Permanent Birth Control: Understanding Your Options

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When women have decided they are "done" having children, they need to understand their options for permanent birth control. Permanent birth control is the second most common form of birth control in the United States, according to the Centers for Disease Control and Prevention (CDC), but a recent survey conducted by Harris Interactive on behalf of HealthyWomen found that a majority of women aren't aware of all their options for permanent birth control. And, most women surveyed hadn't discussed the topic with their OB/GYN.

Why women choose permanent birth control
According to the survey, women find many benefits of permanent birth control. These include never having to worry about an unplanned pregnancy, the ability to have sex when and where you want, not having to take hormones and the overall ease it brings.

The survey cited effectiveness in preventing pregnancy as one of the most important factors when considering permanent birth control. Permanent birth control procedures range between 98 and 99.8 percent effective, depending on the method. Permanent birth control is more effective than most temporary methods of birth control, particularly barrier methods such as the condom and diaphragm.

Talk to your health care professional about permanent birth control
Determining whether or not you're ready for permanent birth control is an important decision. While a majority of the women surveyed who are interested in permanent birth control have talked to their partner about it, less than a quarter of women have discussed the topic with their health care professional.

Here are some tips for talking to your health care professional:

1. While booking your appointment, let them know that you would like to talk about your permanent birth control options so that you have ample time for that discussion.
2. Bring a checklist of questions to your appointment to help guide the conversation.
3. Let your health care professional know what is most important to you when looking at your options.
4. Take notes.
5. If you don't understand your doctor's responses, keep asking questions until you do.
6. Ask your doctor to write down information or give you printed materials that you can take home.

Is permanent birth control a good option for me?
Your readiness for permanent birth control will depend a lot on your life circumstances. Here are some questions to ask when contemplating this option:

• Am I done having children?
• Do I want a permanent method of birth control?
• Am I happy with my current form of birth control and its effectiveness?
• Do I constantly worry about having an undesired pregnancy?
• Am I comfortable using hormonal birth control?
• Would I like a type of birth control that I don't have to worry about anymore?
• Is my partner sure that he does not want a pregnancy in the future?
• Am I considering this just because my partner wants it?
• If my circumstances change, such as my marital status, is there a chance I may want to get pregnant?
• Do I have medical issues that may make pregnancy unsafe?
• Have I discussed all my options with my health care provider?

How do you know you're done?
Women consider many factors when making a decision about whether they are done having children. Age is the most commonly cited factor that goes into the decision, followed by financial situation and having the number of children they wanted. What's more, the majority of the women surveyed expressed satisfaction, happiness or relief with their decision to be done. Only a small percentage (9 percent) felt regret, often attributed to a change in their life circumstances. Therefore, it's important to consider what's happening in your life at the time of your decision. Times when you may choose to delay your decision about permanent birth control could include the following:

• If you are young. You may decide you would like to have children in the future. Permanent birth control is just that—permanent—and cannot always be reversed.
• If you are recently divorced or in an unstable marriage. Avoid making such a big decision during this or any other very stressful time.
• If your life circumstances are changing. The most common factor associated with regret is a change in marital status.
• Immediately postpartum. During this time, you could be feeling a lot of different things that may change a few months down the line.

If you are having difficulties making up your mind, consider going for counseling, either alone or with your partner. Talking about your concerns can help.

I'm ready—what are my options?
If you've made a decision to pursue permanent birth control, it's important to learn about the various surgical and nonsurgical procedures available to you or your partner. Though most women surveyed by HealthyWomen are familiar with tubal ligation (also known as "getting your tubes tied") and vasectomy, only 12 percent have heard of permanent birth control that does not involve surgery. It's time to become aware of all your permanent options:

For you:
Permanent options for females, work by closing a woman's fallopian tubes by blocking, tying or cutting them so an egg cannot travel to the uterus. There are two primary forms of permanent birth control for females:

Nonsurgical permanent birth control (sometimes called fallopian tube occlusion): This procedure involves inserting a small insert in each fallopian tube. A natural barrier forms around the inserts in about three months, blocking the tubes. The procedure can be performed in your doctor's office. No anesthesia is required, though local anesthesia may be used, depending on the procedure and the patient. Backup contraception is required until you have your three-month follow-up appointment to ensure the inserts are in place and the fallopian tubes are blocked.

Tubal ligation (often called "getting your tubes tied"): In this procedure, the fallopian tubes are surgically closed, either by burning or severing and/or blocking with a clip. It is performed under general anesthesia in a hospital and can be done laparoscopically, using a telescope-like device that is inserted through a small incision in the abdomen.

With both forms of permanent birth control, the hormones that control a woman's menstruation and sexuality will not change, therefore your menstrual cycle or your desire for sex will not be affected. Your ovaries will continue to produce eggs; your body absorbs the unfertilized eggs just as it did before the procedure. These procedures will not bring on early menopause.

For him:
Permanent birth control for males is called a vasectomy. This procedure is performed in the doctor's office. The scrotum is numbed with an anesthetic, so the doctor can make a small incision to access the vas deferens, the tubes through which sperm travels from the testicle to the penis. The doctor then seals, ties or cuts the vas deferens. Following a vasectomy, a man continues to ejaculate, but the fluid does not contain sperm. Backup contraception is required until the doctor verifies that sperm are no longer present.

While more than one-third of the women surveyed say their husbands offered to have a vasectomy, many of the women found themselves waiting for the surgery to take place—in many cases, for more than five years.

Talk to your health care provider about what's right for you, and learn more about your options here.