Part three of this series discusses the surgical methods of birth control as well as other methods, including withdrawal, breastfeeding, and rhythm. Part one discusses barrier methods and part two discusses hormonal methods.
Surgical and Other Methods:
The most widely used surgical methods include vasectomy for men and tubal ligation for women. These methods are considered to be irreversible and should only be used if you are certain you do not want children. Although vasectomies can be reversed in some cases, the longer the period between the vasectomy and the vasovasostomy (reversal surgery), the less likely the male will be able to produce viable sperm. Pregnancy rate after this reversal surgery is about 50% (Matthews, et al., 1997).
A vasectomy can be done in a doctor’s office, usually an urologist, with local anesthetic. The procedure doesn’t take very long and costs considerably less than female sterilization methods and less than the price of most hormonal methods taken over a productive female’s lifetime. This surgery cuts and closes the vas deferens, which is the duct that carries sperm from the testicles to the penis. This means that after a vasectomy, there will be no sperm in the ejaculate fluid. The release of testosterone will continue as normal.
A tubal ligation is more invasive than a vasectomy and costs more, but is also 100% effective in preventing pregnancy long term. A small incision is made in the woman’s abdomen and an instrument called a laparoscope is inserted and used to find the fallopian tubes. The ends of the tubes are usually cauterized, cut, or tied to block the egg from descending into the fallopian tubes. This also blocks sperm from reaching eggs. Menstruation and the release of estrogen will continue as usual until menopause.
After these surgeries, men and women can enjoy sex without the worry of pregnancy, although condoms should still be used to protect against STDs.
Other methods that do not fit into these categories include withdrawal, rhythm, and breastfeeding. The withdrawal method tends to be used frequently by young people and those who have religious or cultural boundaries regarding using other birth control methods. Withdrawal can be effective if used correctly every single time. This method does have a 30% or higher chance of unintended pregnancy, however. Problems with this method include the male not pulling out before he actually ejaculates and there being sperm in the pre-ejaculate (pre-cum) fluid that may be used for lubrication or go unnoticed entirely. Also, without any barriers of any kind, this method DOES NOT protect against transferring a sexually transmitted disease or infection (STD/STI – including HIV/AIDS).
Rhythm methods, including using a calendar, taking basal temperature, and measuring cervical mucous, are about 80% effective when used alone as a means of stopping unwanted pregnancy. It is highly recommended that condoms be used when engaging in sex during fertile days.
Women who have recently given birth may also feel that nursing reduces the likelihood of pregnancy. Nursing does result in amenorrhea, or lack of menstruation, but this does not stop ovulation. In fact it is likely that the longer a women breastfeeds, the more likely she is to ovulate (Kennedy & Trussell, 1998). Since there is no way of knowing when ovulation will begin again, breastfeeding is not a very effective method of birth control.
Hopefully this will give you enough information to help you decide which methods are best for you. Please consult your gynecologist or urologist about surgical or hormonal methods to determine what your individual risks may be. It is highly recommended that if you are going to use a method of birth control, use several. Combining methods decreases your chance of unwanted pregnancy significantly when used correctly. And, condoms pull double duty, protecting against unwanted pregnancy and STDs.
Some information provided in this article comes from the textbook Our Sexuality, by Robert Crooks and Karla Baur.
Comments
Just to clarify, if you use 2 birth control techniques at the same time, don't use 2 that can't combine. For instance male condom plus female condom will actually reduce efficiency.
Re vasectomies. My husband was nervous about this option because he knew a guy who'd "ripped his stitch". However, that was because the guy was SO comfortable after the surgery that he ignored instructions and engaged in physical activity right afterward. Anyway my husband did finally get a vasectomy and he says it's one of the best decisions he made in his life. :)
Comments you have not discussed the standard of care the "Essure procedure" it takes 10 minutes and is done in your doctors office. This has replaced tubal ligation as a safer more effective procedure for women.
Nina -- I am currently researching this technique and will be including a follow-up article. Thank you!
Lori -- Many thanks for your clarification. :)
Very inaccurate info re breatfeeding as a contraceptive: breastfeeding is the most effective and popular contraceptive world wide. I invite you to look at Sheila Kippley's work on ecological breastfeeding/ Natural Child Spacing.
It works: I am an 'ecological' breastfeeder and I have not had a period since October 2004; my first baby was born in Aug 2005 and #2 Jan 2008 (I ovulated once, obviously!). Still no period!
Katie -- Breastfeeding may be popular but is not the most effective method according to scientific research. You are quite lucky that you have not become pregnant while actively breast feeding. Many women, however, find that they become pregnant in less than a year since their last child if they are only using breast feeding as a method of birth control. And, it does not protect against STDs.
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