Saturday 21 September 2019

Dear Dr Nina: Our family is complete. Should my husband have a vasectomy or should I have my tubes tied?

Dr Nina Byrnes
Dr Nina Byrnes

Q. My husband and I are in our early 30s and have two lovely children. Our family is complete and neither of us want any more children.

I am unable to take the Pill as I have Hughes syndrome. We are arguing about what method of contraceptive to use. Are there other forms, other than condoms, that we can use before resorting to surgery? With regards to surgery, can you outline the side effects of having my tubes tied and also of my husband having a vasectomy? A friend of his heard a horror story of a guy who had a vasectomy and is now left with sore testicles and isn't keen on the operation.

A. Hughes syndrome is more commonly known as anti-phospholipid syndrome. This is a clotting disorder, which increases the risk of clot, stroke or heart attack. Oestrogen further increases this risk, and so methods containing this are not an option for you.

You can consider a method, which uses progesterone only. These include a progesterone-only Pill, depot progesterone injection, contraceptive implant or intrauterine system. The progesterone-only Pill must be taken daily. The depot injection is given every 12 weeks. The contraceptive implant is about the size of a hair pin and is placed under the skin of the arm. It can stay in place for up to three years. The intrauterine system is a progesterone-coated coil which is placed in the womb. This can stay in place between three and five years.

If you want to avoid hormones altogether, options include using condoms, a copper coil, vasectomy or female sterilisation.

If you are sure your family is complete, one of the longer-acting or irreversible options may suit you better. The advantage of the progesterone Pill, implant, injection, intrauterine system or coil is that they are highly effective but reversible, should you change your mind and decide you want another child.

Sterilisation should be considered irreversible. Female sterilisation is normally performed under general anaesthetic, which itself has risks. The surgery itself is more invasive so there is a risk of damaging the bowel bladder or other structures in the pelvis. Failure rates are higher than for vasectomy.

Male vasectomy is a much more straightforward procedure than it used to be and much less invasive than female sterilisation. It can be done with a local anaesthetic in a GP's surgery.

Vasectomy involves sealing the tubes that carry sperm from the testicles to the penis. After the procedure, semen is still produced and ejaculated, but it does not contain any sperm. This procedure does not affect the production of circulating levels of male hormones and sperm do not build up, they are merely reabsorbed into the body.

Complications of vasectomy are rare, but may include a wound infection and bruising or haematoma of the scrotum. There are two complications involving the transportation tubes. The epididymis is the tube which carries sperm to the testes. Inflammation of this tube is epididymitis and this can be a side effect of vasectomy.

The vas deferens is the tube that carries sperm from the testes to the urethra (tube which allows passage out of the body). Small lumps called granuloma can occur here in about 5pc of vasectomy cases. Persistent pain in the testes is very rare.

Progesterone-only methods result in menstruation being absent or irregular. A small percentage of people get problematic, frequent or prolonged irregular bleeding on these methods. Menstruation tends to get heavier in those who have a copper coil in situ or who undergo female sterilisation.

Contraceptive choice at any age is a very personal choice. Talk to your partner and your GP to decide which method will work best for you.



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