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Dear Dr. Vanessa: Tubal Sterilization OR Vasectomy?

Wed, Nov 25, 2009

Advice, What's Up Doc?

hand_scissors_victoryphoto by galateadia

Please help us welcome Dr. Vanessa Cullins into the EMandLO.com fold. She is a board-certified obstetrician/ gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America who will be answering your questions here every few weeks. To ask her your own question, click here.

Dear Dr. Vanessa,

My husband and I are late 30s/early 40s, with two great kids. We don’t want any more, so we’re trying to decide between tubal ligation and a vasectomy. My vote is for the vasectomy — I carried and delivered the kids, so now it’s his turn. Plus, tubal ligation is much more invasive and painful and expensive, from what I’ve heard. Seems like a no-brainer to me, but he’s wary of getting snipped. What do you think?

–Snippy

Dear Snippy,

Deciding who will get sterilized can be a difficult decision requiring serious soul-searching conversations over time.  You are right about vasectomy.  It’s less expensive, complications are extremely rare, and as surgeries go, it is less invasive than tubal sterilization.  I think it is very important that you and your husband continue to talk about what a decision about vasectomy means to you and what it means to him.

It is important that you find out more about his reluctance to have a vasectomy.  He may fear that vasectomy will affect his ability to have or maintain an erection.  Or he may have experienced a time in his past when he experienced scrotal pain that he does not want to run the risk of experiencing again as he recovers from the procedure.  Or he just might not like doctors or going to the doctor or having an operation, no matter what the operation is.  Neither you nor I can guess what is fueling his reluctance.

In the same vein, he may not really realize just how important it is to you that he now take responsibility for preventing pregnancy. These private conversations may take weeks to months to work through. You may even need to consult with a urologist who is experienced in vasectomy and a counselor, so that they can help your husband become more comfortable with how the procedure is done and what recovery is like.  One thing is for sure, neither you nor he should make a decision that leads to lasting resentment and marital discord.

He may come to recognize that his sexual experience will not change after vasectomy — that even his ejaculate will look the same and appear in about the same amounts. This is because most of the fluid in ejaculate is seminal fluid and fluid from the prostate and Cowper’s glands. Flow of this fluid is not interrupted by vasectomy.  Vasectomy just prevents sperm from being in the fluid. Sperm make up only two to five percent of the ejaculate, and that’s too small an amount to be noticed.

Some men have a deep cultural and emotional fear of castration — that their bodies will stop producing testosterone, the hormone that makes a person masculine. Vasectomy is not castration. The hormones that affect masculinity, including beard growth, voice, sex drive, and muscle tone, will still be produced in the testicles and released into the blood where they will still flow throughout his body and do their jobs.

Check out the Planned Parenthood for more information about vasectomy.

Whether you continue to have your discussion about sterilization with one another only or with a urologist or a counselor, it’s very important to understand one another’s point of view.  So be sure that both of you listen carefully and kindly to one another about concerns each of you has.  The decision should not be a contest of who has the strongest will.  Hopefully the process of coming to a decision that feels right to both of you will bring both of you much closer to each other.

Best of luck as you both figure out what is best for your family, and your marriage.

Vanessa
Planned Parenthood

dr_vanessa_cullins

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.

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4 Responses to “Dear Dr. Vanessa: Tubal Sterilization OR Vasectomy?”

  1. M. Ryan Says:

    Last year at 47, single and no children I elected to have a tubal ligation during an exploratory laparoscopy. Had I known then what I know now I would never have opted to have the procedure. While I realize everyone has different outcomes to surgery, it has caused nothing but problems. I had conducted extensive research at the time and found no reason not to proceed. Since then I have learned otherwise. Every man I know that has had a vasectomy, has said that while initially reluctant it was the best thing that they have done.

  2. Aaron Says:

    A family doctor perspective-
    Assuming that his scrotal contents are normal there is no good medical reason to choose tubal ligation over vasectomy. It is safer and more easily reversed should the need arise.
    There are lots of social biases against it, but guys just need to metaphorically “grab their sack”, man up and get snipped.
    Another option you might consider would be an IUD if he is just really freaked out.

  3. Donna Says:

    This choice is a very personal one that you have to make. I elected to have a Tubal instead of my ex-husband getting snipped. It was the best thing for me personlly. I, again, I, made the decision not to have more children. Yes it is easier and cheaper for the man to get snipped, but, I made the choice that I would no longer be able to have more children. I am so happy with my decision. I was married to my childhood sweetheart, we had two great boys, and we decided that we did not want more children. I know that physicall, mentally, and economically, I didn’t want more, so the choice was easy for me to make. I am recently divorced now from the childhood sweetheart and I like the fact that I don’t have to worry about getting pregnant again. My ex, though, does have to worry about it happening to him. Again, my choice worked for me. My surgery was over fairly quickly, I was out of the hospital the same day, and back to life the next. Mine was done 13 years ago and the doctor went through my belly button. No big scar, no sore stomach, no problems.

  4. AJ Says:

    I’m glad to hear that Donna. I’m overly amazed at the “it quick, easy, and safe” for the men, and if they don’t do it they’re simply selfish. Not true. As alluded to, past injuries, very close calls – two in my case made #3 vasectomy simply not ever an option. Luckily it was instant agreement for tied tubes after child 3 for us. 16 years ago and wonderful ever since.
    The “sufficient research” and “no-brainer” really is hogwash re: vasectomy. Because all a man needs is to be in the 5% problem category and for those men it is 100% a problem, such as pain so severe…other options were discussed. And the 95%: Reports have improved and developed over time. Erections are less overall after vasectomies. There’s absolutely no getting around it.
    Simply Google, “vasectomy problems.” The men and women did not invent and desire to have a story to tell. As a result of some latent body responses to a fragile, but a little too routine some days, outpatient surgery, does a couple lose 10 natural erection/sex years? About that. If so, is he selfish not to rush to the blue pill or get seen (common request: “you need to get seen”).
    With all due respect, and I’m certainly not trying to sound like a baby (and if I do, okay) but every trauma to the man’s privates has about 3-4 major repercussions. Every cut and errant or intentional collision has some sort of repercussion. It’s nearly impossible for a woman to be struck (and I’d never want it to be this way, please understand!) where she could be unable to have kids, lose her sexual identity, and not be able to participate in sex all at once.


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