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  • Title: The cervical cap: a barrier contraceptive.
    Author: Hastings-Tolsma MT.
    Journal: MCN Am J Matern Child Nurs; 1982; 7(6):382-6. PubMed ID: 6813625.
    Abstract:
    The cervical cap may eventually prove to be a safe, satisfactory, noninvasive, and nonhormonal contraceptive alternative for women in the US. The cap is currently approved for investigational use only, and is available from a limited number of providers. The Prentif cavity rim cap is the most commonly used and is available in 4 sizes. The soft rubber device is thimble shaped, approximately 1 1/4 inches long, with a narrow groove along the inner surface that creates a suction seal when fitted over the cervix. The inability to match cap and cervical circumferences precisely is a recognized drawback. Theoretically, the cap alone should prevent sperm entry into the uterus, however, the use of a spermicide placed in the dome before insertion is recommended. The cap's effectiveness is not yet documented. Estimates from a 1953 study of 143 users were 92.4/100 women years of use for use effectiveness, and the theoretical effectiveness is believed to be more than 98%. Failures with the cap may result from a variety of reasons, particularly dislodgement. The advantage of the cap over other barrier methods is that it can be inserted any time prior to intercourse and left in place longer. The ideal safety period for placement has not been validated, but a range of 1-7 days has been recommended. The length of time the spermicide remains effective and the cervical effects of prolonged contact are of prime concern. The cap may be used by some women who cannot be properly fitted for a diaphragm due to vaginal or uterine anomalies. Sexual arousal and orgasmic response are reported by some cap users to be more pleasurable with the cap than with the diaphragm. Reported problems with use include discomfort during intercourse and improper fit during some days of the menstrual cycle. Contraindications for use include cervical inconsistencies, infection, allergy to the spermicide or the rubber, and inability to learn proper insertion and removal techniques. Insertion and removal may be difficult, and clients should be given sufficient time to practice. Cap placement needs to be checked manually after insertion and intercourse. With proper use, cleaning, and storage, the cap will last for several years. Instruction in use requires a significant amount of the practioner's time and methods must be sensitive to the client's needs. Attitudes of practitioners and other staff may impact on the acceptability of this method. Additional research is needed on the characteristics of cap users, partners' attitudes, the need to use spermicides, the length of time of spermicidal effectiveness and cap effectiveness rates. Further development of instructional methodologies is needed.
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