Permanent contraceptive methods

What are permanent contraceptive (sometimes called sterilization) methods?

• These are methods that use surgical procedures to make you unable to get pregnant or to get someone else pregnant. This means you are infertile.
• In people with ovaries*, this is done through tubal ligation (sometimes called having your tubes tied).
• In people with testicles*, this is done through vasectomy.
• Although vasectomies can sometimes be reversed, both vasectomies and tubal ligations are meant for people who are certain that they do not want any (or more) biological children.

Tubal ligation

How does tubal ligation prevent pregnancy?

• In order to get pregnant, sperm must enter your vagina**, swim up into your uterus and fertilize an egg that has been released from your ovaries into your fallopian tubes during ovulation.
• With tubal ligation, your fallopian tubes are sealed shut, preventing sperm and eggs from meeting.

How do you get a tubal ligation?

• Tubal ligations are performed by gynaecologists. To see a gynaecologist, you need a referral from a doctor or nurse practitioner.
• The procedure is done in a hospital, under general anaesthetic, which means you will be asleep.
• Wait times to see your gynaecologist vary across Ontario and are on average 6-9 months (may be longer)
• The most common method of tubal ligation is laparoscopy. A harmless gas is injected into your abdomen to inflate it, making it easier to see your internal organs. Tiny cuts are made in the abdomen and the fallopian tubes are cut, sealed, burned or closed with bands or clips using a tiny camera and other small instruments.
• The procedure takes about 30 minutes. You can move around in about 8 hours (or as directed by your surgeon) and resume normal activities in a few days although physical exertion should be avoided for the first week.
• The procedure is effective immediately.
• Getting a tubal ligation may be possible while having a C-section. Talk to your clinician.
• Tubal ligations are covered by OHIP. If you do not have an OHIP card, the procedure currently costs about $1,500 – $2,000.

What are the side effects of tubal ligation?

• For 2-5 days afterwards, you may experience tiredness, neck/shoulder pain, menstrual-like cramping and a swollen abdomen from the gas used during the procedure.
• Side effects from the general anesthetic could last a few days. They include nausea and vomiting, confusion, and sore throat from using a breathing tube while under general anaesthetic.
• Rare side effects include infections, bleeding and possible damage to organs such as the bladder, bowel and uterus.
• In the rare case that a tubal ligation is unsuccessful, it can increase the risk of having an ectopic pregnancy.
• Tubal ligation does not affect your hormones or menstrual** cycle.

Vasectomy

How does vasectomy prevent pregnancy?

• In order to get someone pregnant, sperm in semen (cum) must enter their vagina.
• With vasectomy, the tube (vas deferens) that carries sperm from the testicles into your urethra is cut, preventing sperm from coming out of your penis** with semen during ejaculation.

How effective is vasectomy?

• Vasectomy is over 99.5% effective. This means that if 1000 people used it as their method of birth control for one year, only 5 of them would get pregnant.

How do you get a vasectomy?

• Vasectomies can be performed by family doctors or by urologists. To see a urologist, you need a referral from a family doctor. There are also clinics throughout Toronto that specialize in doing vasectomies. Many clinics do not require a referral, which means you can call them yourself to make an appointment.
• The procedure is done in a doctor’s office with a local anaesthetic, which means you will be awake.
• A doctor makes a tiny cut or puncture into your scrotum (the sac that holds the testicles) using a scalpel blade or other instrument. They cut the tubes which carry sperm from your testicles to your penis** and seal the ends.
• The procedure takes about 15 minutes. You can resume regular activities right away and recovery is very fast.
• It may take up to 6 months to be fully effective at preventing pregnancy (this varies widely for each person). You need to use another birth control method during this time. After 3 months, a sperm count test is required to make sure the vasectomy is effective.
• Vasectomies are covered by OHIP, although some clinics have additional fees. If you do not have an OHIP card, the procedure currently costs about $500 – $1000.

What are the side effects of vasectomy?

• You may experience pain and swelling for up to 2 weeks.
• Infection is possible but rare.
• You will still be able to get/maintain erections and ejaculate (cum) as usual after a vasectomy.

Advantages of permanent contraceptive methods

• They are permanent, one-time procedures.
• You don’t have to do anything before or after you have sex to prevent pregnancy.
• Your partner(s) don’t have to be involved.
• There are no hormonal side effects. People who can’t or do not want to take hormonal birth control can use these methods.
• Vasectomies are one of the few birth control options for people with testicles.
• Your sexual pleasure or performance won’t be impacted.
• They are both covered by OHIP, although vasectomies can come with additional fees.

Disadvantages of permanent contraceptive methods

• Reversal is expensive, difficult and sometimes impossible.
• Neither of these methods protect against sexually transmitted infections
• With tubal ligation, you have to have surgery and be put under general anaesthestic
• It may be difficult to find a clinician who will perform these procedures on someone who is under 35 and/or who doesn’t have any children.
• Often people seeking tubal ligation might feel pressured by a clinician to have their partner(s) seek a vasectomy instead, as it is less invasive, cheaper, and has a lower risk of complications. We at PPT support your decision and autonomy.

*People with testicles are usually designated male at birth while people with ovaries are usually designated female at birth. People with testicles don’t always identify as male and people with ovaries don’t always identify as female.
** We know these aren’t the words everyone uses for their bodies (e.g. trans folks), and support you using the language that feels best for you.