Sterilization: Why Do More Women Than Men Opt for It?

Voluntary sterilization—not the Pill, condoms, or IUD—is the most popular birth control method in the U.S. Among couples using contraception, around 25 percent choose the number two method, birth control pills, and 15 percent the number three method, condoms. But sterilization, at 29 percent, is the top choice.

Compared with women’s sterilization, vasectomy is quicker, cheaper, easier, and less physically traumatic. But each year, more women opt to be sterilized—700,000 women compared to 500,000 men.

Why the Gender Gap?

There are several reasons why women get sterilized more often:

• Women are the ones who get pregnant: As a result, they usually take primary responsibility for birth control. When couples want permanent contraception, women are more likely to have it done.
• Sexism: Contraception is the couple’s responsibility, not just women’s, but many men don’t see it that way.
• Fertility differences: Few women get pregnant after 40, but men can father children throughout older adulthood. If they get divorced or become widowed, older men may marry younger women who may still be fertile and want children. So men often hedge their bets and decide to remain fertile.
• Virility: Many men believe (incorrectly) that inability to father children is emasculating and compromises their manhood.

Whatever the reason, sterilization decisions are life-changing and should never be made impulsively, for example, soon after an unplanned pregnancy, abortion, or difficult delivery. Those who express the greatest long-term satisfaction generally consider their decisions for at least a year and deeply ponder questions most people would rather not consider: What if your relationship ended? Would you want children in your next one? What if your children died? Would you want more?

If you think you can reverse sterilization, think again. Reversals are a roll of the dice. Success cannot be guaranteed. They’re also costly—around $10,000, sometimes more—and health insurers rarely cover them.

Sterilization for Men: Vasectomy

Vasectomy involves a minor, 20-minute office surgical procedure under local anesthesia. Urologists make two tiny incisions in the upper scrotum. They find the two tubes that carry sperm out of the testicles (vas deferens), cut them, and seal their ends. After vasectomy, sperm cannot leave the testicles and semen eventually becomes sterile.

But men are not sterile immediately after vasectomy. Millions of sperm remain in the tubes above the incision sites. It takes about 25 ejaculations to expel them from the body. During that time, couples must use another method. A few months after vasectomy, men return to their urologists for follow-up semen analysis. They masturbate and doctors examine their semen microscopically. When samples are sperm-free, couples no longer need to use contraception.

After vasectomy, men ejaculate normally. Sperm account for only about 2 percent of semen volume, so there’s no noticeable difference.

Urologists perform most vasectomies on Fridays. Over the weekend, men should take it easy—no heavy lifting. Most feel fine by Monday.

Every year, the most popular time for vasectomies is March during “March Madness,” the NCAA basketball tournament. Men take it easy after vasectomy by binge-watching the games.

Post-vasectomy, the testicles continue making sperm, but the body reabsorbs them.

After vasectomy, many couples report an increase in sexual frequency and satisfaction that typically lasts up to a year, after which they usually return to pre-vasectomy baseline frequency.

After men are declared sterile, vasectomy failures are very rare, but possible. Vasectomy does not increase risk of prostate cancer, heart disease, stroke, or any other serious conditions.

• Availability: Requires surgery.
• Side Effects: After vasectomy, men usually feel sore and see some discoloration around incision sites. Around 1 percent of men develop post-surgical wound infections or anesthesia reactions.
• Advantages:
  • Permanent. No need for contraception ever again.
  • Modest cost. Most insurers cover it.
  • After sterilization, some couples experience temporarily increased libido and sexual frequency.
• Disadvantages:
  • Possible incision site soreness.
  • Possible wound infection.
  • It takes two dozen ejaculations to become sterile.
  • No protection against STIs.
  • Permanent. Reversals are possible, but costly and can’t be guaranteed.

Sterilization for Women: Tubal Ligation

For women, sterilization involves cutting the tubes that connect the ovaries to the uterus (fallopian tubes). Tubal ligation requires an abdominal incision under anesthesia in a hospital. Scarring at the incision site is possible, but incisions are small, and most surgeons locate them in the lower abdomen so that even skimpy bikini bottoms cover them. Recovery typically takes several days.

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Tubal ligation is more traumatic and costly than vasectomy.

After women become sterile, some studies show an increase in sexual frequency and satisfaction lasting up to a year.

Women certain they want to be sterilized should ask their physicians for a surgical referral.

• Effectiveness: Tubal ligation is virtually 100 percent effective immediately after surgery. Failure is possible but very rare.
• Availability: Tubal ligation requires surgery.
• Side Effects: Possible complications include: wound infection, possible anesthesia reactions, abdominal pain, extended recovery, and very rarely, sterilization failure.
• Advantages:
  • No need for contraception ever again.
  • Modest cost. Most insurers cover it.
  • After sterilization, many couples experience temporarily increased libido and sexual frequency.
• Disadvantages:
  • Tubal ligation requires hospitalization and anesthesia.
  • No protection against STIs.

If you have questions about sterilization, or are considering it and want counseling, consult a family planning provider or Planned Parenthood.