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. It is requested by people or couples who feel their family is complete and who want a method they never have to think about again. The single most important framing in primary care is that this is 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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