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Tubal Ligation vs Withdrawal

A side-by-side comparison of two birth control methods — efficacy, cost, how they work, and who shouldn't use them.

Last verified October 11, 2026Updated October 11, 2026

Side-by-side comparison

Female Sterilization A permanent surgical procedure that blocks or removes the fallopian tubes to prevent pregnancy.
Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.

Method	Female Sterilization A permanent surgical procedure that blocks or removes the fallopian tubes to prevent pregnancy.	Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.
Efficacy	Female Sterilization 99.5% typical use Most effective: over 99 out of 100 people successfully prevent pregnancy per year.	Withdrawal 80% typical use Least effective: under 90 out of 100 people successfully prevent pregnancy per year.
Cost	Female Sterilization $0–$6,000 Insurance: Usually	Withdrawal $0
Duration	Female Sterilization Permanent	Withdrawal Per act
Reversibility	Female Sterilization Permanent	Withdrawal Reversible
STI protection	Female Sterilization No	Withdrawal No
How it works	Female Sterilization Surgical disruption (clipping, banding, cauterization, or complete removal) of the fallopian tubes prevents sperm from reaching the egg.	Withdrawal The man withdraws his penis from the vagina before ejaculation to keep semen out of the vagina. Pre-ejaculate may contain some sperm. 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	Female Sterilization Required In-Person Procedure	Withdrawal Not required Self-Directed
Side effects	Female Sterilization Surgical risks (bleeding, infection, organ damage) Anesthesia side effects Ectopic pregnancy (a serious risk if pregnancy occurs after the procedure)	Withdrawal None reported
Who shouldn't use this	Female Sterilization Medical instability for general anesthesia or laparoscopy Uncertainty about future fertility desires Known allergy or hypersensitivity to materials used in the procedure	Withdrawal Partner unable to withdraw consistently before ejaculation Need for highly effective contraception

Key differences

With typical use, 0.5 in 100 people using Female Sterilization get pregnant in a year, vs 20 in 100 with Withdrawal (most effective vs least effective). How long it lasts: Female Sterilization, permanent; Withdrawal, per act. Female Sterilization: permanent. Withdrawal: reversible. A prescription is needed for Female Sterilization, not for Withdrawal. Female Sterilization: costs $0–$6,000. Withdrawal: costs $0.