Another Barrier to Pregnancy

Hey, Casanova, the cervical cap is no lemon

Though the Pill and intrauterine device are among the most effective ways of preventing pregnancy, increased concern over their side effects has led many women and their partners to switch to the less hazardous "barrier" contraceptives, the condom and diaphragm. Now interest is reviving in yet another barrier device, the centuries-old cervical cap.

Like the diaphragm, the cap works by preventing sperm from migrating from the vagina to the uterus and then to the fallopian tubes, where conception occurs. The diaphragm is a thin rubber shield held in place against the vaginal wall by the tension of its springy rim. The cap is a thicker, thimble-shaped rubber or plastic cup that fits snugly around the neck of the uterus, the cervix, and is kept in place by suction. Both devices are used with spermicidal cream or jelly.

Cervical caps have a long and colorful history. Women in the ancient Far East covered the cervix with cups molded of opium or oiled silky paper. In the 18th century, Casanova advised women to use halves of squeezed lemons. The modern version was developed in 1838 by F.A. Wilde, a German gynecologist. It gained widespread acceptance in Europe but never caught on in the U.S., although it was thought to be as reliable as the diaphragm. A major reason: Birth Control Pioneer Margaret Sanger championed the diaphragm.

The cap does have drawbacks. It can be difficult to insert and remove, especially for women with long vaginas. But the cap has a decided advantage over the diaphragm: it can be reliably left in place for several days (against hours for the diaphragm) and thus affords greater sexual spontaneity. There is even promise of a cap that could be worn for years. In Chicago Gynecologist Uwe Freese and Dentist Robert Goepp are experimenting with custom-fit devices that have a one-way valve to allow menstrual blood to escape automatically.

Feminist health clinics, which have spearheaded the revival of cervical caps, say the device has received impressive notices. Iowa City's Emma Goldman Clinic for Women has fitted 700 caps since 1978, and reports that over half the clients using barrier contraceptives select the cervical cap.

The Food and Drug Administration has designated the cap an "investigational device." Beginning this week, caps will be available only to women enrolled in research studies. The agency notes that no major published work on the caps' safety and effectiveness has appeared since 1953. Says Dr. Lillian Yin of the FDA: "We just don't know if there will be a problem with abrasion of the cervix, and we don't know what will be the rate of infection or the long-term problem with tissue erosion." But critics charge that the FDA is being overcautious. Dr. D.J. Patanelli of the National Institute of Child Health and Human Development, which will sponsor a three-year study of cap and diaphragm use in 2,400 women, finds their impatience hypocritical. Says she: "The people who are complaining are the same ones who yelled at the FDA for not requiring more studies on tampons. Either they want the FDA to protect them or they don't." qed

This file is automatically generated by a robot program, so viewer discretion is required.