A cervical dilation procedure can be done in different ways. In the first, the physician uses a speculum to hold open the vagina (the speculum is the device that resembles the beak of a duck). The physician then inserts a thin, smooth metal rod into the vagina and up into the tiny cervical opening. The rod is briefly left in place, then taken out and replaced by a slightly larger rod.

Another way to dilate the cervix is through the use of an osmotic dilator. This is a device that absorbs moisture from the tissues around the cervix, causing it to slowly expand. The expansion of the dilator slowly opens the cervix and usually causes little discomfort.

There are two common types of osmotic dilators:

Laminaria stick: This is a small tube made of dried seaweed that is inserted into the cervix eight to 24 hours before a procedure. It usually requires a person to come in the day before their procedure to have it inserted. Most of the cervical dilation happens within the first six hours, with maximum dilation occurring 12 to 24 hours after insertion. Dilapan (synthetic dilator): This is a dry, sterile sponge that is inserted into the cervix several hours before a procedure. A synthetic dilator tends to be easier to insert and opens the cervix in less time than the laminaria method.

The Essure insert itself was threaded through the catheter and positioned in the opening of the fallopian tube. The second implant was then placed in the other fallopian tube in the same way. The entire procedure took around 10 to 30 minutes.

After having the Essure procedure, people reported symptoms such as:

Vaginal bleeding caused by the manipulation of the uterusMild to moderate pain and cramping lasting a few daysTemporary changes to the menstrual cycle (heavier or longer than normal periods, bleeding, or spotting between periods)Pelvic, abdominal, or back painRegret

Following the Essure procedure, people could resume sexual intercourse as soon as they felt up to it. However, it was essential that they used back-up birth control methods for the first three months.

It took about three months for scar tissue to build up around the Essure inserts. It was this scar tissue, not the inserts themselves, that fully blocked the fallopian tubes and prevented pregnancy.

The HSG was performed in a radiology department using a table with an X-ray machine overhead. Patients would lie on the table and place their feet in stirrups. At this time, a dye was injected through the cervix and uterus via a thin catheter. Then, an X-ray was taken to produce pictures of the uterus and fallopian tubes.

The HSG revealed whether the coil implants were in the correct position and showed if the tubes had been successfully blocked. If they were, patients no longer had to use another birth control method.

One of the disadvantages of the Essure tubal ligation procedure was the need to use an alternative birth control method for three months until scar tissue blocked the fallopian tubes.

Additionally, the Essure hysteroscopic sterilization procedure was not reversible. Because the fallopian tube tissue and coil implants grow together to create a closed passage, the micro-inserts cannot be surgically removed without damaging the fallopian tubes.

About 86 percent of these reports involved cases in which the Essure device had to be removed because of side effects and device failures. The most commonly reported issues were:

Allergic reaction to nickel in the device Chronic pain Depression/anxiety Device break-up, fragments Fatigue Hair loss Headache Heavy bleeding Irregular periods Miscarriage Perforation (the device punctured the fallopian tube or uterus) Pregnancy Rash Weight fluctuations

During tubal ligation surgery, the surgeon makes small incisions in the abdomen. They then use one of several methods to block, cut, or remove the fallopian tubes. This procedure is often done right after a person gives birth, but it can be done at any time.

As it is a truly permanent option, this method may be best suited for older persons who already have children.

There are a number of other long-term birth control options to consider. Many of these options are equally as effective as tubal ligation but are much less invasive and easily reversible.

IUDs (intrauterine devices) are an excellent “set it and forget it” option. Depending on which type you choose, they can provide anywhere from three to 12 years of pregnancy prevention. They can be removed anytime you decide to become pregnant.

The birth control implant is another option. This tiny device provides up to five years of pregnancy prevention.