GPAtlas🧭 When to consider sterilisation
Sterilisation is a permanent surgical method of contraception – vasectomy in men (occlusion of the vas deferens) and tubal occlusion in women.
• Sterilisation is requested by people or couples who feel their family is complete and who want a method they never have to think about again.
• In primary care, present it as one option among several, not the default endpoint.
That framing matters because modern long-acting reversible contraception (LARC) – the implant and the intrauterine system (IUS) – is as effective as, or more effective than, sterilisation, yet is fully reversible.
• Between the two operations, vasectomy is safer, simpler, more effective and lower-risk than female sterilisation, and is usually done under local anaesthetic as a day case.
• The decision must be informed, voluntary and free of coercion.
| Method | Typical failure rate | Reversible? |
|---|---|---|
| Etonogestrel implant (Nexplanon) | ~0.05% (≈ 1 in 2,000) – most effective method | Yes |
| 52 mg LNG-IUS (e.g. Mirena) | ~0.2% (≈ 1 in 500) | Yes |
| Vasectomy (male) | ~0.05% (≈ 1 in 2,000, after clearance) | No – permanent |
| Female sterilisation (tubal occlusion) | ~0.5% (≈ 1 in 200, lifetime) | No – permanent |
|
⚠️ Common pitfall • Referring a woman for tubal occlusion without genuinely offering vasectomy. • Vasectomy is safer, simpler, more effective and carries a lower risk of major complications than female sterilisation, yet women are still referred by default. • Which partner is sterilised should follow a full, balanced discussion – never an assumption about who "should" have it done. |
Source: FSRH
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