The cervical cap is a form of
barrier contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
. A cervical cap fits over the
cervix and blocks
sperm from entering the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
through the
external orifice of the uterus
The cervical canal is the spindle-shaped, flattened canal of the cervix, the neck of the uterus.
Anatomy
The cervical canal communicates with the uterine cavity via the internal orifice of the uterus (or internal os) and with the vagina via the ...
, called the ''os''.
Terminology
The term ''cervical cap'' has been used to refer to a number of barrier contraceptives, including the Prentif, Dumas, Vimule, and Oves devices.
In the United States, Prentif was the only brand available for several decades (Prentif was withdrawn from the U.S. market in 2005).
During this time, it was common to use the term ''cervical cap'' to refer exclusively to the Prentif brand.
The Lea's Shield was a cervical barrier device which was discontinued as of 2008. Some sources use ''cervical cap'' to refer to the FemCap and Lea's Shield.
Other sources include FemCap in the term ''cervical cap'', but classified the Lea's Shield as a distinct device.
In the 1920s, cervical caps (and also
diaphragms) were often just called ''pessaries''.
Cervical caps or conception caps have also been designed as a form of
assisted reproductive technology, used to help people experiencing infertility.
Medical use
The effectiveness of cervical caps, as with most other forms of
contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, can be assessed two ways: ''method effectiveness'' and ''actual effectiveness''. The method effectiveness is the proportion of couples correctly and consistently using the method who do not become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and do not become pregnant; it includes couples who sometimes use the method incorrectly, or sometimes not at all. Rates are generally presented for the first year of use. Most commonly the
Pearl Index
The Pearl Index, also called the Pearl rate, is the most common technique used in clinical trials for reporting the effectiveness of a birth control method. It is a very approximate measure of the number of unintended pregnancies in 100 woman-years ...
is used to calculate effectiveness rates, but some studies use
decrement table Decrement tables, also called life table methods, are used to calculate the probability of certain events.
Birth control
Life table methods are often used to study birth control effectiveness. In this role, they are an alternative to the Pearl Ind ...
s.
''Contraceptive Technology'' reports that the method failure rate of the Prentif cervical cap with spermicide is 9% per year for
nulliparous
In biology and human medicine, gravidity and parity are the number of times a woman is or has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity). These terms are usually coupled, sometimes with additional te ...
women (women who have never given birth), and 26% per year for
parous women (who have given birth).
The actual pregnancy rates among Prentif users vary depending on the population being studied, with yearly rates of 11%
to 32%
being reported. An FDA-mandated study reported failure rates: Method rate 6.4% (vs. 4.6% for the
diaphragm); Overall rate 17.4% (vs. 16.7% for the
diaphragm).
Little data is available on the effectiveness of the Oves cap and FemCap. The Oves manufacturer cites one small study of 17 users.
The FemCap website does not cite any data on the current version of the FemCap, but lists data for an older version which is no longer approved by the FDA.
The effectiveness trial of Lea's Shield was too small to determine method effectiveness. The actual pregnancy rate was 15% per year. Of the women in the trial, 85% were parous (had given birth). The study authors estimate that for nulliparous women (those who have never given birth) the pregnancy rate in typical use may be lower, around 5% per year.
Compared to other barrier methods
In the 1920s,
Marie Stopes
Marie Charlotte Carmichael Stopes (15 October 1880 – 2 October 1958) was a British author, palaeobotanist and campaigner for eugenics and women's rights. She made significant contributions to plant palaeontology and coal classification, ...
considered the cervical cap to be the best method of contraception available. Among barrier methods it provides the least intervention of a barrier surface between the penis and vagina resulting in natural contact between them. Except for the Fem-Cap, it also leaves exposed all the vaginal wall so that the hormones, etc. in the
seminal fluid
Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphroditic animals and can fertilize the female ovum. Semen is ...
of the man can be better absorbed by the woman. The
condom does not allow any absorption and the
diaphragm exposes less area. However the
condom does significantly reduce the likelihood of transmission of
STDs. The
diaphragm is inserted painlessly. It does not stretch the vagina, nor does it interfere with internal muscle movements during sex, as it is too high up in the vagina. The tip of the penis might touch the condom depending on the position and the size of the penis. Note that what Stopes calls the "Dutch cap" is today known as the "
diaphragm". A partial objection to this claim is that most women do not know how to voluntarily control these muscles, and that some size diaphragms do not stretch the vagina that much, especially if they are smaller in size The cervical cap can be worn for a significantly longer period of time than the
diaphragm. It can be inserted several hours before intercourse and used successfully even if a woman's partner is drunk, etc. Stopes concludes in favor of the cervical cap and "condemns" the
diaphragm "for general use"
Side effects
Insertion and removal
There are more complaints about difficulties in removal than difficulties with insertion. Since suction holds the cap on, it may sometimes be difficult to remove unless one knows the tricks of removal.
Marie Stopes
Marie Charlotte Carmichael Stopes (15 October 1880 – 2 October 1958) was a British author, palaeobotanist and campaigner for eugenics and women's rights. She made significant contributions to plant palaeontology and coal classification, ...
wrote that for rim caps, one should work the tip of one's finger under the rim and pull with a jerk. The idea is to release suction before pulling hard. If one's fingers are too short (and/or the vagina too long), one can use an inserter (intended for diaphragms) or have one's partner do it.
Odor
Since the cervical cap can be worn for longer periods of time than the diaphragm, it is more prone to develop odors which might begin to appear after three continuous days of wear.
Types
![Cervical Cap](https://upload.wikimedia.org/wikipedia/commons/a/ad/Cervical_Cap.png)
Several brands of caps were manufactured during the late 20th and early 21st centuries. They can be divided into two types: cavity rim caps, and other caps. Cavity rim caps adhere to the cervix, while other caps adhere to the vaginal walls around the cervix. However, the FemCap (the only cervical cap sold in the United States after 2008) adheres to both.
The cavity rim caps are Prentif, made of latex, and the disposable cap Oves, made of silicone. There are four sizes of Prentif: 22, 25, 28, and 31 mm. There are three sizes of Oves: 26, 28, and 30 mm. Unique among cervical caps, it adheres to the cervix by
surface tension, rather than by suction.
The other devices are the latex Dumas and Vimule, and the silicone FemCap, Lea's Shield, and Shanghai Lily. There are five sizes of Dumas: 50, 55, 60, 65, and 75 mm. There are three sizes of Vimule: 42, 48, and 52 mm. There are three sizes of FemCap: 22, 26, and 30 mm. There are four sizes of Shanghai Lily: 54, 58, 62, and 66 mm. Lea's Shield is manufactured in a single size. Unlike the other caps, Lea's Shield has a one-way air valve that helps it seal to the vaginal walls. The valve also allows the passage of
cervical mucus. FemCap does not have such a valve and as such can be used to collect cervical mucus to support the
Billings method. Both Lea's Shield and FemCap have loops to assist in removal.
Shanghai Lily is only available in
China.
As of 2008, many of the other devices are no longer being manufactured: Prentif, Vimule, and Dumas have been discontinued. Oves is only being sold as a
conception cap
A conception device is a medical device which is used to assist in the achievement of a pregnancy, often, but not always, by means other than sexual intercourse (natural insemination, or NI). This article deals exclusively with conception devices ...
, not as a birth control device. As of February 2009, FemCap was the only brand of cervical cap available in the United States.
FemCap is also available in the UK via the NHS on prescription and is often distributed free from Family Planning Clinics depending on the health authority.
Lea's Shield is only available as the German brand LEA contraceptivum.
FemCap
As of 2009, FemCap is the only brand available in the United States.
A new FemCap performed poorly in a user acceptability study, suggesting that the modifications increased coital pain or discomfort among female users and their male sex partners, and that the modifications did not improve ease of use overall.
[ However, FemCap users are still less likely to report such pain or discomfort than diaphragm users.
]
Sponge covered cap
A cap of the 1920'a had a sponge permanently attached to the outer surface of the cap to hold a liquid spermaticide such as vinegar. It was not as easy to clean the cap when removed, due to the sponge part.
2-part cap
This cap of the 1920s (the "Mizpah") had a separate ring (rim) which went around the base of the cervix and was worn constantly. The cap portion (which has its own ring/rim) is snapped into the base ring for use. A criticism of it was that due to the groove in the base ring (so it could attach itself to the cap part) it could not be kept perfectly clean without removing it.
Design
Height of dome
The dome of a cervical cap may be low with little air space between the dome and the cervix, or high with plenty of air space above the cervix enclosed under the dome. Stopes recommends the high dome type for the following reasons: 1. The high dome cap has room to store secretions from the uterus such as menstrual flow or flow possibly resulting from an orgasm. 2. The high dome cap is allegedly less likely to become dislodged should the penis push hard against the cervix.
Rim
Per Stopes (in the 1920s) they should be made of very pliable soft rubber which should not be wrinkled or withered.
Caps of the 1920s had three types of rims: solid rubber (like an o-ring), air-inflated rubber, or a spring encased in rubber. Stopes recommended the all-rubber cap with the solid rubber rim There is also the question as to what is the best shape of the rim cross-section so that the penis is less likely to dislodge the cap by contact with the rim. Some caps such as the Prorace, advocated by Stopes, had a wide but flat thin rim so that a penis contact would tend to push the rim against the fornix which it is already resting against.
Stopes recommendations
The type of rim cap recommended by Stopes in the 1920s with a high dome of thin rubber was experimentally revived by Lamberts in England in 1981 and called the "test cap". It came in six sizes and its light weight meant that it was not as apt to be felt during sexual activity. It was not received well. Some thought it was too flimsy and more likely to dislodge, but Stopes had (in the 1920s) claimed just the opposite for this design, as did the director of a woman's health center who tried it out.
Process
Fitting
Individuals who wish to use a cervical cap are screened by a health care provider
A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive ...
to determine if a cervical cap, or one brand of cap, is appropriate for them. If a cap is determined to be appropriate, the provider will determine the proper size. The user must be refitted after any duration of pregnancy, whether the pregnancy is aborted
Aborted is a Belgian death metal band formed in 1995 in Waregem. The group currently consists of vocalist, founder and only constant member Sven de Caluwé, guitarist Ian Jekelis, bassist Stefano Franceschini and drummer Ken Bedene. Although t ...
, miscarried, or carried to term through vaginal childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glob ...
or caesarean section.
Several factors may make a cap inappropriate for a particular woman. Women who have given birth may have scar tissue or irregularly shaped cervixes that interfere with the cap forming a good seal. For some women, available sizes of cervical caps do not provide a correct fit. Also, cavity rim caps are not recommended for women with an anteflexed uterus. In infrequent cases a woman may have a long vagina but short fingers and thus may not be able to place the cap correctly. Overall, 80% to 85% of women who want caps can be fitted without issues.[Chalker1 p.. 262]
The rim cap should be such that the rim tucks into the fornix snugly and evenly so as to maintain good suction to hold it in place.
In some countries, some devices (such as the Lea's Shield) are available without a prescription.[Summary of Safety and Effectiveness Data]
Method of use
The first step in inserting or removing a cervical cap is handwashing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the hands ...
, to avoid introducing harmful bacteria
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of prokaryotic microorganisms. Typically a few micrometr ...
into the vaginal canal. The cap is inserted prior to sexual intercourse; some sources state that insertion prior to sexual arousal decreases the risk of incorrect placement. Most sources recommend the use of spermicide
Spermicide is a contraceptive substance that destroys sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicid ...
with the cap, but some sources say spermicide use is optional.
The cap remains in the vagina for a minimum of 6 - 8 hours after the last intravaginal ejaculation
Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the male reproductory tract as a result of an orgasm. It is the final stage and natural objective of male sexual stimulation, and an essential compone ...
. It is recommended the cap be removed within 72 hours (within 48 hours is recommended in the U.S.). Other than the disposable Oves cap, cervical caps can be washed and stored for reuse. Silicone devices may be boiled to sterilize them. Reusable caps may last for one or two years.
Some caps have a pull tab for removal but it is claimed that pulling on it should not be done since it the cap tends to adhere very tightly to the cervix. Instead, putting a finger under the rim and pulling with a jerk should easily detach it.
Acceptability
It was reported in the 1980s (during the cervical cap renaissance in the U.S.) that "women overwhelmingly preferred the cap to the diaphragm". On average, women also reported an increase in libido and frequency of sex.
The Oves cap and the new version of the FemCap performed poorly in user acceptability studies. The study on the FemCap concluded that the modifications to the FemCap significantly increased pain and discomfort among female users and their male sex partners, and that the modifications decreased acceptability of the device compared with the earlier version. The study of the Oves cap reported that few women indicated that they would use the cap in the future.
A pilot study conducted in Britain prior to the Lea's Shield's approval concluded that the Lea's Shield "may be acceptable to a highly select minority of women".
As of 2002, the cervical cap was one of the least common methods of contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
in the United States. A 2002 study indicated that of sexually active American women, 0.6% are currently using either the cervical cap, contraceptive sponge
The contraceptive sponge combines barrier and spermicidal methods to prevent conception. Sponges work in two ways. First, the sponge is inserted into the vagina, so it can cover the cervix and prevent any sperm from entering the uterus. Secondly ...
, or female condom as their primary method of contraception, and fewer than 1% have ever used a cervical cap.
History
Ancient
The idea of blocking the cervix to prevent pregnancy
Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occur ...
is thousands of years old. Various cultures have used cervix-shaped devices such as oiled paper cones or lemon halves. Others made sticky mixtures that included honey
Honey is a sweet and viscous substance made by several bees, the best-known of which are honey bees. Honey is made and stored to nourish bee colonies. Bees produce honey by gathering and then refining the sugary secretions of plants (primar ...
or cedar rosin
Rosin (), also called colophony or Greek pitch ( la, links=no, pix graeca), is a solid form of resin obtained from pines and some other plants, mostly conifers, produced by heating fresh liquid resin to vaporize the volatile liquid terpene comp ...
, to be applied to the os. The modern idea of a cervical cap as a fitted device that seals itself against the vagina
In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...
l walls is of more recent origin; it emerged within the past century.
19th century
In 1838, German gynecologist
Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined ...
Friedrich Wilde created the first modern cervical cap by making custom-made rubber
Rubber, also called India rubber, latex, Amazonian rubber, ''caucho'', or ''caoutchouc'', as initially produced, consists of polymers of the organic compound isoprene, with minor impurities of other organic compounds. Thailand, Malaysia, an ...
molds of the cervix for some of his patients.[Chalker1 p. 280] These caps were probably short-lived, as uncured rubber degrades fairly quickly. An important precursor to the invention of more lasting caps was the rubber vulcanization
Vulcanization (British: Vulcanisation) is a range of processes for hardening rubbers. The term originally referred exclusively to the treatment of natural rubber with sulfur, which remains the most common practice. It has also grown to includ ...
process, patented by Charles Goodyear
Charles Goodyear (December 29, 1800 – July 1, 1860) was an American self-taught chemist and manufacturing engineer who developed vulcanized rubber, for which he received patent number 3633 from the United States Patent Office on June 15, 1844. ...
in 1844. In the 1840s or 1860s E.B. Foote, a U.S. physician claims to have invented the cervical cap but it's reported that his patent was denied since the device could be used for obscene purposes. Foote claimed that his invention was "widely counterfeited". An occlusive pessary
A pessary is a prosthetic device inserted into the vagina for structural and pharmaceutical purposes. It is most commonly used to treat stress urinary incontinence to stop urinary leakage and to treat pelvic organ prolapse to maintain the locati ...
marketed in the United States as the " womb veil" seems to have been an early form of diaphragm or cervical cap.
Over the next several decades, the cervical cap became the most widely used barrier contraceptive method in Western Europe
Western Europe is the western region of Europe. The region's countries and territories vary depending on context.
The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the ancient Mediterranean ...
and Britain. Although the diaphragm was always more popular in the United States than the cervical cap, the cap was also common.
20th century
Many designs were developed in the later 19th and early 20th century in various countries. The Vimule cap became available as early as 1927. A book by Vimule and Co., published in 1898, advertises the Vimule Cap. The Prentif brand cap was introduced in the early 1930s. The Dumas cap was initially made of plastic, and was available by the 1940s. Lamberts (Dalston) Ltd. of the UK manufactured these three cap types. Other types of caps had stems to hold them in place in the cervix; some of the stems actually extended into the uterus. These stem pessaries became precursors to the modern intrauterine device (IUD).
Margaret Sanger in the 1910s brought cervical caps to the U.S. but later on seemingly preferred the diaphragm but never repudiated the cap. This may have been influenced by her visit to the Netherlands where the diaphragm (also known as the "Dutch Cap") reigned supreme.
Use of all barrier methods, but especially cervical barriers, dropped dramatically after the 1960s introduction of the combined oral contraceptive pill
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. The pill contains two important hormones: proges ...
and the IUD. In 1976, the U.S. government enacted the Medical Device Regulation Act
The Medical Device Regulation Act or Medical Device Amendments of 1976 was introduced by the 94th Congress of the United States. Congressman Paul G. Rogers and Senator Edward M. Kennedy were the chairperson sponsors of the medical device amendme ...
. This law required all manufacturers of medical device
A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
s to provide the United States Food and Drug Administration (FDA) with data on the safety and efficacy of those devices. Lamberts (Dalston) Ltd., the only manufacturer at that time, failed to provide this information, and the FDA banned the use of cervical caps in the United States.
In the late 1970s, the FDA reclassified the cervical cap as an investigational device, and it regained limited availability. Within a few years, the FDA withdrew investigational status from the Vimule cap, following a study that associated its use with vaginal laceration
A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epid ...
s. In 1988, the then 60-year-old Prentif cap gained FDA approval. The feminist movement
The feminist movement (also known as the women's movement, or feminism) refers to a series of social movements and political campaigns for radical and liberal reforms on women's issues created by the inequality between men and women. Such ...
played a large role in re-introducing the cervical cap to the United States. One paper called its involvement at all steps of the FDA approval process "unprecedented". This renewed interest in the cervical cap has been called "The cervical cap renaissance".
Quality
In the 1920s it was reported from England that "careless and hasty construction" could sometimes be found in many brands. Some caps had a seam in the dome (two parts of it were welded together making a seam) and the seam might be defective and even contain minute perforations. Also the junction between the rim and the dome might be rough and difficult to clean. Caps that were seamless avoided the "seam" problem. It was suggested that caps should be inspected for possible defects by the user under a magnifying glass.
In popular culture
Cervical cap is very likely to be the contraceptive that maid Anna Bates buys for her mistress Lady Mary Crawley in the second episode of the fifth serie of the historical drama Downton Abbey
''Downton Abbey'' is a British historical drama television series set in the early 20th century, created and co-written by Julian Fellowes. The series first aired in the United Kingdom on ITV on 26 September 2010 and in the United States o ...
. Mary Crawley is inspired by the book ''Married Love
''Married Love or Love in Marriage'' is a book by British academic Marie Stopes. It was one of the first books openly to discuss birth control.
The book begins by stating that "More than ever to-day are happy homes needed. It is my hope that thi ...
'', from Marie Stopes
Marie Charlotte Carmichael Stopes (15 October 1880 – 2 October 1958) was a British author, palaeobotanist and campaigner for eugenics and women's rights. She made significant contributions to plant palaeontology and coal classification, ...
.What Kind Of Contraceptive Did Anna Buy For Mary On “Downton Abbey”?
(The Take)
Bibliography
*
*
*
References
External links
Cervical Barrier Advancement SocietyDiaphragms and Caps(Yahoo Group)
FemCapwebsite
website
{{DEFAULTSORT:Cervical Cap
Barrier contraception