Vasectomy vs. Tubal Ligation vs. Essure®

It's important to understand your choices 
before deciding on permanent birth control.

(The Essure product was removed from the market in 2018 due to complications including pain.)

When it comes to permanent birth control (sterilization), both men and women should know and compare the differences, benefits and risks of vasectomy vs. tubal ligation. For most couples, vasectomy is usually the safer and simpler of the two procedures. There is ample medical and personal reason why a couple might prefer vasectomy to the female equivalent: tubal ligation.

Cost, Safety and Risks

For women, tubal ligation involves conventional hospitalization or surgicenter care with general anesthesia and lengthier, more complicated surgery than a vasectomy. In comparison, no-scalpel vasectomy may be completed in less than 10 minutes, barely scoring the skin of the scrotum.

A majority of tubal ligations are laparoscopic (intra-abdominal) procedures that require several hours of hospital facility recovery time and days of recuperation. The potential serious risks with this type of surgery include perforation of the intestine, infection, complications from anesthesia and even pulmonary embolism. Less serious but also important are the long-term possible side effects of tubal ligation. These include painful menstrual cycles, pelvic pain and a controversial complication that is still under study, called "post tubal ligation syndrome."

The female procedure of Essure has been promoted as an alternative to the more invasive tubal ligation. This innovative technique involves the micro-insertion of tiny metal coils into both fallopian tubes via an endoscope. Scar tissue usually forms around the micro-inserts to block the fallopian tubes, thereby preventing sperm from reaching the egg. Depending on the size of the uterus or the presence of fibroids, the procedure can be more arduous. The procedure is generally performed in a surgery center under sedation or general anesthesia.

The Essure procedure is less effective than vasectomy and has no easy means to confirm sterility (as opposed to semen sample(s) for a vasectomy). In general, at least one hysterogram (an x-ray looking for blockage of contrast material at the fallopian tube) must be performed. Unlike vasectomy, the Essure procedure is generally considered irreversible, though there are some reports of its reversal. The cost for an Essure procedure is similar to a tubal ligation.

Vasectomies are usually outpatient procedures performed in the doctors' office. There is almost no risk of serious complications and long-term complications are rare with vasectomy. Quick recovery usually allows patients to have the procedure on Friday and to return to work on Monday.

When it comes to cost, a vasectomy is usually more than four times less expensive than a tubal ligation. Still, couples may opt for tubal ligation or Essure because they may perceive birth control as solely a woman's responsibility. Or they may choose to have a tubal ligation done at the time of a cesarean section.

Making the Loving Choice

You and your spouse can discuss these issues with your physician, however, when it comes to cost, risks and benefits, vasectomy is more often the best option - and a loving choice for husbands who chose to spare their wives' the greater burdens and risks of tubal ligation.


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Dr. Ted Benderev is a well known urologist since 1990 who has performed more than 10,000 vasectomy and vasectomy reversal procedures. His practice is conveniently located in the Orange County communities including Aliso Viejo, Anaheim, Costa Mesa, Corona, Fountain Valley, Fullerton, Huntington Beach, Irvine, Ladera Ranch, Laguna Hills, Laguna Niguel, Mission Viejo, Newport Beach, Orange, Rancho Santa Margarita, San Juan Capistrano, Santa Ana, San Clemente, Tustin, Westminster, and adjacent Inland Empire counties of Riverside and San Bernardino, San Diego and Los Angeles.