Tubal LigationvsWithdrawal
A side-by-side comparison of two birth control methods — efficacy, cost, how they work, and who shouldn't use them.
Side-by-side comparison
| Method |  Female SterilizationA permanent surgical procedure that blocks or removes the fallopian tubes to prevent pregnancy. |  WithdrawalThe man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg. |
|---|---|---|
| Efficacy | 99.5% typical use Most effective: over 99 out of 100 people successfully prevent pregnancy per year. | 80% typical use Least effective: under 90 out of 100 people successfully prevent pregnancy per year. |
| Cost | $0–$6,000 Insurance: Usually | $0 Insurance: Varies |
| Duration | Permanent | Per act |
| Reversibility | Permanent | Reversible |
| STI Protection | No | No |
| How it works | Surgical disruption (clipping, banding, cauterization, or complete removal) of the fallopian tubes prevents eggs from reaching the uterus and sperm from reaching the egg. | The man withdraws his penis from the vagina before ejaculation to keep semen out of the vagina. Pre-ejaculate may contain some sperm, which is why perfect use is not 100%. A 2024 pilot study found sperm in about 13% of pre-ejaculate samples, though roughly 75% of participants had no sperm in any sample. |
| Prescription | Required Prescription required | OTC No prescription / OTC |
| Side effects |
| None reported |
| Who shouldn't use this |
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Key differences
Female Sterilization is more effective (99.5% vs 80% typical use). Female Sterilization duration: Permanent. Withdrawal duration: Per act. Female Sterilization is permanent; Withdrawal is reversible. Female Sterilization requires a prescription; Withdrawal does not. Female Sterilization: costs $0–$6,000. Withdrawal: costs $0.