Every year, about half a million men in the United States get a vasectomy, which is the most effective form of birth control for people with penises. Currently vasectomy and condoms are the only birth control options available to people with penises. A vasectomy is a relatively simple outpatient procedure that blocks sperm from entering semen during ejaculation.
But plenty of people considering a vasectomy have concerns about its safety and the long-term impact of this form of sterilization. Though more expensive than the original procedure, a vasectomy is usually reversible.
However, there is a slim chance that the effects of the vasectomy are permanent. Like any medical procedure, there are potential health risks and side effects that may make you wonder if there is a good alternative.
Birth control options range from implanted devices and surgical procedures to injections, pills, and other non-invasive methods. Unfortunately, the options for birth control for people with penises are limited, so the responsibility often falls on the person with the vagina.
Some of the more widely used alternatives to a vasectomy include:
For people with penises
A male condom remains the most widely used form of male birth control. A thin sheath made of latex or similar material fits over the penis during intercourse, blocking sperm from reaching the uterus. Female condoms, which are placed in the vagina, are less commonly used.
Male birth control
Progress toward male contraceptive options is still in the experimental stages. Development and research into these options is ongoing.
For people with vaginas
An IUD (intrauterine device) is a small, T-shaped device placed inside the uterus by a doctor. The levonorgestrel IUD is usually implanted for 3 to 6 years, and releases a small daily amount of progestin to prevent pregnancy.
A copper T IUD is a non-hormonal device that may remain in the uterus for up to 10 years. The copper coil that wraps around the device causes an inflammatory response that interferes with the ability of sperm to fertilize an egg.
One of a few commonly used hormonal methods of birth control is a rod-like implant placed under the skin of the upper arm. It releases progestin for about 3 years until it must be removed or replaced.
A progestin shot, often referred to as the Depo-Provera or Depo shot, is administered every 3 months to help prevent ovulation. It can be a safe, non-invasive birth control method, but the shots must be administered in a timely manner to be effective.
Birth control pills, which stop ovulation, have been around since the 1960s and are used by nearly 10 million people in the United States every day. However, other birth control methods are becoming more popular, while the number of people using oral contraceptives is starting to decline.
Tubal ligation is a surgical procedure known informally as having your tubes tied. It’s a form of female sterilization, in which the fallopian tubes are cut or blocked. This prevents an egg from traveling from an ovary through a fallopian tube to the uterus, where it can be fertilized.
While no birth control method is 100 percent guaranteed, some have nearly as good a track record. The following list indicates failure rate in preventing pregnancy for several commonly used birth control methods:
|Contraceptive implant||0.1 percent|
|Tubal litigation||0.5 percent|
|IUD||0.1 to 0.8 percent|
|Birth control pills||7 percent|
|Male condom||13 percent|
|Female condom||21 percent|
The right birth control choice for you and your partner depends on several considerations. Consider the following questions before making a decision:
- Is this for long-term or short-term birth control?
- Do you have children and definitely do not want more, or do you not want children in the foreseeable future and want some assurance that pregnancy is not an option?
- Are there underlying health concerns that would affect the choice?
- What can you spend on birth control? Some methods and procedures are covered by insurance and others are not, so check with your insurance carrier first.
There are pros and cons with every birth control option.
Pros: On the plus side, a vasectomy is nearly 100 percent effective and rarely affects sexual function or desire.
Cons: A vasectomy is meant to be a permanent solution to birth control, so if you change your mind later, a reversal can be an expensive step with some risk that it won’t be effective. It’s also a surgical procedure, which carries risks, including a 1 to 2 percent risk for chronic pain.
Pros: An IUD is so small you can’t feel it, and is fairly low maintenance. It can also be removed easily by a doctor if you want to become pregnant.
Cons: There is a rare but possible event of slippage. An IUD also requires a doctor to insert it initially and remove it, either permanently or for a replacement.
Pros: An implant is one of the most effective birth control options, and it requires no maintenance after it’s been inserted. Fertility should return once the device is removed.
Cons: If not covered by insurance, an implant can be expensive. It must also be removed after 3 years.
Pros: You only need one shot every 3 months. With regular use, it can be more effective than the pill.
Cons: You could experience more intense side effects than the pill, and a longer wait time after stopping your shots in order to become pregnant.
Pros: The positive aspects of birth control pills include less bleeding and cramping with periods, clearer skin, and possibly reduced risk of ovarian cysts and an ectopic pregnancy.
Cons: Your menstrual cycles may be delayed when the pill is no longer taken. It may also be less effective when taken with certain medications, such as anti-fungal and anti-seizure medications, as well as various herbal supplements, including St. John’s wort.
Pros: Unlike most other birth control methods, condoms reduce the risk of sexually transmitted diseases, because they limit the exchange of bodily fluids. Condoms are also relatively inexpensive compared to various surgical procedures, and they do not affect an individual’s hormone chemistry.
Cons: Unfortunately, condom misuse or unseen tears in a condom are common causes of unwanted pregnancies.
Pros: The procedure is sometimes performed after childbirth, but can often be reversed later on. It immediately eliminates the risk of pregnancy and never causes a hormonal imbalance. The procedure may lower the risk of ovarian cancer, too.
Cons: The main cons for this procedure is the high cost and requirement for abdominal surgery and general anesthesia. It’s also not as effective as a vasectomy. Reversing a tubal ligation can also be expensive.
Most commercially available birth control methods are generally safe and well tolerated, but side effects and other risks can occur. It’s important to understand the risks associated with your chosen birth control method and talk with a medical professional about symptoms or complications.
The main risk is a 1 to 2 percent chance of chronic pain after the procedure. Rare risks include bleeding or infection. Though also rare, procedure failure may mean sperm are still entering your semen during ejaculation.
With hormonal IUDs, side effects may include spotting between periods or irregular periods. Copper IUDs may also cause irregular periods, as well as heavier periods with more cramping. Expect some pain in the days after the IUD is implanted.
Occasionally, the implant may move slightly in the arm, making its retrieval more complicated. Side effects can include:
Irregular periods may occur during the first year. You could also experience:
Though generally well tolerated, birth control pills are associated with a potential side effects, including:
- spotting between periods
- breast tenderness
- mood changes
Often these side effects diminish during the first few months of taking the pill. In other cases, changing the type of pill may help.
There are few side effects related to condom use, but some people may have a reaction to the lubricants used on some condoms.
There is a slight chance of infection, as there is with any surgical procedure. Rarely, injury to the bladder or bowel can occur.
A hysterectomy is a surgical procedure to remove the uterus. In some cases, the ovaries as well as the fallopian tubes may be removed. A hysterectomy is most often done for medical reasons, including cancer, endometriosis, fibroids, and other conditions.
A vasectomy is less invasive and carries fewer risks of side effects and complications than a hysterectomy. Recovery time is also shorter. Perhaps the most significant difference is that, unlike most vasectomies, a hysterectomy is not reversible. It means you will permanently not be able get pregnant.
For people with penises, questions or concerns about reproductive and sexual health should be directed to a urologist at first. People with vaginas should take up similar questions with an OB-GYN. And because a vasectomy and other means of birth control can take time to schedule and become effective, the earlier you start this conversation, the better.
If you are in a committed relationship and want to make long-term birth control plans, talk with your partner and see a medical professional together. Discuss risks and benefits of all birth control options, and what choice will make the most sense for your lifestyle and long-term plans.
A vasectomy is a popular birth-control option, but it’s certainly not the only one available. However, until more male contraceptive products and procedures become available, many of the vasectomy alternatives become the responsibility of the person with a vagina in a relationship.
Sharing the decision-making, cost, and other obligations associated with pregnancy prevention may help ease the burden. Discussing vasectomy alternatives with a medical professional will help you make the best decision for you, your partner, and your short- and long-term plans.