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

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Vasectomy is quicker, cheaper, and easier, but women get sterilized more often. Voluntary sterilization—not the Pill or condoms—is the most popular birth control method in the U.S. Among couples using contraception, around 25 percent use the number two method, birth control pills, and 15 percent opt for the number three method, condoms. But sterilization is the top choice—29 percent.

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

Why the Gender Gap?

Common sense? Women usually take primary responsibility for birth control, so they’re more likely to opt for the permanent approach.
Sexism? Contraception is the couple’s responsibility, not just women’s, but many men don’t see it that way.
Fertility differences? Few women can get pregnant after 40, but men can father children throughout older adulthood. If they get divorced or become widowed, many older men opt for 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 the 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, 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. They cannot be guaranteed. They’re also costly—around $10,000, sometimes more—and health insurers rarely cover them.

Vasectomy

Vasectomy involves a minor, 20-minute surgical procedure under local anesthesia. Urologists make two tiny incisions in the upper scrotum. They find the 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 twenty-five ejaculations to expel them from the body. During that time, couples must use another method. A couple of 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 taking it easy after vasectomy binge-watch games—and the women in their lives don’t complain.

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

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

Vasectomy failures are rare—around 1 per 1,000. Slim odds, but failures are possible, which is why couples should use another method until the man tests sperm-free.

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.

Vasectomy does not increase risk of prostate cancer, heart disease, stroke, or any other serious conditions.

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 so that even bikini bottoms cover them. Recovery typically takes several days.

Ttubal 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 one year.

Tubal ligation can be reversed, but it’s costly. Insurers don’t cover it. And there’s no guarantee of success.

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. But over time, for reasons that remain unclear, some fallopian tubes spontaneously reattach. This is rare, but remotely possible.
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: