II. Preparations: Models available

  1. FemCap
    1. Only available Cervical Cap in U.S,
  2. Prentif Cavity Rim Cap (Lambert in U.K)
    1. No longer available in U.S.
  3. Vimule and many other models available in Europe

III. Efficacy

  1. Overall failure rate 17.4% (range 7-18% in studies)
    1. Method failure: 6.3%
    2. User failure: 11.1%
  2. Multiparous users have higher failure rate (26%)
  3. Contraceptive Diaphragm has similar failure rate

IV. Mechanism

  1. Thimble shaped device fits snugly over Cervix
    1. Develops slight suction to prevent cap dislodging
    2. Prevents sperm entry into upper genital tract
  2. Spermicide provides extra protection
    1. Spermicide not required (contrast with diaphragm)

V. Dose: Sizing

  1. Sizes available (80% of women can be fitted)
    1. Small: 22 mm internal diameter
    2. Medium: 25 mm internal diameter (most common)
    3. Large: 28 mm internal diameter
    4. Extra-large: 31 mm (rarely needed)
  2. Fitting pearls
    1. Cervix Requirements
      1. Cervix must be smooth to develop suction
      2. Cervix must have enough length to accommodate cap
    2. Timing of Fitting (very similar to Diaphragm)
      1. Fit during mid-cycle (Contrast for diaphragm)
      2. Postpartum: >6 weeks
      3. Post-Miscarriage or abortion: >2 weeks
      4. Refit needed after completing Lactation
      5. Refit needed after 10 pounds weight gain or loss
    3. Preparation for fitting
      1. Confirm no pelvic infection
      2. Empty bowel and Bladder prior to fitting
    4. Check fitting for:
      1. Adequate Cervical Coverage
      2. Proper seal
        1. Suction rim should be visible after removing
        2. Positional stability
    5. Sterilize Cervical Caps between patients
      1. SEE Cervical Cap Cleaning

VI. Contraindications

  1. Toxic Shock Syndrome History
  2. Vaginal Spermicide allergy
  3. Latex Rubber allergy
  4. Anatomical variation of Cervix preventing good fit
    1. Anteverted Cervix
    2. Severe cervical Laceration or vaginal septum
  5. Cervical or uterine malignancy
  6. Unresolved abnormal Pap Smear or recent cervical biopsy
  7. Acute Pelvic Inflammatory Disease
  8. Cervicitis or vaginal infection

VII. Technique

  1. Can leave in 48 hours (Contrast with 24h for diaphragm)
    1. Can place 40 hours before intercourse
    2. Leave in place at least 6-8 hours after intercourse
  2. Place small amount of Vaginal Spermicide in top of cap
  3. Place in vagina and apply over Cervix
  4. Do not use during Menses or to catch Menses

VIII. Adverse Effects

  1. Increased risk of Urinary Tract Infection
  2. Allergic Reaction to Vaginal Spermicide
  3. Vaginal odor if cap left in place too long
  4. Discoloration and odor if cap is not properly cleaned
  5. No reported cases of Toxic Shock with Cervical Cap

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