The Family Groove | Control Issues, Part Two | Dr. Randy Fink Talks Permanent Birth Control

CONTROL ISSUES, PART TWO
TFG’S ON-CALL OB-GYN EXPERT DR. RANDY FINK TALKS PERMANENT BIRTH CONTROL
—AND IT’S GOT US THINKING

Birth control! What are you using? Do you like it? Is there anything new on the market? I hate
condoms and I don’t think I want to be on the pill forever. Have you ever thought about going the
permanent route? My husband should just get a vasectomy! Yes, this hot topic seems to be on
everyone’s mind lately. There’s a lot to consider, so we asked our resident ob-gyn Dr. Randy Fink
to give us the inside scoop on our options.

For the latest on the short-term and long-term solutions, check out “Control Issues: Pills, IUDs, Rings, Oh My!”

Here, Dr. Fink explains the three more lasting—as in forever—birth control options.

Control Issues Part 2

There are three methods of permanent sterilization. One is for the man to do it. This is called a vasectomy, and it can even be performed in an urologist’s office under local anesthesia. It’s sometimes hard to get your husband to go and get a vasectomy—somehow it always seems to get put off! For female sterilization, there are two procedures. The goal is to provide a roadblock in the fallopian tubes. For a woman to get pregnant, sperm enters through the vagina, then swims into the uterus and up the fallopian tubes. When you ovulate, the egg is released from your ovary into the fallopian tube. The sperm and egg meet one another in the tube, and thus fertilization and pregnancy take place.

The first method is the classic tubal ligation, also known as getting your tubes tied. Assuming you are not having it done at the time of a C-section, most commonly it is done by laparoscopy, or what I call “belly button surgery.” It is done under general anesthesia, which is to say you are completely asleep. The surgeon places a small telescope through your belly button and makes another small incision just above your pubic hair line. With a special instrument, the fallopian tubes are blocked such that sperm and egg cannot meet. The blockade can be made by burning, clamping, cutting, tying or even removing a portion of the fallopian tube. It is a very straightforward procedure that takes only a few minutes. If done at the time of a C-section, when there is a large incision already made, it takes only a minute or two and doesn’t add to the recovery time at all.

In the past, we would always tell our patients that it is easier for the man to have a vasectomy than it is for the woman to have a tubal ligation. This was because the vasectomy is an office-based procedure, whereas a tubal ligation requires general anesthesia and has some slight (but important) risks. Now there is a method for tubal sterilization called Essure that can be performed right in the gyno’s office. It can be performed in the operating room under general anesthesia but is really best suited for an office setting. The doctor places a small telescope through your cervix into your uterine cavity. We locate the opening of the left and right fallopian tubes from the inside of the uterus, and place a tiny coil of metal inside these openings. The tiny coils stay in place, and your body slowly develops a natural barrier around them. It is said to take three months for this barrier to form, during which time you must continue to use another form of birth control. At the three-month mark, you have a special type of X-ray performed called a hysterosalpingogram (HSG), which confirms that the tubes are blocked.

The advantage of Essure is that it is usually done in the office setting in which (hopefully) you are already comfortable. There is no general anesthesia, so the recovery is much quicker. There is no incision on your abdomen, thus no scar. There is very little discomfort (slight cramping), but most doctors have a protocol for pain and relaxation medication you use beforehand. The disadvantages are that, being awake, you are aware of what’s going on! If you tend to be an anxious person, this may cause you to be uncomfortable. You also have to find a doctor who knows how to do the procedure, since every gynecologist doesn’t know the Essure technique.

The advantages of a laparoscopic tubal ligation are that you feel nothing during the procedure, and the doctor has a chance to look at everything inside your abdomen, your liver and gallbladder, your appendix, and, most importantly, your uterus and ovaries. A laparoscopic tubal is performed by most gynecologists and is effective immediately; there is no three-month delay, and no test is required to make sure it is working. The disadvantages are as I mentioned: the anesthesia, the scar and the small risk of damage to your internal organs when the telescope is placed inside.

For more information about Randy A. Fink, MD, please go to www.drrandyfink.yourmd.com.