Editing Cervical cap

{{short description|Form of barrier contraception}}
{{about|the contraceptive device|devices used to help achieve pregnancy|conception device}}
{{Infobox Birth control
|name                 = Cervical cap
|image                = Cape cervicale.jpg
|width                = 250
|caption              = Oves brand cervical cap (discontinued)
|bc_type              = Barrier
|date_first_use       = 1838
|failure_measure      = first year
|rate_type            = Pregnancy
|perfect_failure%     = Prentif, nulliparous: 9% <br>Prentif, parous: 26
|typical_failure%     = Prentif, nulliparous: 16% <br>Prentif, parous: 32% <br>Lea's Shield: 15
|duration_effect      =
|reversibility        = Immediate
|user_reminders       = Inserted with spermicide and left in place for 6 hours after intercourse
|clinic_interval      = For fitting and subsequent replacements
|STD_protection_YesNo =
|periods_advantage    =
|benefits             = Femcap may be left in place for 48 hours
|periods_disadvantage =
|weight_gain_YesNo    =
|risks                =
|medical_notes        =
}}

The '''cervical cap''' is a form of [[barrier contraception]].  A cervical cap fits over the [[cervix]] and blocks [[sperm]] from entering the [[uterus]] through the [[external orifice of the uterus]], 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.<ref name="CBAS">{{cite web|title=Cervical Caps|work=Cervical Barrier Advancement Society|date=March 2005|url=http://www.cervicalbarriers.org/information/cervicalcaps.cfm|access-date=2008-04-26|url-status=dead|archive-url=https://web.archive.org/web/20080509134032/http://www.cervicalbarriers.org/information/cervicalcaps.cfm|archive-date=2008-05-09}}</ref> In the United States, Prentif was the only brand available for several decades (Prentif was withdrawn from the U.S. market in 2005).<ref name="CBAS" />  During this time, it was common to use the term ''cervical cap'' to refer exclusively to the Prentif brand.<ref name="hatcher">{{cite book|first=R.A.|last=Hatcher|year=2000|title=Contraceptive Technology|edition=18th|publisher=Ardent Media|location=New York|isbn=0-9664902-6-6|author2=Trussel, J.|author3=Stewart, F.|display-authors=2}}{{Page needed|date=September 2011}}</ref><!--
 --><ref name="contonline">{{cite web|title=FDA Approves Lea's Shield|work=The Contraception Report|publisher=Contraception Online|date=June 2002|url=http://www.contraceptiononline.org/contrareport/article01.cfm?art=210|access-date=2008-04-26|archive-url=https://web.archive.org/web/20080428015725/http://www.contraceptiononline.org/contrareport/article01.cfm?art=210<!-- Bot retrieved archive -->|archive-date=2008-04-28}}</ref>

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.<ref name="fwhc">{{cite web|title=Cervical Cap|publisher=Feminist Women's Health Center|date=September 2006|url=http://www.fwhc.org/birth-control/capinfo.htm|access-date=2008-04-26|url-status=dead|archive-url=https://web.archive.org/web/20080416120745/http://www.fwhc.org/birth-control/capinfo.htm|archive-date=2008-04-16}}</ref><!--
 --><ref name="uc">{{cite web|title=Cervical Cap|publisher=University of Chicago Student Care Center|year=2006|url=http://scc.uchicago.edu/pdf/sex_contra_cevical_cap.pdf|access-date=2008-04-26|archive-url=https://web.archive.org/web/20061231214904/http://scc.uchicago.edu/CervicalCap.pdf|archive-date=2006-12-31}}</ref> Other sources include FemCap in the term ''cervical cap'', but classified the Lea's Shield as a distinct device.<ref name="CBAS" /><ref name="fda">{{cite web|title=Birth Control Guide|publisher=U.S. Food and Drug Administration|date=December 2003|url=https://www.fda.gov/fdac/features/1997/babytabl.html|access-date=2008-04-26|archive-date=2008-05-11|archive-url=https://web.archive.org/web/20080511175136/http://www.fda.gov/Fdac/features/1997/babytabl.html|url-status=dead}}</ref>

In the 1920s, cervical caps (and also [[Diaphragm (birth control)|diaphragms]]) were often just called ''pessaries''.{{sfn|Stopes|1924|pp=138, 160}}

Cervical caps or conception caps have also been designed as a form of [[assisted reproductive technology]], used to help people experiencing infertility.<ref>{{cite web|url=https://www.accessdata.fda.gov/cdrh_docs/pdf6/K063227.pdf|title=K063227.pdf|url-status=dead|access-date=May 25, 2021|date=March 14, 2007|archive-date=February 24, 2017|archive-url=https://web.archive.org/web/20170224130038/https://www.accessdata.fda.gov/cdrh_docs/pdf6/K063227.pdf}}</ref>{{Clarify|reason=mechanism of action etc.|date=December 2022}}

==Medical use==
The effectiveness of cervical caps, as with most other forms of [[birth control|contraception]], 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]] is used to calculate effectiveness rates, but some studies use [[decrement table]]s.

''Contraceptive Technology'' reports that the method failure rate of the Prentif cervical cap with spermicide is 9% per year for [[Parity (medicine)|nulliparous]] women (women who have never given birth), and 26% per year for [[Parity (medicine)|parous]] women (who have given birth).<!--
 --><ref name="hatcher"/>  The actual pregnancy rates among Prentif users vary depending on the population being studied, with yearly rates of 11%<ref name="eighties">{{cite journal |pmid=2664609 |year=1989 |last1=Richwald |first1=GA |last2=Greenland |first2=S |last3=Gerber |first3=MM |last4=Potik |first4=R |last5=Kersey |first5=L |last6=Comas |first6=MA |title=Effectiveness of the cavity-rim cervical cap: Results of a large clinical study |volume=74 |issue=2 |pages=143–8 |journal=Obstetrics and Gynecology}}</ref> to 32%<ref name="hatcher" /> being reported.  An FDA-mandated study reported failure rates:  Method rate 6.4% (vs. 4.6% for the [[Diaphragm (birth control)|diaphragm]]);  Overall rate 17.4% (vs. 16.7% for the [[Diaphragm (birth control)|diaphragm]]).<ref>Chalker1 ,p.182</ref>

Little data is available on the effectiveness of the Oves cap and FemCap. The Oves manufacturer cites one small study of 17 users.<ref name=ovesdata>{{Cite web |url=http://www.oves.com/english/html/medical/medical_data.htm |title=Oves Medical Data |access-date=2008-04-05 |archive-url=https://web.archive.org/web/20090214011644/http://www.oves.com/english/html/medical/medical_data.htm |archive-date=2009-02-14 |url-status=dead }}</ref> 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.<ref name=femcapfaq />

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.<ref>{{cite journal |doi=10.1016/0010-7824(96)00081-9 |title=Lea's Shield: A study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide |year=1996 |last1=Mauck |first1=Christine |last2=Glover |first2=Lucinda H. |last3=Miller |first3=Eric |last4=Allen |first4=Susan |last5=Archer |first5=David F. |last6=Blumenthal |first6=Paul |last7=Rosenzweig |first7=Bruce A. |last8=Dominik |first8=Rosalie |last9=Sturgen |first9=Kim|journal=Contraception |volume=53 |issue=6 |pages=329–35 |pmid=8773419| display-authors= 8 |doi-access=free }}</ref>

===Compared to other barrier methods===
In the 1920s, [[Marie Stopes]] considered the cervical cap to be the best method of contraception available.{{sfn|Stopes|1924|pp= 151, 162}} Among barrier methods it provides the least intervention of a barrier surface between the penis and vagina resulting in natural contact between them.{{sfn|Stopes|1924|p=138}}  Except for the Fem-Cap, it also leaves exposed all the vaginal wall so that the hormones, etc. in the [[seminal fluid]] of the man can be better absorbed by the woman.{{sfn|Stopes|1924|pp=72-3, 163, 208}}  The [[condom]] does not allow any absorption and the [[diaphragm (birth control)|diaphragm]] exposes less area.  However the [[condom]] does significantly reduce the likelihood of transmission of [[Sexually transmitted infection|STDs]].{{sfn|Stopes|1924|pp= 127-8}}  The [[diaphragm (birth control)|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 cap depending on the position and the size of the penis.  Note that what Stopes calls the "Dutch cap" is today known as the "[[diaphragm (birth control)|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 <ref>Cook, Hera.  The long sexual revolution: English women, sex, and contraception, 1800-1975.  London, Oxford University Press, 2005.  p.247</ref><ref>Chalker2, pp.123-4</ref>  The cervical cap can be worn for a significantly longer period of time than the [[diaphragm (birth control)|diaphragm]].  It can be inserted several hours before intercourse{{sfn|Stopes|1924|p=144}} and used successfully even if a woman's partner is drunk, etc.{{sfn|Stopes|1924|p=157}} Stopes concludes in favor of the cervical cap and "condemns" the [[diaphragm (birth control)|diaphragm]] "for general use" {{sfn|Stopes|1924|p=165}}

==Side effects==
===Insertion and removal===
There are more complaints about difficulties in removal than difficulties with insertion.<ref>Chalker1 p.282</ref> Since suction holds the cap on, it may sometimes be difficult to remove unless one knows the tricks of removal. [[Marie Stopes]] 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.<ref>Chalker1, p.283/</ref>

==Types==
[[File:Cervical Cap.png|thumb|left|alt=An illustration of a cervical cap and spermicidal cream|Cervical Cap]]

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&nbsp;mm.  There are three sizes of Oves: 26, 28, and 30&nbsp;mm.  Unique among cervical caps, it adheres to the cervix by [[surface tension]], rather than by suction.<ref name="CBAS"/>

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&nbsp;mm.  There are three sizes of Vimule: 42, 48, and 52&nbsp;mm.  There are three sizes of FemCap: 22, 26, and 30&nbsp;mm.  There are four sizes of Shanghai Lily: 54, 58, 62, and 66&nbsp;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]].<ref>{{cite web |url=http://ethicalfamilyplanning.com/resources/femcap/femcap_to_predict_fertility_window.php |title=Ethical Family Planning - Natural Family Planning and Sexual Health with Ethics |access-date=2010-10-12 |url-status=dead |archive-url=https://web.archive.org/web/20100816011942/http://ethicalfamilyplanning.com/resources/femcap/femcap_to_predict_fertility_window.php |archive-date=2010-08-16 }}</ref> Both Lea's Shield and FemCap have loops to assist in removal.<ref name="CBAS" />

Shanghai Lily is only available in [[People's Republic of China|China]].<ref name="CBAS" />  As of 2008, many of the other devices are no longer being manufactured: Prentif, Vimule, and Dumas have been discontinued.<ref>'''Prentif''': {{cite web | title = Birth control options: the Cedar River Clinic's Birth Control Chart | work = Women's Health Activist | publisher = AccessMyLibrary.com | date = 2007-07-01 | url = http://www.accessmylibrary.com/coms2/summary_0286-32457706_ITM | access-date = 2008-07-11 | quote = The Prentif cap is no longer being manufactured, but some clinics still have it in stock. | archive-date = 2009-02-12 | archive-url = https://web.archive.org/web/20090212165101/http://www.accessmylibrary.com/coms2/summary_0286-32457706_ITM | url-status = live }}<br />
'''Prentif, Vimule, and Dumas''': {{cite web | title = Portio Kappen | publisher = Kessel-Marketing | year = 2007 | url = http://www.kessel-marketing.de/portio_kappen.html | access-date = 2008-07-10 | quote = Prentif, Vimule und Dumas sind nicht mehr verfügbar. (Prentif, Vimule and Dumas are no longer available.) | archive-url = https://web.archive.org/web/20080423170400/http://www.kessel-marketing.de/portio_kappen.html | archive-date = April 23, 2008 }}</ref>  Oves is only being sold as a [[conception cap]], not as a birth control device.{{citation needed|date=October 2014}} As of February 2009, FemCap was the only brand of cervical cap available in the United States.<ref name="FemCapPP" />  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.<ref>{{cite web |url=http://buyfemcap.com/about.php |title=Buy FemCap .com - Online Store for FemCap - the Number 1 Cervical Cap for Hormone Free Contraception |access-date=2010-10-12 |url-status=dead |archive-url=https://web.archive.org/web/20100815052755/http://buyfemcap.com/about.php |archive-date=2010-08-15 }}</ref>
Lea's Shield is only available as the German brand LEA contraceptivum.<ref>{{Cite web |url=http://www.barriermethods.com/ |title=Barriermethods.com : Contraception with no hormon caused sideeffects because hormonfree : Diaphragm, cervical caps, lea contraceptivum, female condom ( femidom ) |access-date=2010-01-09 |archive-date=2010-04-18 |archive-url=https://web.archive.org/web/20100418050557/http://www.barriermethods.com/ |url-status=live }}</ref>

===FemCap===
As of 2009, FemCap is the only brand available in the United States.<ref name="FemCapPP">{{cite web
| url = http://www.plannedparenthood.org/health-topics/birth-control/cervical-cap-20487.htm
| title = Cervical Cap (FemCap)
| access-date = 2009-02-03
| author = Planned Parenthood
| date = 2008-05-16
| archive-date = 2009-01-22
| archive-url = https://web.archive.org/web/20090122061920/http://www.plannedparenthood.org/health-topics/birth-control/cervical-cap-20487.htm
| url-status = live
}}</ref> 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.<ref name=PMID16371297/> However, FemCap users are still less likely to report such pain or discomfort than diaphragm users.<ref>{{Cite web |url=http://www.fsrh.org/pdfs/FemCapFinalGP.pdf |title=New Product Review (October 2004) - FemCap |access-date=2018-10-02 |archive-url=https://web.archive.org/web/20110726070449/http://www.fsrh.org/pdfs/FemCapFinalGP.pdf |archive-date=2011-07-26 |url-status=dead }}</ref>

===Sponge covered cap===
A cap of the 1920s 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.{{sfn|Stopes|1924|pp=157 ff.}}

===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.{{sfn|Stopes|1924|pp=166 ff.}}

==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.{{sfn|Stopes|1924|pp= 151-4}}

===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{{sfn|Stopes|1924|pp=150–1, 156}}  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.<ref>See the diagram in Chalker2, p. 78, of the penis wedging itself between the vagina and the side of the cervix while making contact with the rim.</ref>

===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<ref>Chalker2, pp,174-5</ref> 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===
[[Image:Contraception_cape_cervicale_svg_hariadhi.svg|350px|thumb|Position of a cavity rim cap. The actual size of the cap and cervix is significantly larger than shown.<ref>Searching the Internet for anatomical images shows significantly larger cervices than shown here (in all 20+ cases).  Since the cerival cap goes around the cervix, it must be larger also.</ref>]]
Individuals who wish to use a cervical cap are screened by a [[health care provider]] 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 [[abortion|aborted]], [[miscarriage|miscarried]], or carried to term through vaginal [[childbirth]] or [[caesarean section]].<ref name="pp" />

Several factors may make a cap inappropriate for a particular woman.  Women who have given birth may have scar tissue or irregularly shaped [[cervix]]es that interfere with the cap forming a good seal.<ref name="fwhc2">{{cite web |title=Cervical Cap - Q&A |publisher=Feminist Women's Health Center |date=January 2006 |url=http://www.fwhc.org/birth-control/capinfo2.htm |access-date=2008-04-19 |url-status=dead |archive-url=https://web.archive.org/web/20071019002015/http://fwhc.org/birth-control/capinfo2.htm |archive-date=2007-10-19 }}</ref>  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.<!--
 --><ref>{{cite journal |title=Uncertainty exists on availability of cervical cap, distributor says | journal = Contracept Technol Update | volume = 10 | issue = 4 |pages=57–8 |year=1989 | pmid = 12342202 |author1=<Please add first missing authors to populate metadata.>}}</ref> In infrequent cases a woman may have a long vagina but short fingers and thus may not be able to place the cap correctly.{{sfn|Stopes|1924|pp=142-3}}  Overall, 80% to 85% of women who want caps can be fitted without issues.<ref name="Chalker1 p.. 262">Chalker1 p.. 262</ref>

The rim cap should be such that the rim tucks into the [[Vaginal fornix|fornix]] snugly and evenly so as to maintain good suction to hold it in place.<ref name="Chalker1 p.. 262"/>

In some countries, some devices (such as the Lea's Shield) are available [[Over-the-counter drug|without a prescription]].<ref name=summary>[https://www.fda.gov/cdrh/pdf/P010043b.pdf Summary of Safety and Effectiveness Data] {{webarchive |url=https://web.archive.org/web/20080912045050/https://www.fda.gov/cdrh/pdf/P010043b.pdf |date=September 12, 2008 }}</ref>

===Method of use===
The first step in inserting or removing a cervical cap is [[hand washing]], to avoid introducing harmful [[bacteria]] into the vaginal canal.<ref name="pp">{{cite web |last=Johnson |first=Jennifer |title=Diaphragm, Cervical Cap and Shield |publisher=Planned Parenthood |date= December 1, 2005  |url=http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-cervical-cap-shield-4244.htm |access-date=2008-04-19 |archive-url = https://web.archive.org/web/20080325011659/http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-cervical-cap-shield-4244.htm |archive-date = March 25, 2008}}</ref> The cap is inserted prior to [[sexual intercourse]];<ref name="CBAS" /> some sources state that insertion prior to [[sexual arousal]] decreases the risk of incorrect placement.<ref name="femcapdirections">{{cite web |title=Directions for use |publisher=FemCap |year=2007 |url=http://www.femcap.com/directions.htm |access-date=2008-04-19 |archive-url = https://web.archive.org/web/20080310075905/http://www.femcap.com/directions.htm |archive-date = March 10, 2008}}</ref>  Most sources recommend the use of [[spermicide]] with the cap,<ref name="CBAS" /><ref name="pp" /><ref name="femcapdirections" /><ref name="ovesinstructions">{{cite web |title=Instructions for Use |publisher=Veos PLC |year=2003 |url=http://www.oves.com/english/html/consumer/consumer_usage.htm |access-date=2008-04-19 |archive-url=https://web.archive.org/web/20090210040935/http://www.oves.com/english/html/consumer/consumer_usage.htm |archive-date=2009-02-10 |url-status=dead }}</ref> but some sources say spermicide use is optional.<!--
 --><ref name="fwhc2" /><ref name="fpn">{{cite web |title=Cervical Cap |work=Family Practice Notebook |year=2000 |url=http://www.fpnotebook.com/GYN11.htm |access-date=2008-04-19 |archive-url = https://web.archive.org/web/20070930023601/http://www.fpnotebook.com/GYN11.htm |archive-date = September 30, 2007}}</ref>

The cap remains in the vagina for a minimum of 6<ref name="femcapdirections" /><ref name="ovesinstructions" /> to 8<ref name="CBAS" /><ref name="fpn" /> hours after the last intravaginal [[ejaculation]]. It is recommended the cap be removed within 72 hours (within 48 hours is recommended in the U.S.).<ref name="CBAS" />  Other than the disposable Oves cap, cervical caps can be washed and stored for reuse.<ref name="fwhc"/> Silicone devices may be boiled to sterilize them.<ref name=video>{{Cite web |url=http://www.leasshield.com/images/leasvideo.mpg |title=Instructional video |access-date=2008-05-24 |archive-date=2015-10-18 |archive-url=https://web.archive.org/web/20151018194543/http://www.leasshield.com/images/leasvideo.mpg |url-status=live }}</ref>  Reusable caps may last for one<ref name="femcapfaq">{{cite web |title=Frequently Asked Questions |publisher=FemCap |year=2007 |url=http://www.femcap.com/faq.htm |access-date=2008-04-19 |url-status=dead |archive-url=https://web.archive.org/web/20080511223914/http://femcap.com/faq.htm |archive-date=2008-05-11 }}</ref> or two<ref name="pp" /> 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.{{sfn|Stopes|1924|pp= 141-2}}

==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.<ref>Chalker1 pp.281-2</ref>

The Oves cap and the new version of the FemCap performed poorly in user acceptability studies.<ref name=PMID12419058>{{cite journal |pages=188–92 |doi=10.1783/147118902101196829 |title=Oves contraceptive cap: Short-term acceptability, aspects of use and user satisfaction |year=2002 |last1=Roizen |first1=Judith |last2=Richardson |first2=Sue |last3=Tripp |first3=John |last4=Hardwicke |first4=Hilary |last5=Lam |first5=Tran Quang |journal=Journal of Family Planning and Reproductive Health Care |volume=28 |issue=4 |pmid=12419058|doi-access=free }}</ref><ref name=PMID16371297>{{cite journal |pmid=16371297 |year=2006 |last1=Mauck |first1=CK |last2=Weiner |first2=DH |last3=Creinin |first3=MD |last4=Archer |first4=DF |last5=Schwartz |first5=JL |last6=Pymar |first6=HC |last7=Ballagh |first7=SA |last8=Henry |first8=DM |last9=Callahan |first9=MM |title=FemCap with removal strap: ease of removal, safety and acceptability |volume=73 |issue=1 |pages=59–64 |doi=10.1016/j.contraception.2005.06.074 |pmc=2876188 |journal=Contraception}}</ref>  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".<ref name=PMID10023094>{{cite journal |pmid=10023094 |year=1999 |last1=Bounds |first1=W |last2=Guillebaud |first2=J |title=Lea's Shield contraceptive device: Pilot study of its short-term patient acceptability and aspects of use |volume=24 |issue=4 |pages=117–20 |journal=The British Journal of Family Planning}}</ref>

As of 2002, the cervical cap was one of the least common methods of [[contraception]] 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]], or [[female condom]] as their primary method of contraception, and fewer than 1% have ever used a cervical cap.<!--
 --><ref>{{cite journal |url=https://www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf |pmid=16532609 |year=2005 |last1=Chandra |first1=A |last2=Martinez |first2=GM |last3=Mosher |first3=WD |last4=Abma |first4=JC |last5=Jones |first5=J |title=Fertility, family planning, and reproductive health of U.S. Women: Data from the 2002 National Survey of Family Growth |issue=25 |pages=1–160 |journal=Vital and Health Statistics |series=Series 23, Data from the National Survey of Family Growth |access-date=2017-09-09 |archive-date=2007-06-30 |archive-url=https://web.archive.org/web/20070630135904/http://www.cdc.gov/nchs/data/series/sr_23/sr23_025.pdf |url-status=live }} See Table 53 and 56.</ref>

==History==

===Ancient===
The idea of blocking the cervix to prevent [[pregnancy]] 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]] or cedar [[rosin]], to be applied to the [[External orifice of the uterus|os]].<ref name="pp2">{{cite web|title=A History of Birth Control Methods |work=Planned Parenthood |date=June 2002 |url=http://www.plannedparenthood.org/resources/research-papers/bc-history-6547.htm |access-date=2006-07-05 |url-status=dead |archive-url=https://web.archive.org/web/20080517045452/http://www.plannedparenthood.org/resources/research-papers/bc-history-6547.htm |archive-date=May 17, 2008 }}</ref>  The modern idea of a cervical cap as a fitted device that seals itself against the [[vagina]]l walls is of more recent origin; it emerged within the past century.

===19th century===
In 1838, German [[gynecologist]] [[Friedrich Wilde]] created the first modern cervical cap by making custom-made [[rubber]] molds of the cervix for some of his patients.<ref name="pp2" /><ref name="Chalker1 p. 280">Chalker1 p. 280</ref> 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]] process, patented by [[Charles Goodyear]] in 1844.  In the 1840s or 1860s [[Edward Bliss Foote|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.<ref name="Chalker1 p. 280"/>  Foote claimed that his invention was "widely counterfeited".  An occlusive [[pessary]] marketed in the United States as the "[[womb veil]]" seems to have been an early form of [[diaphragm (contraceptive)|diaphragm]] or cervical cap.<ref>Janet Farrell Brodie, ''Contraception and Abortion in Nineteenth-Century America'' (Cornell University Press, 1994), p. 216 [https://books.google.com/books?id=Wbeoi0rGvpkC&pg=PA216&q=%22womb%20veil online]; Andrea Tone, ''Devices and Desires: A History of Contraceptives in America'' (MacMillan, 2001), p. 14.</ref>

Over the next several decades, the cervical cap became the most widely used barrier contraceptive method in [[Western Europe]] and Britain. Although the [[Diaphragm (birth control)|diaphragm]] was always more popular in the United States than the cervical cap, the cap was also common.<ref name="weiss">{{cite journal |pmid=1990736 |year=1991 |last1=Weiss |first1=BD |last2=Bassford |first2=T |last3=Davis |first3=T |title=The cervical cap |volume=43 |issue=2 |pages=517–23 |journal=American Family Physician}}</ref>

===20th century===
Many designs were developed in the later 19th and early 20th century in various countries.{{sfn|Stopes|1924|p= 156}}  The Vimule cap became available as early as 1927.  A book by Vimule and Co., published in 1898, advertises the Vimule Cap.<ref>{{cite web |title=the Vimule permanent sheath, as purveyed by Lamberts of London, 1927 |work=Condom pictures |url=http://www.lesleyahall.net/condillo.htm |access-date=2006-11-12 |archive-date=2006-11-12 |archive-url=https://web.archive.org/web/20061112220926/http://www.lesleyahall.net/condillo.htm |url-status=live }}</ref> The Prentif brand cap was introduced in the early 1930s.<ref>{{cite journal |title=Cervical Cap Newsletter |publisher=Internet Archive |date=Winter 2002 |url=http://www.cervcap.com/download/news_winter_02.pdf  |access-date=2007-07-22 |archive-url=https://web.archive.org/web/20040225153945/http://www.cervcap.com/download/news_winter_02.pdf |archive-date=2004-02-25 |journal=CXC |volume=15 |url-status=usurped |issue=1}}</ref>  The Dumas cap was initially made of plastic, and was available by the 1940s.<ref>{{cite journal |pmid=12233290 |year=1944 |last1=Grafenberg |first1=E |last2=Dickinson |first2=RL |title=Conception control by plastic cervix cap |volume=12 |issue=8 |pages=335–40 |journal=Western Journal of Surgery, Obstetrics, and Gynecology}}</ref> Lamberts (Dalston) Ltd. of the UK manufactured these three cap types.<ref>{{cite web |title=96/281/2 Contraceptive cervical cap, "Vimule" cap |work=Powerhouse Museum Collection |year=1995 |url=http://www.powerhousemuseum.com/collection/database/?irn=152305&images=&c=&s= |access-date=2006-11-12 |archive-date=2007-09-27 |archive-url=https://web.archive.org/web/20070927204600/http://www.powerhousemuseum.com/collection/database/?irn=152305&images=&c=&s= |url-status=live }}</ref> 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 pessary|stem pessaries]] became precursors to the modern [[intrauterine device]] (IUD).

[[Margaret Sanger]] brought cervical caps to the U.S. in the 1910s, but later on seemingly preferred the [[diaphragm (contraceptive)|diaphragm]], and 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]] and the IUD. In 1976, the [[U.S. government]] enacted the [[Medical Device Regulation Act]]. This law required all manufacturers of [[medical device]]s to provide the United States [[Food and Drug Administration|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.<ref name="weiss" />

In the late 1970s, the FDA reclassified the cervical cap as an [[Investigational device exemption|investigational device]], and it regained limited availability.<ref>{{cite journal |pmid=7018094 |year=1980 |last1=Fairbanks |first1=B |last2=Scharfman |first2=B |title=The cervical cap: Past and current experience |volume=5 |issue=3 |pages=61–80 |journal=Women & Health |doi=10.1300/j013v05n03_06}}</ref> Within a few years, the FDA withdrew investigational status from the Vimule cap, following a study that associated its use with vaginal [[laceration]]s.<ref name="weiss" /><ref>{{cite journal |doi=10.1016/0010-7824(82)90143-3 |title=Studies of cervical caps: I. Vaginal lesions associated with use of the vimule cap |year=1982 |last1=Bernstein |first1=Gerald S. |last2=Kilzer |first2=Linda H. |last3=Coulson |first3=Anne H. |last4=Nakamura |first4=Robert M. |last5=Smith |first5=Grace C. |last6=Bernstein |first6=Ruth |last7=Frezieres |first7=Ron |last8=Clark |first8=Virginia A. |last9=Coan |first9=Carl |journal=Contraception |volume=26 |issue=5 |pages=443–56 |pmid=7160179}}</ref> In 1988, the then 60-year-old <ref>Chalker2, p.170</ref> Prentif cap gained FDA approval.<ref>{{cite journal |pmid=12289360 |year=1988 |author1=United States. Food and Drug Administration FDA |title=Notice, 11 July 1988 |volume=15 |pages=19 |journal=Annual Review of Population Law}}</ref>  The [[feminist movement]] 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".<ref>{{cite journal |doi=10.1300/J013v15n02_07 |title=Feminism and Regulation Collide |year=1989 |last1=Gallagher |first1=Dana |last2=Richwald |first2=Gary |journal=Women & Health |volume=15 |issue=2 |pages=87–97|pmid=2781812 }}</ref>  This renewed interest in the cervical cap has been called "The cervical cap renaissance".<ref>Chalker1, p.281</ref>

===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.{{sfn|Stopes|1924|pp= 151,154}}

==In popular culture==
A cervical cap is very likely the contraceptive that maid Anna Bates buys for her mistress Lady Mary Crawley in the second episode of the fifth series of the period drama [[Downton Abbey]]. Mary Crawley is inspired by the book ''[[Married Love]]'', from [[Marie Stopes]].<ref>[https://the-take.com/read/what-kind-of-contraceptive-did-anna-buy-for-mary-on-downton-abbey What Kind Of Contraceptive Did Anna Buy For Mary On “Downton Abbey”?] (The Take)</ref>

==Bibliography==

* {{cite book|last=Chalker|first=Rebecca|chapter=Recent experience with the cervical cap in the United States|editor=Runnebaum|display-editors=etal|title=Female Contraception, Update and Trends|publisher=Springer-Verlag|year=1988|pages=280–285}}
* {{cite book|last=Chalker|first=Rebecca|title=The complete cervical cap guide|publisher=Harper & Row|year=1987}}
* {{cite book|author-link=Marie Stopes|last=Stopes|first=Marie|title=Contraception (birth control), its theory, history and practice|location=London|publisher=John Bale, Sons & Danielsson, limited|year=1924}}

==References==
{{reflist}}

==External links==
*[https://web.archive.org/web/20061004052132/http://cervicalbarriers.org/ Cervical Barrier Advancement Society]
*[https://groups.yahoo.com/group/DiaphragmsAndCaps Diaphragms and Caps] (Yahoo Group)
*[http://www.femcap.com/ FemCap] website
*[https://web.archive.org/web/20080416052340/http://www.oves.com/english/index.htm Oves] website

{{Birth control methods}}

{{DEFAULTSORT:Cervical Cap}}
[[Category:Barrier contraception]]