---

---

Years ago, the ancient Sumatrans of Indonesia knew about barrier methods of birth control. They fashioned caps made of opium to fit around their cervixes. Women in the Orient moulded oiled silk paper over their cervixes. And in Hungary, women used beeswax to make their caps. The modern world has been slow to catch up.

Finally, in Germany, Dr. Adolphe Wilde rediscovered the cap in 1838, 44 years before the diaphragm was discovered. Dr. Wilde took an individual impression of a woman's cervix and then created a custom-fitted cap made of rubber. At about the same time, a New York physician named Dr. E.B. Foote invented his own version of the cap. Since then, although the cap remained popular in England and central Europe, and was even manufactured in the U.S. until the 1960's, the cap never caught on well in the U.S. and Canada, particularly with the advent of the pill and the I.U.D.

The cap is a thimble-like rubber object that fits snugly over the cervix and is held in place by suction. It works by blocking sperm from going into the uterus. Actually, it is a more versatile birth control method than the diaphragm, and one with an equal success rate. But until recently few women had even heard of the cervical cap.

The great advantage of all barrier methods of birth control, whether the cervical cap, diaphragm or condom, is their safety and lack of side effects. This, combined with the fact that if used correctly and consistently, they are 95 to 97 percent effective in preventing pregnancy, make them a highly attractive choice for some women.

Perhaps because doctors receive little training in diaphragm fitting, and usually none in cervical cap fitting, and because both are time consuming to fit and to instruct women how to use properly, both the diaphragm and the cervical cap have been overlooked in spite of many excellent attributes. And of course until the last 25 years, women were more squeamish and less knowledgeable about handling their bodies.

In the last decade, women's clinics, in their search for safe and reliable alternatives to the pill and IUD, have rediscovered the cervical cap, and have started to fit caps and make them available to women in the U.S. and Canada. However, the caps still have to be imported from England, as there is no U.S. or Canadian manufacturer yet.

The main advantage of the cervical cap over the diaphragm is esthetics. The caps are smaller (one and a half inches long and about one inch wide), use far less spermicide, are therefore less messy, and best of all, can be left in place up to 48 hours at a time, allowing for more spontaneous sex. Since the cap can be inserted up to 40 hours in advance, it also means that birth control can be separated from actual love making.

Usually the cervical cap is used with spermicidal jelly. At present, it is recommended that the cap always be used one-third to one-half filled with spermicide and left in place eight to 12 hours after the last episode of sex. If the cap is left in place longer, up to three days, no further spermicide need be used. Some women feel so confident with their caps that they use no spermicide at all. This may be possible because the cervical cap functions mainly by means of the suction or surface tension that adheres it snugly to the cervix, and not so much as a holder for spermicide as the diaphragm does.

To date there are no known side effects of the cap but several studies are presently in progress. The Canadian Cancer Society in Vancouver believes that the cap, like all barrier methods, provides some protection against cervical cancer. And like condoms, the cap offers some protection against sexually transmitted diseases like gonorrhea and chlamydia.

In 1986, an F.D.A. sponsored study in the United States concluded that the effectiveness of the cervical cap and the diaphragm was identical. The effectiveness rate of the cap varied from 83 percent to 94 percent. The lower rates occurred for women who did not use their caps faithfully every time they had sex. Failure rates were also higher in women who had sex more than three times a week.