Cervical cap

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.

Cervical cap
Cape cervicale
Oves brand cervical cap (discontinued)
Background
TypeBarrier
First use1838
Pregnancy rates (first year)
Perfect usePrentif, nulliparous: 9%
Prentif, parous: 26%
Typical usePrentif, nulliparous: 16%
Prentif, parous: 32%
Lea's Shield: 15%
Usage
ReversibilityImmediate
User remindersInserted with spermicide and left in place for 6 hours after intercourse
Advantages and disadvantages
BenefitsFemcap may be left in place for 48 hours

Terminology

The term cervical cap has been used to refer to a number of barrier contraceptives, including the Prentif, Dumas, Vimule, and Oves devices.[1] In the United States, Prentif was the only brand available for several decades (Prentif was withdrawn from the U.S. market in 2005).[1] During this time, it was common to use the term cervical cap to refer exclusively to the Prentif brand.[2][3]

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.[4][5] Other sources include FemCap in the term cervical cap, but classified the Lea's Shield as a distinct device.[1][6]

In the 1920s cervical caps (and also diaphragms) were often just called pessaries [7]

Cervical caps or conception caps have also been designed as a form of assisted reproductive technology, used to help people experiencing infertility.[8]

Medical use

The effectiveness of cervical caps, as with most other forms of 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 tables.

Contraceptive Technology reports that the method failure rate of the Prentif cervical cap with spermicide is 9% per year for nulliparous women (women who have never given birth), and 26% per year for parous women (who have given birth).[2] The actual pregnancy rates among Prentif users vary depending on the population being studied, with yearly rates of 11%[9] to 32%[2] being reported. An FDA-mandated study reported failure rates: Method rate 6.4% (vs. 4.6% for the diaphragms); Overall rate 17.4% (vs. 16.7% for the diaphragm).[10]

Little data is available on the effectiveness of the Oves cap and Femcap. The Oves manufacturer cites one small study of 17 users.[11] 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.[12]

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.[13]

Compared to other barrier methods

In the 1920s, Marie Stopes considered the cervical cap to be the best method of contraception available.[14] Among barrier methods it provides the least intervention of a barrier surface between the penis and vagina resulting in natural contact between them.[15] 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.[16] The condom doesn't allow any absorption and the diaphragm exposes less area. However the condom does significantly reduce the likelihood of transmission of STDs.[17] The diaphragm may significantly stretch the vagina. While this may be unwholesome in itself it also interferes with certain desirable internal muscle movements of the woman (for the man's benefit) during the sex act.[18] A partial objection to this claim is that most women don't know how to voluntarily control these muscles, and that some size diaphragms don't stretch the vagina that much, especially if they are smaller in size [19][20] The cervical cap can be worn for a significantly longer period of time than the diaphragm. It can be inserted several hours before bedtime [21] and used successfully even if a woman's husband is drunk, etc.[22] Stopes concludes in favor of the cervical cap and "condemns" the diaphragm "for general use" [23]

Side effects

Insertion and removal

There are more complaints about difficulties in removal than difficulties with insertion.[24] Since suction holds the cap on, it may sometimes be difficult to remove unless one know 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 male partner do it.

Odor

Since the cervical cap can be worn of longer periods of time than the diaphragm, it is more prone to develop odors which might begin to appear after 3 continuous days of wear.[25]

Types

Cervical Cap
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 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.[1]

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.[26] Both Lea's Shield and FemCap have loops to assist in removal.[1]

Shanghai Lily is only available in China.[1] As of 2008, many of the other devices are no longer being manufactured: Prentif, Vimule, and Dumas have been discontinued.[27] Oves is only being sold as a conception cap, not as a birth control device. As of February 2009, FemCap was the only brand of cervical cap available in the United States.[28] 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.[29] Lea's Shield is only available as the German brand LEA contraceptivum.[30]

FemCap

FemCap as of 2009, is the only brand available in the United States.[28] 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.[31] However, FemCap users are still less likely to report such pain or discomfort than diaphragm users.[32]

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.[33]

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.[34]

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.[35]

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[36] 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.[37]

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[38] 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

Contraception cape cervicale
Position of a cavity rim cap. The actual size of the cap and cervix is significantly larger than shown.[39]

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 aborted, miscarried, or carried to term through vaginal childbirth or caesarean section.[40]

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.[41] 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.[42] In infrequent cases a woman may have a long vagina but short fingers and thus may not be able to place the cap correctly.[43] Overall, 80% to 85% of women who want caps can be fitted without issues.[44]

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.[44]

Some races may have much larger cervices than others. Jewish women in England in the 1920s were found to need extra-large cervical caps.[45]

In some countries, some devices (such as the Lea's Shield) are available without a prescription.[46]

Method of use

The first step in inserting or removing a cervical cap is handwashing, to avoid introducing harmful bacteria into the vaginal canal.[40] The cap is inserted prior to sexual intercourse;[1] some sources state that insertion prior to sexual arousal decreases the risk of incorrect placement.[47] Most sources recommend the use of spermicide with the cap,[1][40][47][48] but some sources say spermicide use is optional.[41][49]

The cap remains in the vagina for a minimum of 6[47][48] - 8[1][49] 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.)[1] Other than the disposable Oves cap, cervical caps can be washed and stored for reuse.[4] Silicone devices may be boiled to sterilize them.[50] Reusable caps may last for one[12] or two[40] years.

Some caps have a pull tab for removal but it's 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.[51]

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.[52]

The Oves cap and the new version of the Femcap performed poorly in user acceptability studies.[53][31] 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".[54]

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.[55]

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 os.[56] The modern idea of a cervical cap as a fitted device that seals itself against the vaginal 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.[56][57] 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 1860's 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.[57] 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 or cervical cap.[58]

Over the next several decades, the cervical cap became the most widely used barrier contraceptive method in Western Europe and Britain. Although the diaphragm was always more popular in the United States than the cervical cap, the cap was also common.[59]

20th century

Many designs were developed in the later 19th and early 20th century in various countries.[60] The Vimule cap became available as early as 1927. A book by Vimule and Co., published in 1898, advertises the Vimule Cap.[61] The Prentif brand cap was introduced in the early 1930s.[62] The Dumas cap was initially made of plastic, and was available by the 1940s.[63] Lamberts (Dalston) Ltd. of the UK manufactured these three cap types.[64] 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.

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 and the intrauterine device (IUD). In 1976, the U.S. government enacted the Medical Device Regulation Act. This law required all manufacturers of medical devices 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.[59]

In the late 1970s, the FDA reclassified the cervical cap as an investigational device, and it regained limited availability.[65] Within a few years, the FDA withdrew investigational status from the Vimule cap, following a study that associated its use with vaginal lacerations.[59][66] In 1988, the then 60-year-old [67] Prentif cap gained FDA approval.[68] 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."[69] This renewed interest in the cervical cap has been called "The cervivcal cap renaissance".[70]

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 (2 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 (difficult to clean). Caps that were seamless avoided the "seam" problem. It was suggested that caps should be inspected for possible defects by the woman user under a magnifying glass.[71]

Bibliography

  • 1.Chalker, R.: Recent experience with the cervical cap in the United States. in Runnebaum, et al.: Female Contraception, Update and Trends. Springer-Verlang, 1988, pp. 280–285
  • 2.Chalker, Rebecca: The complete cervical cap guide. Harper & Row, 1987,
  • Stopes, Marie: Contraception (birth control), its theory, history and practice. London. John Bale, Sons & Danielsson, limited, 1924.

References

  1. ^ a b c d e f g h i j "Cervical Caps". Cervical Barrier Advancement Society. March 2005. Archived from the original on 2008-05-09. Retrieved 2008-04-26.
  2. ^ a b c Hatcher, RA; Trussel J; et al. (2000). Contraceptive Technology (18th ed.). New York: Ardent Media. ISBN 0-9664902-6-6.
  3. ^ "FDA Approves Lea's Shield". The Contraception Report. Contraception Online. June 2002. Archived from the original on 2008-04-28. Retrieved 2008-04-26.
  4. ^ a b "Cervical Cap". Feminist Women's Health Center. September 2006. Archived from the original on 2008-04-16. Retrieved 2008-04-26.
  5. ^ "Cervical Cap" (PDF). University of Chicago Student Care Center. 2006. Retrieved 2008-04-26.
  6. ^ "Birth Control Guide". U.S. Food and Drug Administration. December 2003. Retrieved 2008-04-26.
  7. ^ Stopes pp.138, 160
  8. ^ http://www.fda.gov/cdrh/pdf6/K063227.pdf
  9. ^ Richwald, GA; Greenland, S; Gerber, MM; Potik, R; Kersey, L; Comas, MA (1989). "Effectiveness of the cavity-rim cervical cap: Results of a large clinical study". Obstetrics and Gynecology. 74 (2): 143–8. PMID 2664609.
  10. ^ Chalker1 ,p.182
  11. ^ "Oves Medical Data". Archived from the original on 2009-02-14. Retrieved 2008-04-05.
  12. ^ a b "Frequently Asked Questions". FemCap. 2007. Archived from the original on 2008-05-11. Retrieved 2008-04-19.
  13. ^ Mauck, Christine; Glover, Lucinda H.; Miller, Eric; Allen, Susan; Archer, David F.; Blumenthal, Paul; Rosenzweig, Bruce A.; Dominik, Rosalie; et al. (1996). "Lea's Shield®: A study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide". Contraception. 53 (6): 329–35. doi:10.1016/0010-7824(96)00081-9. PMID 8773419.
  14. ^ Stopes pp. 151, 162
  15. ^ Stopes p.138
  16. ^ Stopes pp.72-3, 163, 208
  17. ^ Stopes pp. 127-8
  18. ^ Stopes pp.162-3. Note that what Stopes calls the "Dutch cap" is today known as the "diaphragm".
  19. ^ Cook, Hera. The long sexual revolution: English women, sex, and contraception, 1800-1975. London, Oxford University Press, 2005. p.247
  20. ^ Chalker2, pp.123-4
  21. ^ Stopes p.144
  22. ^ Stopes p.157
  23. ^ Stopes p.165
  24. ^ Chalker1 p.282
  25. ^ Chalker1, p.283/
  26. ^ "Archived copy". Archived from the original on 2010-08-16. Retrieved 2010-10-12.CS1 maint: Archived copy as title (link)
  27. ^ Prentif: "Birth control options: the Cedar River Clinic's Birth Control Chart". Women's Health Activist. AccessMyLibrary.com. 2007-07-01. Retrieved 2008-07-11. The Prentif cap is no longer being manufactured, but some clinics still have it in stock.
    Prentif, Vimule, and Dumas: "Portio Kappen". Kessel-Marketing. 2007. Archived from the original on April 23, 2008. Retrieved 2008-07-10. Prentif, Vimule und Dumas sind nicht mehr verfügbar. (Prentif, Vimule and Dumas are no longer available.)
  28. ^ a b Planned Parenthood (2008-05-16). "Cervical Cap (FemCap)". Retrieved 2009-02-03.
  29. ^ "Archived copy". Archived from the original on 2010-08-15. Retrieved 2010-10-12.CS1 maint: Archived copy as title (link)
  30. ^ http://www.barriermethods.com/
  31. ^ a b Mauck, CK; Weiner, DH; Creinin, MD; Archer, DF; Schwartz, JL; Pymar, HC; Ballagh, SA; Henry, DM; Callahan, MM (2006). "FemCap™ with removal strap: ease of removal, safety and acceptability". Contraception. 73 (1): 59–64. doi:10.1016/j.contraception.2005.06.074. PMC 2876188. PMID 16371297.
  32. ^ "New Product Review (October 2004) - FemCap" (PDF). Archived from the original (PDF) on 2011-07-26. Retrieved 2018-10-02.
  33. ^ Stopes p. 157+
  34. ^ Stopes p166+
  35. ^ Stopes pp. 151-4
  36. ^ Stopes pp.150–1, 156
  37. ^ 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.
  38. ^ Chalker2, pp,174-5
  39. ^ 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.
  40. ^ a b c d Johnson, Jennifer (December 1, 2005). "Diaphragm, Cervical Cap and Shield". Planned Parenthood. Archived from the original on March 25, 2008. Retrieved 2008-04-19.
  41. ^ a b "Cervical Cap - Q&A". Feminist Women's Health Center. January 2006. Archived from the original on 2007-10-19. Retrieved 2008-04-19.
  42. ^ <Please add first missing authors to populate metadata.> (1989). "Uncertainty exists on availability of cervical cap, distributor says". Contracept Technol Update. 10 (4): 57–8. PMID 12342202.
  43. ^ Stopes p.142-3
  44. ^ a b Chalker1 p.. 262
  45. ^ Stopes pp. 155-6, 191
  46. ^ Summary of Safety and Effectiveness Data Archived September 12, 2008, at the Wayback Machine
  47. ^ a b c "Directions for use". FemCap. 2007. Archived from the original on March 10, 2008. Retrieved 2008-04-19.
  48. ^ a b "Instructions for Use". Veos PLC. 2003. Archived from the original on 2009-02-10. Retrieved 2008-04-19.
  49. ^ a b "Cervical Cap". Family Practice Notebook. 2000. Archived from the original on September 30, 2007. Retrieved 2008-04-19.
  50. ^ Instructional video
  51. ^ Stopes pp. 141-2
  52. ^ Chalker1 pp.281-2
  53. ^ Roizen, Judith; Richardson, Sue; Tripp, John; Hardwicke, Hilary; Lam, Tran Quang (2002). "Oves® contraceptive cap: Short-term acceptability, aspects of use and user satisfaction". Journal of Family Planning and Reproductive Health Care. 28 (4): 188–92. doi:10.1783/147118902101196829. PMID 12419058.
  54. ^ Bounds, W; Guillebaud, J (1999). "Lea's Shield contraceptive device: Pilot study of its short-term patient acceptability and aspects of use". The British Journal of Family Planning. 24 (4): 117–20. PMID 10023094.
  55. ^ Chandra, A; Martinez, GM; Mosher, WD; Abma, JC; Jones, J (2005). "Fertility, family planning, and reproductive health of U.S. Women: Data from the 2002 National Survey of Family Growth" (PDF). Vital and Health Statistics. Series 23, Data from the National Survey of Family Growth (25): 1–160. PMID 16532609. See Table 53 and 56.
  56. ^ a b "A History of Birth Control Methods". Planned Parenthood. June 2002. Archived from the original on May 17, 2008. Retrieved 2006-07-05.
  57. ^ a b Chalker1 p. 280
  58. ^ Janet Farrell Brodie, Contraception and Abortion in Nineteenth-Century America (Cornell University Press, 1994), p. 216 online; Andrea Tone, Devices and Desires: A History of Contraceptives in America (MacMillan, 2001), p. 14.
  59. ^ a b c Weiss, BD; Bassford, T; Davis, T (1991). "The cervical cap". American Family Physician. 43 (2): 517–23. PMID 1990736.
  60. ^ Stopes p. 156
  61. ^ "the Vimule permanent sheath, as purveyed by Lamberts of London, 1927". Condom pictures. Retrieved 2006-11-12.
  62. ^ <Please add first missing authors to populate metadata.> (Winter 2002). "Cervical Cap Newsletter" (PDF). Internet Archive. Archived from the original (PDF) on 2004-02-25. Retrieved 2007-07-22.
  63. ^ Grafenberg, E; Dickinson, RL (1944). "Conception control by plastic cervix cap". Western Journal of Surgery, Obstetrics, and Gynecology. 12 (8): 335–40. PMID 12233290.
  64. ^ "96/281/2 Contraceptive cervical cap, 'Vimule' cap". Powerhouse Museum Collection. 1995. Retrieved 2006-11-12.
  65. ^ Fairbanks, B; Scharfman, B (1980). "The cervical cap: Past and current experience". Women & Health. 5 (3): 61–80. doi:10.1300/j013v05n03_06. PMID 7018094.
  66. ^ Bernstein, Gerald S.; Kilzer, Linda H.; Coulson, Anne H.; Nakamura, Robert M.; Smith, Grace C.; Bernstein, Ruth; Frezieres, Ron; Clark, Virginia A.; Coan, Carl (1982). "Studies of cervical caps: I. Vaginal lesions associated with use of the vimule cap". Contraception. 26 (5): 443–56. doi:10.1016/0010-7824(82)90143-3. PMID 7160179.
  67. ^ Chalker2, p.170
  68. ^ United States. Food and Drug Administration FDA (1988). "Notice, 11 July 1988". Annual Review of Population Law. 15: 19. PMID 12289360.
  69. ^ Gallagher, Dana; Richwald, Gary (1989). "Feminism and Regulation Collide". Women & Health. 15 (2): 87. doi:10.1300/J013v15n02_07.
  70. ^ Chalker1, p.281
  71. ^ Stopes pp. 151,154

External links

Cervicitis

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Death may occur. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms.

The condition is often confused with vaginismus which is a much simpler condition and easily rectified with simple exercises. [1] Cervicitis affects over half of all women during their adult life.

Cervix

The cervix or cervix uteri (Latin: neck of the uterus) is the lower part of the uterus in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during pregnancy. The narrow, central cervical canal runs along its entire length, connecting the uterine cavity and the lumen of the vagina. The opening into the uterus is called the internal os, and the opening into the vagina is called the external os. The lower part of the cervix, known as the vaginal portion of the cervix (or ectocervix), bulges into the top of the vagina. The cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago.

The cervical canal is a passage through which sperm must travel to fertilize an egg cell after sexual intercourse. Several methods of contraception, including cervical caps and cervical diaphragms, aim to block or prevent the passage of sperm through the cervical canal. Cervical mucus is used in several methods of fertility awareness, such as the Creighton model and Billings method, due to its changes in consistency throughout the menstrual period. During vaginal childbirth, the cervix must flatten and dilate to allow the fetus to progress along the birth canal. Midwives and doctors use the extent of the dilation of the cervix to assist decision-making during childbirth.

The cervical canal is lined with a single layer of column-shaped cells, while the ectocervix is covered with multiple layers of cells topped with flat cells. The two types of epithelia meet the squamocolumnar junction. Infection with the human papillomavirus (HPV) can cause changes in the epithelium, which can lead to cancer of the cervix. Cervical cytology tests can often detect cervical cancer and its precursors, and enable early successful treatment. Ways to avoid HPV include avoiding sex, using condoms, and HPV vaccination. HPV vaccines, developed in the early 21st century, reduce the risk of cervical cancer by preventing infections from the main cancer-causing strains of HPV.

Clelia Duel Mosher

Clelia Duel Mosher (KLEEL-ya DUE-el MOE-sher; December 16, 1863 – December 21, 1940) was a physician, hygienist and women's health advocate who disapproved of Victorian stereotypes about the physical incapacities of women.

Comparison of birth control methods

There are many different methods of birth control, which vary in what is required of the user, side effects, and effectiveness. It is also important to note that not each type of birth control is ideal for each user. Outlined here are the different types of barrier methods, spermicides, or coitus interruptus that must be used at or before every act of intercourse. Immediate contraception, like physical barriers, include diaphragms, caps, the contraceptive sponge, and female condoms may be placed several hours before intercourse begins (note that when using the female condom, the penis must be guided into place when initiating intercourse). The female condom should be removed immediately after intercourse, and before arising.[1] Some other female barrier methods must be left in place for several hours after sex. Depending on the form of spermicide used, they may be applied several minutes to an hour before intercourse begins. Additionally, the male condom should be applied when the penis is erect so that it is properly applied prior to intercourse.

With an insertion of an IUD (intrauterine device), female or male sterilization, or hormone implant, there is very little required of the user post initial procedure; there is nothing to put in place before intercourse to prevent pregnancy.[2] Intrauterine methods require clinic visits for installation and removal or replacement (if desired) only once every several years (5-12), depending on the device. This allows the user to be able to try and become pregnant if they so desire, upon removal of the IUD. Conversely, sterilization is a one-time, permanent procedure. After the success of surgery is verified (for vasectomy), no subsequent action is usually required of users.

Implants provide effective birth control for three years without any user action between insertion and removal of the implant. Insertion and removal of the Implant involves a minor surgical procedure. Oral contraceptives require some action every day. Other hormonal methods require less frequent action - weekly for the patch, twice a month for vaginal ring, monthly for combined injectable contraceptive, and every twelve weeks for MPA shots. Fertility awareness-based methods require some action every day to monitor and record fertility signs. The lactational amenorrhea method (LAM) requires breast feeding at least every four to six hours.

Conception device

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 for human reproduction.

Decrement table

Decrement tables, also called life table methods, are used to calculate the probability of certain events.

Diaphragm (birth control)

The diaphragm is a barrier method of birth control. It is moderately effective, with a one-year failure rate of around 12% with typical use. It is placed over the cervix with spermicide before sex and left in place for at least six hours after sex. Fitting by a healthcare provider is generally required.Side effects are usually very few. Use may increase the risk of bacterial vaginosis and urinary tract infections. If left in the vagina for more than 24 hours toxic shock syndrome may occur. While use may decrease the risk of sexually transmitted infections, it is not very effective at doing so. There are a number of types of diaphragms with different rim and spring designs. They may be made from latex, silicone, or natural rubber. They work by blocking access to and holding spermicide near the cervix.The diaphragm came into use around 1882. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. In the United Kingdom they cost the NHS less than 10 pounds each. In the United States they cost about 15 to 75 USD and are the birth control method of 0.3% of people. These costs do not include that of spermicide.

History of birth control

The history of birth control, also known as contraception and fertility control, refers to the methods or devices that have been historically used to prevent pregnancy. Planning and provision of birth control is called family planning. In some times and cultures, abortion had none of the stigma which it has today, making birth control less important; abortion was in practice a means of birth control.

Holloway, London

Holloway is an inner-city district of the London Borough of Islington, 3.3 miles (5.3 km) north of Charing Cross, which follows the line of the Holloway Road (A1). At the centre of Holloway is the Nag's Head commercial area which sits between the more residential Upper Holloway and Lower Holloway neighbourhoods. Holloway has a multicultural population. It is the home of Arsenal Football Club. Holloway is in the historic county of Middlesex.

Married Love

Married Love or Love in Marriage is a book by British academic Marie Stopes. The book begins by stating that 'More than ever to-day are happy homes needed. It is my hope that this book may serve the State by adding to their number. Its object is to increase the joys of marriage, and to show how much sorrow may be avoided'.The preface of the book states that a book geared to teaching married couples how to have a happy marriage, including 'great sex' - and it was thus offering a service to 'the State' by reducing the number of people affected by failed marriages.

The central question is how can the “desire for freedom” and “physical and mental exploration” be balanced with the limits of monogamy and raising a family. The answer is not “in the freedom to wander at will” but a “full and perfected love”. In Stopes' lexicography love means sex and “access to the knowledge of how to cultivate it”.

Nabothian cyst

A nabothian cyst (or nabothian follicle) is a mucus-filled cyst on the surface of the cervix. They are most often caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus). This tissue growth can block the cervical crypts (subdermal pockets usually 2–10 mm in diameter), trapping cervical mucus inside the crypts.

Neck

The neck is the part of the body, on many vertebrates, that separates the head from the torso. It contains blood vessels and nerves that supply structures in the head to the body. These in humans include part of the esophagus, the larynx, trachea, and thyroid gland, major blood vessels including the carotid arteries and jugular veins, and the top part of the spinal cord.

In anatomy, the neck is also called by its Latin names, cervix or collum, although when used alone, in context, the word cervix more often refers to the uterine cervix, the neck of the uterus. Thus the adjective cervical may refer either to the neck (as in cervical vertebrae or cervical lymph nodes) or to the uterine cervix (as in cervical cap or cervical cancer).

Nonoxynol-9

Nonoxynol-9, sometimes abbreviated as N-9, is an organic compound that is used as a surfactant. It is a member of the nonoxynol family of nonionic surfactants. N-9 and related compounds are ingredients in various cleaning and cosmetic products. It is widely used in contraceptives for its spermicidal properties.

Pessary

A pessary is a prosthetic device inserted into the vagina to reduce the protrusion of pelvic structures into the vagina. It can be a route of administration of medication and provides a slow and consistent release of the medication. Pessaries are of varying shapes and sizes. They may cause vaginal ulceration if they are not correctly sized and routinely cleansed. Depending on locale, pessaries can be fitted by health care practitioners; in some countries, pessaries may be available over the counter.

The term is derived from Ancient Greek: πεσσάριον, translit. pessárion, "a piece of medication-soaked wool/lint, inserted into the vagina." Pessaries are mentioned in the oldest surviving copy of the Hippocratic Oath as something that physicians should never administer for the purposes of an abortion: "Similarly I will not give to a woman a pessary to cause abortion."

Pilot (Masters of Sex)

"Pilot" is the first episode of the first season of the American period drama television series Masters of Sex. It originally aired on September 29, 2013 in the United States on Showtime. The episode was written by series creator Michelle Ashford and directed by John Madden. The series is based on Thomas Maier's biography Masters of Sex: The Life and Times of William Masters and Virginia Johnson, the Couple Who Taught America How to Love.

Rebecca Chalker

Rebecca Chalker is a health writer and women's rights activist is the author of several books including "The Complete Cervical Cap Guide," "Overcoming Bladder Disorders," and "A women's Book of Choices: Abortion, Menstrual Extraction, RU-486," which all provide self-help techniques for women's health. Her most famous book is "The Clitoral Truth," which also has a second edition educating women about their genital anatomy and ways to enhance their sexual responses. Chalker currently lives in New York City and has continued to lecture on women's health and sexuality issues.

Shanghai Lily

Shanghai Lily may refer to:

A main character in Shanghai Express (film)

A brand of cervical cap available in China

Sperm bank

A sperm bank, semen bank or cryobank is a facility or enterprise which purchases and stores human semen from men known as sperm donors for use by women who wish to use donor-provided sperm to achieve a pregnancy or pregnancies other than by a sexual partner. Sperm sold by a sperm donor is known as donor sperm. Sperm is introduced into the recipient woman by means of artificial insemination or by IVF and the process may also involve donated eggs or the use of a surrogate.

From a medical perspective, a pregnancy achieved using donor sperm is no different from a pregnancy achieved using partner sperm, and it is also no different from a pregnancy achieved by sexual intercourse. By using sperm from a donor, however, the process is a form of third party reproduction.

A sperm donor must generally meet specific requirements regarding age and medical history. In the United States, sperm banks are regulated as Human Cell and Tissue or Cell and Tissue Bank Product (HCT/Ps) establishments by the Food and Drug Administration. Many states also have regulations in addition to those imposed by the FDA. In the European Union a sperm bank must have a license according to the EU Tissue Directive. In the United Kingdom, sperm banks are regulated by the Human Fertilisation and Embryology Authority.

Womb veil

The womb veil was a 19th-century American form of barrier contraception consisting of an occlusive pessary, i.e. a device inserted into the vagina to block access of the sperm into the uterus. Made of rubber, it was a forerunner to the modern diaphragm and cervical cap. The name was first used by Edward Bliss Foote in 1863 for the device he designed and marketed. "Womb veil" became the most common 19th-century American term for similar devices, and continued to be used into the early 20th century. Womb veils were among a "range of contraceptive technology of questionable efficacy" available to American women of the 19th century, forms of which began to be advertised in the 1830s and 1840s. They could be bought widely through mail-order catalogues; when induced abortion was criminalized during the 1870s, reliance on birth control increased. Womb veils were touted as a discreet form of contraception, with one catalogue of erotic products from the 1860s promising that they could be "used by the female without danger of detection by the male."The use of rubber pessaries for contraception likely arose from the 19th-century practice of correcting a prolapsed uterus with such a device; the condition seems to have been far more frequently diagnosed than its incidence would warrant, and at times may have been a fiction for employing a pessary for birth control. As with the production of condoms for men, the development of vulcanized rubber by Charles Goodyear helped make barrier contraceptives for women more reliable and inexpensive. Other terms for the contraceptive diaphragm were "female preventatives", "female protectors", "Victoria's protectors", and the "French pessary" ("F.P.") or pessaire preventif. This linguistic variety, some of it euphemistic, makes it difficult to distinguish in the literature among diaphragms, cervical caps, female condoms, and other pessaries; one form of "womb veil" is described in 1890 as "like a ring pessary covered by a membraneous envelope." Another source in 1895 describes it as "a small soft rubber cup surrounded at the brim by a flexible rubber ring about an inch or inch and a quarter in diameter."

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