Appendix I: Permanent Contraception

At a glance

This page includes recommendations for health care providers for the use of permanent contraception for persons who have certain characteristics or medical conditions. This information comes from the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC).

Overview

Tubal surgery (including laparoscopic and abdominal approaches) and vasectomy are methods of permanent contraception available in the United States. In general, no medical conditions absolutely restrict a person's eligibility for permanent contraception (with the exception of known allergy or hypersensitivity to any materials used to complete the permanent contraception procedure). However, certain conditions might increase a person's surgical risk during tubal surgery; in these cases, careful consideration can be given to the risks and benefits of other acceptable long-acting or permanent alternatives, including intrauterine device, implant, and vasectomy.

Patients should be appropriately counseled that permanent contraception is intended to be irreversible and about the availability of highly effective, long-acting reversible methods of contraception. Most persons who choose permanent contraception remain satisfied with their decision. However, a small proportion of women regret this decision (1%–26% from different studies, with higher rates of regret reported by women who were younger at time of permanent contraception procedure).[1],[2] Regret among men about vasectomy has been reported to be approximately 5%,[3] similar to the proportion of women who report regretting their husbands' vasectomy (6%).[4]

Permanent contraception does not protect against sexually transmitted infections (STIs), including HIV infection, and patients using permanent contraception should be counseled that consistent and correct use of external (male) latex condoms reduces the risk for STIs, including HIV infection.[5] Use of internal (female) condoms can provide protection from transmission of STIs, although data are limited.[5] Patients also should be counseled that pre-exposure prophylaxis, when taken as prescribed, is highly effective for preventing HIV infection.[6]

References

  1. Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Poststerilization regret: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 1999;93:889–95. PMID:10362150 https://doi.org/10.1097/00006250-199906000-00001
  2. Peterson HB. Sterilization. Obstet Gynecol 2008;111:189–203. PMID:18165410 https://doi.org/10.1097/01.AOG.0000298621.98372.62
  3. Ehn BE, Liljestrand J. A long-term follow-up of 108 vasectomized men. Good counselling routines are important. Scand J Urol Nephrol 1995;29:477–81. PMID:8719366 https://doi.org/10.3109/00365599509180030
  4. Jamieson DJ, Kaufman SC, Costello C, Hillis SD, Marchbanks PA, Peterson HB; US Collaborative Review of Sterilization Working Group. A comparison of women’s regret after vasectomy versus tubal sterilization. Obstet Gynecol 2002;99:1073–9. PMID:12052602 https://doi.org/10.1016/S0029-7844(02)01981-6
  5. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1–187. PMID:34292926 https://doi.org/10.15585/mmwr.rr7004a1
  6. CDC. US Public Health Service preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

    7. Back to Top

Print
Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health