Snip, shot, or something else?

May 22, 2009 5:46 AM

Snip, shot, or something else? We need the sex but we don't need the baby. What's the most reliable - and permanent - form of birth control that's available with minimal pain / problems?

So my long-term girlfriend (3+ years) and I love the sex. But babies are not an option - financially, practically, and selfishly speaking. Between condoms and her pill we've ensured nothing's happened as of yet. After some long discussions we've decided that children will not be a part of our lives, and a permanent solution would seem to be appropriate. There's the snip, there's the shot, there's the IUD, and there's quite a few other options... So... help?

posted by anonymous to health & fitness (35 comments total)

In terms of permanency, ease of use, and minimization of recovery the procedure you want to ask your doctor for is called a "vasectomy."
posted by majick at 5:49 AM on May 22 [5 favorites]

Mirena IUD is extraordinarily effective, and has the added benefit of reducing/removing your girlfriend's periods. Only needs to be replaced every five years, so that's, like, almost permanent. :-)
posted by wyzewoman at 5:59 AM on May 22

Ditto. Vasectomy is the easiest solution that involves no later follow-up assuming you're happy with it. If you check the vasectomy tag on AskMe, you'll find a lot of reports from guys who have gotten them. It requires a minimum of cost and effort, one weekend of recovery time (and some follow-up visits to make sure it took okay - DANGER jerking off in a cup is not to everyone's liking) and pretty much no side effects assuming it all works okay. IUDs work great but sometimes require tweaking and have some discomfort associated with them when you first get them and the hormonal ones can take adjusting time.I am a big cheerleader for the vasectomy method.
posted by jessamyn at 6:02 AM on May 22

Let me add that, if you choose a vasectomy, be very, very aware that it is likely that you will never have children, reversal is difficult and uncertain. I would not recommend that road to someone much younger than 35.

I had a vasectomy at the age of 21, after having two children. For a lot of reasons I wish now I had chosen another route.
posted by HuronBob at 6:14 AM on May 22

Mirena is usually used in women who have already had a child, I think in part to make the insertion less god-awful. Its effect on periods really varies by person, so don't get your hopes up there.

I have had Mirena for three years, and in general I am happy with it. The no-thinking part works well for me, and side effects have been minimal. I didn't have any real adjustment to it. I do think it may have contributed to some weight gain over the past couple of years, but that might also be due to getting older/eating too much/not working out. I'm in my early thirties, and although my husband and I are pretty sure we're not having more children, we weren't ready to take the leap to surgery.

Everyone I know who has had birth control shots had massive side effects. Emotional problems, period issues, etc. - I don't know if they are even still doing these.

I don't know how old you are, but "definitely no children" in your twenties often changes to "I love my babies" in your thirties. So I would not do anything permanent unless you are well into your 30s.

On preview, what HuronBob said.
posted by jeoc at 6:27 AM on May 22 [1 favorite]

This Wikipedia article compares many birth control methods and the effectiveness of each.
posted by Houyhnhnm at 6:28 AM on May 22

I can't vouch for this personally, but Implanon lasts for three years. There are side effects, but it is supposed to be extremely effective (statistically more so than surgical sterilization in women).
posted by ishotjr at 6:36 AM on May 22

Mirena is usually used in women who have already had a child, I think in part to make the insertion less god-awful.

I have an IUD (Paragard, the copper one, no hormones) and have not had children. Obviously I don't know how much better it would have been otherwise, but I survived the insertion. Sure it was really painful but it was over quickly and now is a distant memory.
posted by misskaz at 6:48 AM on May 22

I can't speak for wyzewoman's endorsement of the Mirena IUD specifically, but I had an IUD (can't remember the trade name) about 10 yrs ago and it HURT LIKE HELL to get it put in. It also made my menstrual cramps HURT LIKE HELL--I mean exponentially worse than ever before--and when I gave up and had the damn thing taken out, it HURT LIKE HELL.

In short, I don't recommend an IUD.
posted by scratch at 6:51 AM on May 22

I would never say never about having kids. That being said, do not do anything that would cause permanent, cannot be reversed situations. Birth control, condoms, not having sex during the time when she is the most able to get pregnant are all better options. Reason I say this is because people change opinions all the time. A vasectomy is a huge bridge to be burning down.
posted by Mastercheddaar at 6:57 AM on May 22

Scratch probably had a no-hormone one. The hormonal ones are reportedly easier. I have a Paragard and I love it - my cramps are no worse and my periods are actually shorter than on the stupid pill - but every woman will react differently. This is something she should discuss with her doctor. If her doctor gives her hell about long-term contraception, switch doctors.

It will be super difficult for her to get sterilized, just from a 'what doctors will do it' point of view. It may be difficult for you, too, but I've heard less refusal stories from men than from women.
posted by cobaltnine at 6:58 AM on May 22

I have a Mirena IUD, and have never had children. I love it, but when it comes time to have it removed, I'm going to look into getting Essure, which is permanent.
posted by amarynth at 7:03 AM on May 22

Three cheers for my vasectomy! The surgery and the recovery were both trivial. I've had dental work that was more traumatic.
posted by browse at 7:18 AM on May 22 [2 favorites]

I have an IUD (Paragard, the copper one, no hormones) and have not had children. Obviously I don't know how much better it would have been otherwise, but I survived the insertion. Sure it was really painful but it was over quickly and now is a distant memory.

On the other hand, I'm also a childless woman who tried an IUD, and even two trys and dilation with lidocaine could not open my teeny weeny cervix to get it in. It’s a very vivid, uncomfortable memory.
posted by Phalene at 7:31 AM on May 22

what browse said
posted by allelopath at 7:38 AM on May 22

I begged, pleaded and insisted on the doctor giving me Mirena while I was in college, prior to law school, knowing it would be years before I wanted to get pregnant. I absolutely loved it - the pain on insertion was pretty bad, but a couple advil prior and the afternoon on the couch with a heating pad took care of it. Compare that pain of insertion with 5 (and I actually left mine in for 6) years of thought-free, VERY low hormone, period-reducing amazing birth control, and I would say it was more than worth it, for me. YMMV.

There are generally two types of IUDs - copper/Paraguard/no hormones - and Mirena. The hormones in Mirena are very minimal, and as it was explain to me, function only to reduce the duration/sympoms of menstruation. They are less than in a mini-pill, and delivered locally rather than through gastro-absorption, so tend to have fewer of the side effects associated with hormonal birth control. (I am not a doctor, I am just reporting what I was told when I was considering it.)

If I hadn't had an emergency hysterectomy thus making the need for birth control irrelevant, I would have put another Mirena in after my pregnancy.

FWIW, my health insurance covered the insertion and removal. And then no copays etc. for monthly refills!
posted by bunnycup at 7:41 AM on May 22 [1 favorite]

Deciding to get a vasectomy is a permanent decision, and should be taken seriously. On the other hand, deciding to have children is also a permanent decision that should be taken seriously, but I doubt that anyone on Metafilter would be advising a couple in a long-term relationship not to have children because they might regret it. If you're sure, don't let people who tell you that you might change your mind stop you from living your lives in the way you've chosen.

Vasectomy is usually easy for the man (certainly easier than the equivalent surgery for a woman), but there are risks to any surgery, so you'll want to talk it over with your doctor. If your partner hasn't previously been on hormonal birth control, hormonal options that are easier to stop may be better so that you can deal with any side effects. The shot lasts 3 months, and there's no way to get the hormones out of your system before then if you have a bad reaction. With an IUD or implant, the device can be removed early if the side effects are serious. I've also heard great things about the Paragard IUD.
posted by decathecting at 7:50 AM on May 22 [3 favorites]

vasectomy
posted by nadawi at 7:57 AM on May 22

Vasectomy is usually easy for the man (certainly easier than the equivalent surgery for a woman)

That's why I'll be looking into Essure (linked above) -- a 13 minute procedure for insertion, you can resume normal activities right away, and then three months later, the fallopian tubes are irreversibly closed.
posted by amarynth at 7:59 AM on May 22

Let me pile on the Mirena bandwagon. I haven't had a period in over three years. It's fantastic. The hormones are nothing like what you get on the pill, as I don't get mood swings, weight gain, etc as I did on the pill. It's so good, permanent birth control is now out of the question for me, even though I don't want any more kids.
posted by crazycanuck at 8:03 AM on May 22

I've heard good things about vasectomies from friends who have had them, but again you should be absolutely sure that you want to remain childfree.

I had a Mirena IUD, on the advice of several other friends who had and had not had kids. I was 29 and may choose to have kids within the next decade or so. Just like the commercial says, it's very easy to remove if you suddenly change your mind. After some annoying side effects while on the pill (including formulary changes with my HMO that made me switch something like three times in a year), I wanted to stay away from hormonal birth control, but my OB/GYN (on her second IUD herself) assured me that it would be fine.

I LOVED the Mirena. The "unprotected" sex was fantastic, and I never had to worry about remembering to take a pill or dislodging a ring or something else. My partner could feel the strings if he paid attention, but not during business time. I was very comfortable with the low hormone level of Mirena; it did nothing except lighten my period and make my face look pristine (oh, the horror!). That was a big thing for me, as I take other medications that can affect my moods, so I was very pleased.

Unfortunately, both of mine expelled. The first came out after three months (VERY unusual, especially after a successful 6-week followup), while the second (inserted the day after the first expelled, I think -- bonus: it didn't hurt nearly as much) came out after about a week. My suspicion was that the strings, which had been trimmed but weren't super-duper short, somehow got caught up when I was removing my DivaCup during my period. There are plenty of women who successfully use a reusable menstrual cup/Instead with an IUD, but apparently I wasn't one of them. And I will absolutely never give up my DivaCup, NEVER, so that was that. Total bummer, but such is life.

I am the only one of my friends (let's say 5 or so) who have had ANY problems with their IUDs. One expelled her first one but is apparently doing fine on the second.
posted by Madamina at 8:10 AM on May 22

Love my Mirena. When I got the first one put in at 28, thought I would never have kids. I'm now a year into my 2nd one, and am thinking that maybe one kid would be kinda cool. It's nice having options. It's also nice not having periods.
posted by rabbitrabbit at 8:47 AM on May 22

Scratch probably a Paraguard IUD, as suggested by cobaltnine. About the only advantage is that they last 10 years, and have no hormones. There are people who love their Paraguards, but I'd strongly recommend some research, and throw in a personal recommendation for the Mirena.

I've been with a fellow who got a vasectomy before, and I am currently using the Mirena IUD. I'd happily recommend both. The real kicker is how permanent you really want it to be, and how sure you are that your relationship is going to last a very long time. You're sure you don't want children with your girlfriend, now; are you very very sure that you're either going to stay together forever, or that you'd never be convinced to have children by another, future partner?

I'm all for people not having children and getting vasectomies, even young, but it is something you've got to want for yourself and be very sure of.

Honestly, having known multiple people who've gotten V's and IUDs and done research on both, I think the pain and potential for complications are pretty similar. That means that who ever you decide is going to get something done to their bits is going to hear a LOT of horror stories. I would like to let you know that, well, things can go wrong with any procedure but they rarely do.

Also, some people are kind of wimps. I'm not talking about anybody in this thread, but I personally witnessed two boys recover from their V's, and one was at work later that day, and the other one was whinging about his purple balls for weeks because that's just the kind of guy he is. Do your research and pay more attention to medical studies and statistics than anecdotes, because the anecdotes are just going to freak you out.
posted by Juliet Banana at 8:53 AM on May 22

Go for the snip. But be aware that your being unmarried may be a hurdle with some doctors. I was required to sign a spousal waiver for my husband's procedure (it was both a state regulation and the policy at our local Catholic hospital).
posted by theraflu at 9:02 AM on May 22

No prior children, plus a supposedly small uterus (according to an exclamation by a doc once), and I *love* my Mirena. I've had it four years now, and will certainly get another next year.
posted by kellyblah at 9:02 AM on May 22

Mirena IUD. It may suck going in, it may not -- mine wasn't too bad. A couple advil and a nap and I was over it. And no, I haven't any any kids either. I love my Mirena. IMHO, it really is the best permanent-for-now solution. And after about only what, 5 or so of them, it becomes a permanent-for-forever solution. Here in Canada, it only cost me $300 or so. (The doc appt was free of course, because its canada.) But thats about the equivalent of about a year of pills, and after that it's paid for itself.
posted by cgg at 9:04 AM on May 22

Sorry to be the voice of dissent.

I have a Mirena, have not had kids and it hurt ridiculously to have put in. I almost passed out and I had taken prescription pain killers. It still hurts like hell - made me bleed more. The cramps I have are spectacular - to the point where it feels like I'm birthing the bloody thing.

I've had it adjusted, had scans and it's coming out after a year of hell. YMMV so wanted to give the other side of the coin.
posted by urbanette at 9:06 AM on May 22

This hasn't really been mentioned, and it would completely be up to your girlfriend to make this decision, but I had my tubes tied at 21 and have never regretted a second of it. The surgery was done laprascopically and I had it done on Thursday and was back to work on Monday. Hell, recovering from my wisdom teeth removal was worse.

However, it's a major commitment to say I never, ever want kids. But if that's what she wants, she should look into it. I chose to do it not only because I didn't want kids, but because I didn't think my boyfriend should have to be fixed. I wasn't a hundred percent sure we would last (and we didn't) and I didn't want to have to go through the no kids discussion again with a new guy.

It's worked out quite well for me. Any guy I date now knows up front that this is not an option and it helps to weed out those guys that are iffy about kids. Plus, I never have to worry about it. That card is off the table forever, and I tell you, it's a huge relief.
posted by teleri025 at 9:28 AM on May 22

Think of this, first, completely independently of your girlfriend's perspective.. because life is long and your relationship may or may not be and no one can predict the future. Are you absolutely certain that you don't want to have biological children?

If you're positive, then by all means get a vasectomy. From all I've heard, the whole process, including healing, really isn't that big of a deal.

My husband was 'snipped' at an age that many would consider "too young" and has no regrets whatsoever. I frequently call the vasectomy "the best invention ever" for reasons that range from no chance of (me) getting pregnant, to the joy of having random, spontaneous sex any ol' time we want without worry. It's.. awesome and I say that with a big grin, two-thumbs-up and a little shimmy-shake for emphasis.

People will always try to tell you that you "can't know what you'll want later in life" and that you should wait 'til X-years of age (as if all X-aged people are mature and make excellent decisions but people "your age" are all idiots) but, seriously, if you KNOW what you (don't) want, it's your body and your life.

Also worth noting - there are many thousands of children of all ages (in North America, and in other countries) who are waiting for adoption. In the event that you one day wake up and think, "Holy crap, I need to pass my mad 1337 skillz on to the next generation!" you can most certainly do so.
posted by VioletU at 9:38 AM on May 22 [5 favorites]

This happened to a friend of mine: He got married young, had kids, got a vasectomy, got divorced; then remarried, had the vasectomy reversed and had three more kids.

So I know it is possible to get the pipes working again after a vasectomy but I honestly don't know the success rate.
posted by shino-boy at 10:34 AM on May 22

I got a Mirena after my second baby...it's nice to not have to hassle about pills, but I'm really looking forward to no spotting. It's been 5 months, and it's still more days of slight spotting than not. (so, at least for me, it's feeling more like all the periods up front, instead of "no periods".) I had hardly any discomfort on insertion, but then, I'd had a couple of kids.
posted by leahwrenn at 10:37 AM on May 22

My boyfriend had a vasectomy last year, and he was surprised at how easy it was. I've never wanted children - it's something I've known all my life. I can't tell you how many people told me I would change my mind when I got older. It was really annoying!
posted by 5_13_23_42_69_666 at 1:28 PM on May 22 [1 favorite]

I absolutely, positively love my Mirena. I'm a weeny when it comes to pain and, even though I've never had kids, it was an easy insertion. I originally got the Paragard out of fear of hormones; however, it gave me cramps (and I'm a weeny when it comes to pain). I got it swapped out with literally NO pain the second time. Easy! And with insurance, cheap!
posted by samthemander at 1:30 PM on May 22

I posted essentially the same comment in 2007, but to update it:

"Well, of all the birth control methods we'd tried, my wife liked the IUD the most. Today we recommend it to friends with the disclaimer that we had only one side effect. His name is Alex, and he's going to be five in August."

My wife had a tubal ligation as part of the C-section delivery. But ultimately, we know a vasectomy is the best way to be fairly iron-clad about it.
posted by pzarquon at 2:28 PM on May 22

Just so you don't write off the shots entirely, I've been on Depo Provera for many years and I love it. I'd still do it even if my husband got a vasectomy. I used to have extremely painful periods, and it's worth it not to have them. Each shot costs me about $20 and lasts 3 months, so it's pretty cheap too. I haven't had a single complication or bad reaction. I'd switch to an IUD but I'm put off by the uncertainty of pain and whether it would suppress my periods as well.
posted by web-goddess at 8:16 PM on June 4