larrabee@decwrl.UUCP (10/03/86)
In article <11800001@hplsla.UUCP> daved@hplsla.UUCP (daved) writes: >Does anyone know what cervical caps are? My closest guess is that they are >actually diaphragms, but the "NO chemical" quailifier seems to cut them >out (unless the spermicidal adhesive isn't being considered a chemical). >If cervical caps are something new (..yet old..) how effective are they? This is long, but the sections have headings. Skip ahead to sections of How to use, or disadvantages, or effectiveness if you feel like it. (No time or patience to proof read: you get my raw typing.) This is from "The New Our Bodies, Our Selves" (copyright 1984) from the chapter on Birth Control: THE CERVICAL CAP The cervical cap is a barrier contraceptive which may soon be more widely available in the United States. It is a thimble-shaped rubber or plastic cap that fits snugly over the cervix. Like the diaphragm, it blocks sperm from entering the cervical opening. usually, a small amount of spermicide is used on the inside of the cap to kill any sperm that might break through to suction seal. Used in some European countries, the cap was also used during the early twentieth century in the U.S.* (*footnote: The idea of the cervical cap is thousands of years old. In ancient Sumatra, women molded opium into cuplike devices to cover their cervices. See Seaman and Seaman, *Women and the Crisis in Sex Hormones*, p. 190) With the rise in the use of the Pill and IUD, the cervical cap, like the diaphragm, declined in popularity. By the mid-1960's, U.S. companies had completely stopped producing it for contraceptive purposes. Although the cap is an "investigational" device not yet approved by the FDA for general contraceptive use, it is, however, available in the United States in major metropolitan areas as of late 1982. Some practitioners participating in FDA-approved studies currently import the cap from England. Although we clearly need more data on the effectiveness and long-term safety of the cap, it is ironic that a device which is probably very safe should be so much harder to get than the more dangerous Pill and IUD. DESCRIPTION By far the most commonly used cervical cap is called the Prentif cavity rim, made of flexible rubber. It looks somewhat like a thimble with a rim and fits over the cervix the same way a thimble fits over your finger. It is about one and a half inches long and covers almost the entire cervix. Since cervices are different sizes, this rubber cap comes in four different sizes, from twenty-two millimeters to thirty-one millimeters in diameter (less than one inch to about one and a quarter inches). Other kinds of caps are the vault (or Dumas) cap and the Vimule cap* (*footnote: Some practitioners have noticed that the Vimule cap, with its flanged rim, has caused small lacerations or abrasions around the cervix. This alarming news may be a good reason tnot to use the Vimule cap at all. In February 1983, the FDA requestied that any woman fitted with a Vimule be notified of this possible adverse effect and be reexamined by her practitioner.). These variations are used mainly when a woman cannot get a good fit with the Prentif cervical cap. (The information below is about the Prentif cervical cap, unless another type is specifically mentioned.) HOW IT WORKS Like other barrier methods, the cervical cap keeps sperm out of the uterus. The cap is desiged to create an almost airtight seal around the cervical opening(os). Suction, or "surface tension," hugs it close to the cervix, and sperm can't swim past the edge of the cap the way they can with the diaphragm. The spermicide both inactivates sperm and strengthens the suction seal between the cap and the cervix. EFFECTIVENESS Only a few studies have been done on the cervical cap. The newest edition of *Contraceptive Technology* lists a *theoretical* failure rate of 2 percent and an *actual failure rate of 13 percent. A certain percentage of failures may be due to the cap being dislodged during intercourse by the penis thrusting against the cervix. HOW TO GET THE CAP You can get a list of practitioners and clinics which fit cervical caps from tNew Hampshire Feminist Health Cente, 38 South Main Street, Concord, NH 03301 (603) 428-2253. The Cervical cap must be fitted to your cervix by a trained practitioner. One of the different models will usually fit a particular woman, but the practitioner may not have all of them in stock. Whenever you are fitted for a cap, be sure that the practitioner gives you time to try inserting and removing it. A cervical cap is somewhat more difficult to use than a diaphragm, since you have to be able to reach your cervix with your fingers to put the cap into place. With practice it becomes easy for most women. HOW TO USE THE CAP Most health workers advise using a small amount of spermicidal jelly or cream. Practitioners debate the amount. Some think the cap should be filled one-third full; others, two-thirds full. If you use too much, it may break the suction. The spermicide should be spread around the inside of the cap up to the rim. You may insert the cap hours or even a day or two before intercourse or vagina-to-penis contact. There is no reliable data to indicate how long a cap remains effective. Some women prefer replacing spermicide each day, just in case. You *must* keep the cap in place for eight to twelve hourse after intercourse. Douching is unnecessary, but in any case, never douche while the cap is in place, since this could dilute the spermicidal jelly or cream. For backup, some women insert cream or jelly into their vagina one-half to one hour before removing the cap. Practitioners debate how often to remove the cap. They generally advise removing it after no more than three days, partly because strong odors tend to develop after that. Many women remove the cap once a day or every other day to allow cervical secretions to flow freely. This may help prevent infections and toxic shock syndrome (*footnote: Some researchers have found high concentreations of *Staphylococcus aureus*, the bacteria involved in toxic shock syndrome, in women who have left the cap in for three days or more.). During your period, remove the cap for twelve hours in rubbing alcohol, water and vinegar, lemon juice. After soaking, rinse and dry the cap before using. For a month or two after you start using the cap, and whenever you have intercourse with a new partner4, use extra spermicide in your vagina or have your partner use a condom for extra protection. Especially if the cap doesn't fit exactly right, and depending on the angle of penetration and your particular anatomy, the cap can become dislodged when a man's penis thrusts against your cervix. Since you might not feel this, check the cap with your finger after intercourse; if it is out of place, put in extra cream or jelly. You may have to see if a different-size cap fits better or switch to a diaphragm. WHO SHOULDN'T USE THE CERVICAL CAP Many women, even those who can't wear the diaphragm, can use the cervical cap, but the existing sizes may not fit all women. If you have a cervical erosion or laceration, you shouldn't use the cap, since it doesn't allow the free flow of cervical secretions, which may be a cause of irritation. If your cervix is very long or of an irregular shape, you may not be able to use the rubber cap, but will probably be able to wear the vault or Vimule caps. Also, it is possible for a woman's vagina to be so long that she can't reach deep enough inside to place or remove the cap easily. A cap inserter would solve this problem and may be developed in the near future. Other reasons for not using the cervical cap are the same for not using the diaphragm (see [appropriate section in book]). ADVANTAGES When used properly, the cap is very effective and you can insert it long before intercourse, which means it need not interfere with lovemaking. The cap itselfe is relatively inexpensive, costing between seven and ten dollars, but the fee for the initial fitting can be high in order to pay costs of research required by the FDA. Since it requires so little spermicide, it's less messy than the diaphragm, and one tube will go a long way. Like the diaphragm, the cap helps us get to know our bodies better. DISADVANTAGES The cap is not widely available, so depending on where you live, it may be difficult to obtain. The cap may cause an unpleasant odor if you don't remove it fairly often. Some women dislike the idea of trapping cervical secretions for as long as the cap is worn, because this may lead to infections. A few health workers wonder if the constant cervical contactwith rubber might be harmful, causing cervical erosions or irritations. Recent studies have demonstrated no such changes as measured by repeated Pap smears. Occasionally a partner feels discomfort if his penis hits the rim of the cap during intercourse. You mhave to keep checking the cap carefully to feel whether it has become dislodged. If the airtight seal is broken, the cap's effectiveness is reduced.