be available and should not be relied upon — may need more than one discussion. 
Remember: LARC are as effective as female sterilisation, especially ENG-implant and IUD and is reversible

  • Does not stop or affect menstruation
  • Good option for women unable to use or tolerate hormonal medicine
  • Failures can happen even many years after the procedure — if pregnancy occurs after sterilisation there is an increased chance of having ectopic pregnancy (pregnancy outside the uterus) — can cause dangerous internal bleeding
  • How she might feel later if a child died or she had a new partner
  • Regret is higher in women who
    • Are younger (under 30 years)
    • Have no children
    • Are having an abortion or caesarean operation
    • Are having relationship difficulties

Male sterilisation

99.98% effective. Easiest and most effective sterilisation method

What — vasectomy. Cutting, clipping and/or cauterising the vas deferens (sperm tube)

How it works — prevents sperm reaching the vas deferens

Timing

  • Considered permanent
  • Takes at least 3 months (20 ejaculations) to clear supply of sperm. Effective contraception needed until then

Operation — simple, done by doctor/specialist under local anaesthetic

Reversal — expensive (thousands of dollars) and may not be successful

Complications — rare. Include bleeding, infection, swelling. Discomfort and bruising pain-relief, ice pack and wearing supporting underwear

Positives

  • Does not affect sex drive, erections or cum
  • No long-term health issues

Preparation — STI check up to date

Special issues

Talk about

  • This is permanent — may need several discussions
  • How he might feel later if a child died or he had a new partner