Contraception II: Cervical Caps and Condoms
Author: Michael Castleman, M.A.
<b>CERVICAL CAP </b> <p>The cervical cap is a small, thimble-shaped device that fits over the cervix and prevents sperm from entering the uterus. <p>The cervical cap is theoretically 94% effective, with an actual effectiveness of 82%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion. <p>The cervical cap fits over the cervix like a bottlecap. A combination of the cap's "fit" and natural suction hold it onto the cervix. The cap is made of rubber and must be fitted by a clinician. In addition to serving as a physical barrier to sperm, it also holds spermicide. <p>Not all women can use cervical caps. The cap is not for you if any statements below apply: <ul> <li type="disc">You're allergic to spermicides or rubber. <li type="disc">Cervical abnormalities interfere with a good seal. <li type="disc">You have a history of toxic shock syndrome. </ul> <p>The cervical cap has several advantages: <ul> <li type="disc">It's small. Some women who can't use diaphragms comfortably can use caps without problems. <li type="disc">It causes no serious side effects. <li type="disc">It helps protect against sexually transmitted diseases. <li type="disc">It can be used after age 40, when the Pill cannot. </ul> <p>The cervical cap also has some disadvantages: <ul> <li type="disc">You might need to interrupt lovemaking to insert it. <li type="disc">It might be too messy for you. <li type="disc">A woman might have problems inserting or removing it. <li type="disc">It might cause cervical irritation. <li type="disc">If it's left in more than a day or two, if might cause an unpleasant odor. <li type="disc">It might increase risk of urinary tract infections. </ul> <p>For reliable contraception the cap should be left in for at least eight hours after your last intercourse. Caps may be left in for a day or two, so you might decide to leave it in during a weekend getaway. But authorities recommend against extended wear because this increases risk of toxic shock syndrome. Cervical caps must be removed during menstruation. <p>If you decide to use a cervical cap, you'll need to have one fitted during a pelvic exam. The cap is more difficult to insert than the diaphragm. The clinician should instruct you how to insert and remove it and check your technique. <p>Before inserting the cap, wash your hands with soap and water. Fill your cap with a half-tablespoon of spermicide. When you insert it, make sure you press it over the cervix and get a good seal. <p>Childbirth can change the size of the cervix, necessitating a refitting. Before you start making love again after delivering, ask your clinician to check your cap's fit. <p>Cervical caps can last several years, but eventually they need to be replaced. Examine yours regularly and if you have any doubts about its integrity, ask your clinician for a replacement. <p>Also consult your clinician if you notice any discomfort, unusual discharge or bleeding or if you feel uncertain about your cap's fit or your ability to insert it properly. <p>Because the cervical cap may increase risk of toxic shock syndrome, users should know the signs of this potentially fatal infection and call 911 or go to an emergency room immediately if they develop any of the following symptoms for no apparent reason: <ul> <li type="disc">Sudden high fever and chills <li type="disc">Vomiting <li type="disc">Diarrhea <li type="disc">Dizziness, faintness and/or weakness <li type="disc">Sore throat with aching muscles and joints <li type="disc">A sunburn-like rash </ul> <p> <b><a href="/shop/dept.asp?dept%5Fid=18">CONDOMS FOR MEN</a></b> <p>Condoms for men are disposable contraceptives. Most are made from latex rubber. Some, called "skins," are made from sheep intestine. Condoms for men cover the erect penis during intercourse and prevent sperm from being deposited in the vagina. <p>Condoms for men can be used with or without spermicide. Without spermicide, they are theoretically 98% effective, with an actual effectiveness of 88%. With spermicide, theoretical effectiveness remains 98%, but actual effectiveness improves to 91%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion. <p>Condoms for men are also known as "rubbers," "prophylactics" and "protection." They have enjoyed a resurgence in popularity since the mid-1980s because the latex rubber variety -- but not skins -- help protect against sexually transmitted diseases, including AIDS. Condoms do not provide perfect protection against AIDS, but they are the best preventive available and public health authorities urge all lovers who are nonmonogamous and/or at risk for AIDS to use condoms during every sexual encounter. <p><a href="/shop/dept.asp?dept%5Fid=18">Condoms</a> are relatively inexpensive and widely available without a prescription at pharmacies, many supermarkets and by mail. There was a time when condoms were kept hidden behind pharmacy counters and boys died of embarrassment asking pharmacists for them. Today they are displayed openly and women buy as many as men. <p>Latex condoms typically have a nipple at the head to catch the ejaculate. They come either straight-sided or contoured in the shape of the erect penis. The contoured variety provide a better fit, which some couples prefer for aesthetic reasons. Most latex condoms come dusted with a thin coating of silicone powder, which lubricates insertion. Some condoms also come with spermicide. These provide extra protection against both pregnancy and AIDS. <p>Unfortunately, several myths continue to discourage men and couples from using condoms: <p><i>"They're like taking a shower with a raincoat on."<br> </i>The myth that condoms dull sensitivity is an outgrowth of the idea that men's sexual pleasure happens only in the penis and only during intercourse. But sex experts agree that preoccupation with the penis is a major reason why men develop sex problems. To enjoy high-quality lovemaking, sex experts urge men to cultivate an appreciation for whole-body sensuality, a massage approach to lovemaking that uses gentle touch to stimulate every square inch of the body. <p>Condom manufacturers have also confused the sensitivity issue by claiming that their condoms deliver "more sensitivity" than anyone else's. This is not true. All condoms are about the same. People may have personal preferences, but sexual pleasure is something lovers create, not something condoms deliver. Some condoms have "ribs" which supposedly enhance the pleasure of intercourse for women. If you like them, fine. But the ribs are virtually imperceptible and while many women enjoy stimulation of the vaginal lips, most women derive the majority of their sexual pleasure from stimulation of the clitoris, which sits outside and above the vagina, an organ ribbed condoms never touch. <p>What about condoms' effect on sexual pleasure in the penis? Imagine that you're watching a movie when suddenly your lover starts carressing you between your legs. Many men would become highly aroused -- despite the fact that several layers of thick clothing stand between those caressing hands and their penises. A shirt, pants and underwear are approximately 500 times as thick as the average condom, yet they don't seem to get in the way of sexual enjoyment. How much sensation can a condom really block? Far from showering with a raincoat on, when used intelligently, condoms are more like showering with a ring on one finger. <p><i>"They interrupt."</i> Many lovers don't like taking a "time out" from lovemaking for the man to slip on a condom. Some men's erections also subside because of the hassle of donning the rubber. But condom use can easily be incorporated into lovemaking. Open the package beforehand to decrease "fiddling" time. And if the woman places it on the man while continuing to caress his penis, there's little if any interruption. <p><i>"They break."</i> This is possible, but the problem can easily be prevented. Never store condoms near a heat source. Heat deteriorates latex rubber. Don't keep condoms in wallets, pants pockets or glove compartments. They're warm enough to cause heat damage. Open the condom beforehand so impatience doesn't get the better of you in the middle of lovemaking, resulting in a ripped condom. Roll the condom onto the penis slowly. Never insert a condom-covered penis (or an uncovered penis) into a vagina not sufficiently lubricated to allow easy insertion. If natural vaginal lubrication is insufficient, use saliva, vegetable oil or a water-based over-the-counter lubricant, such as KY Jelly. Never use petroleum jelly as a lubricant with condoms. Petroleum jelly causes rubber deterioration and condom failure. <p>If a condom breaks, the woman should immediately insert some spermicide. She should not douche. Douching might push the sperm up into the uterus. <p>A few other suggestions: <ul> <li type="disc">Beware of colored condoms. They may look festive, but some men are allergic to the dyes and suffer penile irritation. <li type="disc">Never use a condom whose wrapper has come unsealed. <li type="disc">Put it on before you put it in. Pre-ejaculatory fluid may contain sperm as many surprised couples have found out. <li type="disc">Consider using a spermicide in addition. This increases condom effectiveness. <li type="disc">Use latex rubber condoms, not natural "skins," for best protection against sexually transmitted diseases. Latex blocks transmission of the viruses that cause AIDS, herpes and venereal warts, but skins do not. <li type="disc">Watch out for "lift-offs." Sometimes in the woman-on-top position, the vaginal lips may lift a condom off the penis. Contoured penis-shaped condoms help prevent this. But in the woman-on-top position, the man should hold the condom on to the base of his penis. (In addition to securing the condom, the man can provide direct clitoral stimulation to the woman.) <li type="disc">After ejacualtion, hold the condom onto the base of the penis to keep from leaving an ejacualte-filled condom inside the vagina. <li type="disc">Use condoms only once, then throw them away. </ul> <p>If you develop penile or vaginal irritation from condoms, try changing your spermicide and/or lubricant. If irritation continues or gets worse, consider switching to another form of birth control. <p>If a condom breaks or comes off and you don't want to risk pregnancy, contact a physician immediately about morning-after contraception. For more information about this method, read our article on this method. <p> <b>CONDOMS FOR WOMEN</b> <p>In early 1992, the Food and Drug Administration approved the first condom for women. The female condom, also called the vaginal pouch, is a sheath that lines the vagina. It's about seven inches long, with a plastic ring on each end. One fits over the cervix like a diaphragm. The other rests on the outer vaginal lips. Like condoms for men, the women's version prevents sperm from being deposited in the vagina. <p>Condoms for women appear to be about as effective as condoms for men -- without spemicide, theoretically 98% effective and actually 88% and with spermicide theoretically 98% effective and actually 91%. To learn what contraceptive effectiveness statistics mean and to see how this method compares with the others, see the Overview discussion. <p>Condoms for women are more expensive than condoms for men. They cost about $2.00 each. If you use them, follow the package directions carefully. Use each one only once, then throw it away. <p>If you have problems inserting this device or if you experience any irritation, consult your doctor or a family planning provider.