There are a number of procedures that can sterilize one of the partners in a marriage. Some are done in a clinic in a matter of minutes, others require major surgery. In general, permanent methods of birth control (i.e. sterilization) are highly effective, with a failure rate well below 1%. 

VASECTOMY

For men, a vasectomy cuts the tube that supplies sperm from the testicles to the urethra (vas deferens). However, a vasectomy isn’t considered effective right away, since there can still be sperm elsewhere in the reproductive tract. A back-up method should be used until a semen analysis confirms you’re “shooting blanks.” 

Over 90% of semen volume comes from glands in the male reproductive tract that are not disconnected by a vasectomy. After the procedure, semen will have no sperm and a slightly lower volume, but otherwise semen will be unchanged.

The procedure itself is typically performed in a clinic. The doctor injects freezing to numb the area then makes a small incision to get at the vas deferens. After the tube is cut and the ends sealed shut, the incision is closed with bandages or stitches. Serious complications are rare. 

TUBAL LIGATION

For women, a tubal ligation cuts the fallopian tube, which blocks an egg from reaching the uterus (and sperm from reaching the ovaries). This can be done with a “keyhole” surgery (1) or during a C-section. Clips are applied around the fallopian tube to block it, or a section of it is simply removed with both ends tied off.

Vasectomy and tubal ligation are both reasonably safe procedures. However, because a vasectomy can be done in a clinic without needing to put the man to sleep, it’s considered the safest surgical sterilization procedure. 

These procedures are considered permanent, so if there’s any doubt you want to have more kids, surgical contraception isn’t a good choice for you. In some cases, they can be reversed with another surgery, but this is often unsuccessful to restore fertility. Also, the reverse procedure usually isn’t covered by healthcare plans and can be very expensive.

As with any surgery, complications include bleeding, infection, damage to surrounding structures, and chronic pain. However, long term problems are rare. 

Sterilization is the most common method of birth control worldwide, second only to The Pill.

HYSTERECTOMY

The only 100% effective surgical method of birth control is removal of the uterus (hysterectomy). Without a uterus, the vaginal canal is essentially a dead end – it’s still functional for intercourse, but there will be no periods and nowhere for sperm to go. 

Hysterectomy is never reversible. The only way to have a baby without a uterus is in vitro fertilization with a surrogate mother.

Hysterectomy is a major surgery with significant associated risks. It’s generally not used to prevent pregnancy but to treat various gynecological conditions.

FOOTNOTES

(1) Laparoscopy (“keyhole” surgery) is when a few small incisions are made in the abdomen, which is then inflated. The whole surgery is performed with a camera and tools inserted through the keyholes. The recovery is faster and easier than a laparotomy (making a larger “old-school” incision).