At some point in their relationship, many couples discern that they are done expanding their family and a new baby isn’t in their future. At this juncture, an option that is frequently suggested is sterilization in the form of a vasectomy for the man, or a tubal ligation (“having your tubes tied”) for the woman. Many couples go back and forth, debating (or outright arguing!) who should be the one to go under the knife in the name of responsible family planning. But the truth is, the vasectomy vs tubal ligation discussion presents a false dichotomy. Unbeknownst to many couples, there are other reliable forms of long-term family planning when a couple is tired of using condoms, implants, or oral contraception, such as methods of fertility awareness or natural family planning. And while sterilization can seem like an effective and straightforward option when a couple has decided they don’t want any more children, sometimes navigating and weighing the negative effects of a tubal ligation vs a vasectomy can be anything but simple. This can be especially true of the more “intangible” effects of sterilization, like its possible effects on relationships, and mental and emotional health, which I will be discussing in this article.
The possible effects of a vasectomy or tubal ligation on relationship health
Many women are routinely offered a tubal ligation after giving birth, especially via C-section, as a way to “kill two birds with one stone” (that is, so that they don’t have to come in later should they decide to have the procedure done). On the other hand, some men (or their partners) see having a vasectomy as a way for the man to “take one for the team,” especially after the woman has been the one to shoulder the burden of contraception during the bulk of her childbearing years.
But when choosing sterilization is presented as the only option, it places the burden of responsibility for family planning on one partner as opposed to both. One partner will have to choose to undergo the procedure, go through the recovery process, and accept the potential risks (which exist for both vasectomies and tubal ligations) associated with the procedure. One partner may feel pressured to be the one to have the procedure done, or one partner may even be pressuring the other to have the procedure done. In some cases, this may lead one or both partners to feel resentful towards the other for having to bear the burden of eliminating their fertility for the sake of not having any more children. And you don’t need me to tell you what building pressure and resentment can do to the health of a couple’s relationship.
Conversely, using a fertility awareness method (FAM) presents the opportunity for partners to work together as a team to avoid pregnancy, by using their knowledge of their fertility patterns. This avoids placing the primary responsibility of family planning on one partner over the other, or requiring that one partner (the woman) suffer the potential risks and side effects of contraceptive use. In this way, FAMs foster communication and empower the couple with information, rather than making one partner feel like their only option is to choose a permanent surgery to eliminate the possibility of a pregnancy.
Permanency and the specter of regret
Sterilization procedures are typically permanent. That is why prior to the surgery, patients are (or should be) counseled about the seriousness of choosing this method to prevent pregnancy. Most tubal ligation procedures are irreversible, and attempts to reverse the procedure require major surgery that often isn’t effective, according to the Mayo Clinic. Similarly, vasectomy reversal procedures are not always successful; the Mayo Clinic notes that even if a vasectomy can be reversed, it is not guaranteed one will be able to conceive a child.
One American Family Physician (AFP) article reported that regret for having a tubal ligation was associated with women under 30, which speaks to the reality that we can change our minds—especially while we are younger. What once felt like a permanent decision can change for a variety of reasons (and that’s okay). In fact, in an article on the popular site Scary Mommy, writer Caila Smith shared how she was asked if she wanted to have the procedure done many times when she was pregnant with her daughter, after already having borne twins. She wrote that she opted not to get a tubal ligation at the time, and was later very grateful for that decision, as her daughter tragically passed away from SIDs. She was then able to give birth to another set of twins after her loss—after which she did get a tubal ligation, a procedure which she admits to sometimes regretting.
This isn’t meant to be a fear-mongering story by any means, but a reminder that none of us has a crystal ball to see what the future holds, whether it be disease, changes to your finances, accidents, death, divorce, or remarriage. You may discern that you are done having children, and you may never change your mind. You might also decide not to have children, and then change your mind at some point in the future. It’s good to be honest with others (and ourselves) that a sterilization procedure makes it harder—if not impossible—to reverse such a decision, should life circumstances change, or should you simply have a change of heart.
On the other hand, using a FAM can help you and your partner work with whatever you discern is right for your family, and you can always reaffirm your discernment or change it at the start of each new fertility cycle. In other words, FAMs empower couples without asking anyone to make a permanent decision at any one point in time about the future of their fertility or the size of their family, and FAMs leave the door open should life circumstances change.
Be sure to choose empowerment over fear
Finally, it’s important to be aware of the presence of any fear that may be contributing to your decision to have a vasectomy or tubal ligation. While it’s very normal for couples to be afraid of going through pregnancy and childbirth again or of being able to take care of another child, it’s important to not let fear drive your decisions. When we let fear take the driver’s seat, we make choices that are focused on getting us away from the fear rather than making a choice that is empowering and in our best interest.
Sterilization may be presented as an effective option to prevent pregnancy and eliminate any fears of becoming pregnant. However, due to the permanency of these procedures and their associated risks (however small they may be), it is important to investigate the source of any fear you may be experiencing before making your decision. Making time for self-reflection or even meeting with a trained counselor can help you explore your fears and how you’d like to respond to them before you decide the future of your fertility. One of the many benefits of a FAM is that it naturally empowers you with a wealth of information about your fertility, so that you can make decisions about your family from cycle to cycle.
What will you choose?
When considering a long-term, permanent health decision like sterilization, it’s important to be informed and empowered so that you can make the best decisions for yourself and your health. But what many people may not consider are the possible intangible effects of a vasectomy or tubal ligation when determining whether to undergo the procedure (or have their spouse do so). No one should feel pressured into choosing a permanent and irreversible procedure in order to feel in control of their fertility. Asking someone to be certain that they never want to have (more) children is a significant burden to place on them, not to mention the pressure it can put on a relationship to make such a permanent decision.
While using a FAM method can require significant sacrifice at times, it does not give anyone an ultimatum when it comes to their fertility. And, it should be noted, fertility doesn’t last forever; FAMs recognize that there is a natural “expiration date” on a woman’s fertility, allowing couples to still be intimate and plan their families without ushering in the expiration of fertility prematurely. Additionally, FAMs can increase communication between partners, helping them to feel like they are on the same team rather than at odds with one another. Fertility awareness can therefore be an empowering option where you have the freedom to acknowledge any fears that you have, while simultaneously providing you with the tools to confront those fears and make decisions in your (and your family’s) best interest.
So, if you’re currently having a discussion about which of the two of you should be the one to go under the knife, consider that the best option might be a third one: neither of you.
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Comment by JMS on September 19, 2021 at 12:38 pm
Very helpful because there are too many pressures to drastically limit family sizes. Plus, sterilization regret is not seriously discussed by the medical profession beforehand. They only cursory screen who is a candidate for the procedure. Even imposed waiting limits between counseling and procedure are ignored.