Cervical Caps - Technique, Benefits, and Limitations.

Introduction

Various types of birth control methods are available these days, including oral contraceptive pills, hormonal injections, implants, condoms, diaphragm, sponges, spermicides, cervical caps, and surgery. Some barrier methods of contraception, such as condoms, also help prevent sexually transmitted infections (STIs). No birth control method can be completely perfect, but the risk of pregnancy is lower when a contraceptive is used appropriately according to the instructions. The suitable contraceptive is determined by a doctor based on convenience or comfort, duration of requirement, potential side effects, affordability, and future pregnancy plans. The cervical cap, though smaller compared to the diaphragm, fits tightly over the cervix and is one of the effective methods of contraception.

What Are Cervical Caps?

A cervical cap is a barrier contraceptive made of soft silicone (rubber-like material) designed to be placed over the cervix (opening to the vagina). It is shaped like a sailor’s hat with an upturned brim and a dome in the center. It remains in its place by suction, and a strap is designed across the dome to remove it. It prevents pregnancy by blocking the sperm from entering the uterus (womb). A German gynecologist, Frederick Adlophe Wilde, described the first cervical cap in 1838. Doctors recommend that before insertion, approximately one-third of the cap be filled with a spermicide (a cream or gel used to destroy the sperm) on the outer rim of the cap and in the portion facing the vagina to increase its effectiveness. It is available by prescription and must be fitted by a healthcare professional.

How to Use a Cervical Cap?

The modern-day cervical cap was approved by the United States Food and Drug Administration (USFDA) in 1988. It is available in different brands and sizes. It is a deep silicone cap that is inserted over the cervix before sexual intercourse, so the individual needs practice and must be comfortable using it. A healthcare professional can be consulted for guidance for the first time and subsequently used by following the instructions on the package insert label provided by the manufacturer.

• Insertion: Hands must be thoroughly washed before insertion, and the cervix is felt by inserting the finger into the vagina. A spermicide recommended by the doctor is applied in the dome area and the groove between the brim and the dome. It can be inserted in the squatting position by lying down or standing with one foot on a chair, whichever is comfortable for the individual. The lips of the vulva are separated with one hand, and the cap is held with the other hand. The cervical cap is then squeezed and slid upwards into the vagina by holding it between the thumb and first two fingers with the strap facing downwards. The cap must cover the cervix completely; it can be ensured by inserting a finger to check its position. The cervical cap is left in its position for at least six hours but not more than 48 hours after sexual intercourse. If used with a spermicide, a new dose must be applied on the cap each time after sex.

• Removal: The individual can remove the cervical cap by squatting or in any comfortable position. The finger must be hooked under the strap, the dome must be pushed up to break the suction, and the strap must be gently pulled downwards.

• After Use: Once the cervical cap is removed, it must be washed thoroughly with a gentle soap and warm water and dried completely. It can be placed back in its original container and stored away from excess heat or moisture until the next use. It can be reused for up to two years but must be checked regularly for any signs of discoloration or wear and tear. It must be inspected before insertion for any cracks or holes by filling it with water and checking for leakage. Lubricants or other disinfectants must not be used in the cervical cap as these can cause damage.

How Effective Is a Cervical Cap?

A cervical cap acts as a physical barrier between the cervix and sperm. It inhibits sperm motility and survival and also lowers the pH of the vaginal fluid. It is available in different sizes (small, medium, and large), and the effectiveness of the cervical cap depends on the size, its proper use, and insertion. If it does not fit properly, it may be less effective and can result in accidental pregnancy. Cervical caps are effective in approximately 86 percent of females who have not given birth and about 71 percent who have previously delivered. However, cervical caps do not protect from STIs and are less efficient compared to contraceptive pills, rings, patches, or intrauterine devices (IUDs).

What Are the Benefits of a Cervical Cap?

The benefits of cervical caps include:

• Cervical caps are free of hormones.

• These are reusable, small in size, and affordable.

• The individual can use cervical caps comfortably once practiced to insert them correctly.

• Pregnancy can be planned immediately after the removal.

• It can be inserted for up to six hours and does not interfere with foreplay.

What Are the Drawbacks of a Cervical Cap?

Some of the limitations or drawbacks of cervical caps include:

• Cervical caps can irritate the vagina.

• It is usually not recommended for young women or teenagers as it is difficult to insert it properly.

• Using a spermicide with the cervical cap can be messy.

• Cervical caps do not protect against sexually transmitted infections.

• It can cause cervicitis or inflammation of the cervix.

• If not removed after 48 hours or if used during the menstrual period, cervical caps can cause toxic shock syndrome (a serious condition caused by bacterial infection).

• Cervical caps may be associated with bladder or urinary tract infection risk.

• Cervical caps may not fit properly and can be less effective after a vaginal delivery because the vagina and cervix get stretched during childbirth.

Conclusion

A cervical cap is a type of contraception wherein a thin, soft, silicone circular cap is inserted over the cervix to prevent the sperm from entering the uterus. It can be left for up to six hours following sexual intercourse. When correctly used with a spermicide, a cervical cap is known to be 92 to 96 percent effective in preventing pregnancy. However, using a cervical cap requires initial guidance and has some limitations. Therefore, a healthcare provider must be consulted before using any contraceptive methods.