Contraceptive methods: permanent and reversible

Reversible methods

Among couples who want children in the future or who are not clear about what their wishes will be in the future, several reversible contraceptive methods, that is to say, that once they are removed, they allow fertility to be restored.

• The most used is the condom.
• Among the hormonal methods: we find the contraceptive pill, the patch, the vaginal ring or the subdermal implant.
• The intrauterine device is another reversible contraceptive method, since both the copper IUD and the one with hormones once removed restore normal fertility.

Totally definitive methods

Before doing a sterilization (or definitive method) you must be absolutely convinced that you do not want children in the future. Definitive sterilization is always a surgical method, which consists of sectioning or sealing the tubes that carry sperm or eggs. Currently there are tthree options:

1. Tubal ligation

Tubal ligation consists of the section o sthe side of the fallopian tubes in a way that prevents the arrival of sperm to the egg. The most common currently is to perform it laparoscopically, that is, by insufflating air into the abdominal cavity for a correct visualization of the internal organs, placing a small camera through an incision under the navel and one or two forceps through both holes a little above the pubis. With these instruments, a pair of small staples that collapse the fallopian tube or perform a small burn and subsequent section of the tubes that also renders them useless.

The intervention requires general anesthesia and lasts approximately between 15 and 30 minutes and it usually requires 12-24 hours of hospital admission plus 5-7 days of home recovery. Sometimes it is performed at the time of a cesarean section taking advantage of the surgical intervention or more rarely in a postpartum period.

This method has the advantage of having a almost 100% efficiency, be immediate and not be hormonal, so it does not produce cycle disorders. The drawbacks are the necessary general anesthesia and hospital stay, subsequent recovery, which, although not usually complicated, is recommended.

In the event that the woman later decided to have a child you could undergo in vitro fertilization, but from the outset it should not be carried out in women who are hesitant about later maternity.

2. Vasectomy

Vasectomy consists of the obstruction of the vas deferens, which are the tubes that carry sperm to the seminal vesicles to be expelled during ejaculation. The intervention is carried out with Local anesthesia, making a small incision in the skin of the scrotum and cauterizing and cutting the vas deferens.

The duration of the intervention is about 15 minutes approximately and the patient is sent home without requiring admission to the hospital. It is recommended to wear tight underwear or a jockstrap after a few days to avoid discomfort.

The advantage of this technique over tubal ligation is the simplicity of the technique and the use of local anesthesia instead of general without the need for hospital admission. The downside is that the contraceptive effect it is not immediate and a subsequent control is required to verify the disappearance of sperm in the ejaculate.

If the man decides to reestablish fertility, in some cases reoperation is possible, but it is not always achieved, depending mainly on the time elapsed since sterilization.

3. Essure

The Essure device is a dock composed of titanium and steel, about 4 cm in length, which is placed inside the fallopian tubes to render them useless. The placement is done by hysteroscopy, with a small camera that is inserted through the vagina and cervix. A spring is inserted into each tube and it expands.

Is a outpatient intervention and the patient can go home the same day of placement. This device not effective immediately since it requires a fibrosis reaction to occur that will block the passage of sperm through the tubes. After about three months of installation, it is checked that the springs are correctly positioned.

It is a method absolutely irreversible since the springs cannot be removed and would be a risk factor in case of pregnancy.

• Three options: tubal ligation, Essure device, and vasectomy.
• They are: surgical methods that cut or seal the tubes that carry sperm or eggs.
• Be clear about it: before performing a definitive sterilization you must be absolutely convinced that you do not want (more) children in the future.

Specialist in gynecology and obstetrics