Comeback of A Contraceptive

By Anastasia Toufexis

Women trying to choose a contraceptive these days face a frustrating task. The list of safe, reliable alternatives seems to keep getting shorter. Driven by fears about adverse side effects, many women scrapped first the Pill, then the intrauterine device. Large numbers found themselves forced back to a centuries-old method, the diaphragm. Last week the Food and Drug Administration added a new option by approving the marketing of another ancient birth-control device, the cervical cap.

Like the diaphragm, the cap is a barrier contraceptive that blocks sperm from passing from the vagina into the uterus. A thimble-shaped device made from rubber or plastic and measuring about 1 1/2 in. in diameter, it fits snugly over the cervix, or neck of the uterus, and is held in place by suction. The diaphragm is bigger and more fragile. A thin rubber dome averaging about 3 in. wide, with a flexible rim, it is placed between the pubic bone and the vaginal wall and kept in place by tension. Both contraceptives are used with spermicide.

The two devices, which must be fitted by doctors or midwives and cost around $25 each, are equally effective in preventing pregnancy (failure rate: about 15%). Enthusiasts claim the cap has several advantages. For one thing, it is more durable: a diaphragm can tear and needs to be checked for holes regularly. But the chief benefit of the cap is that it allows greater sexual spontaneity and gratification. Women can wear it for up to 48 hours, compared with 24 hours for the diaphragm. And because the cap fits tightly and rarely leaks, the reintroduction of spermicide before intercourse is unnecessary. Declares Susan Jordan of the National Women's Health Network: "The cervical cap is more economical and more aesthetic."

The FDA's action is a victory for feminist health leaders, who initiated the decade-long campaign to approve the cap. Cervical covers date back more than 2,500 years, and have been made from materials as varied as opium, gold and ivory. Dr. Friedrich Wilde, a German gynecologist, developed the modern rubber version in 1838, and it quickly gained widespread popularity in Europe. In the U.S., however, it never caught on, mainly because Margaret Sanger, a pioneer in family planning in the 1900s, favored the diaphragm.

American interest in the cap revived in 1977 with publication of Women and the Crisis in Sex Hormones, by Barbara Seaman and Dr. Gideon Seaman, which contains a brief chapter extolling the merits of the cervical cap. The women's self-help movement began pushing for the contraceptive, but the FDA, citing a 1976 law regulating medical devices, ruled that it would have to undergo testing for safety and efficacy. More than 40,000 women ultimately took part in the stringent and lengthy trials.

The tests showed that women who use cervical caps rather than diaphragms initially have a higher rate of abnormal Pap tests, a possible sign of infection as well as cervical cancer. Consequently, the FDA recommends that the cap be prescribed only for women with normal Pap smears. It also suggests that a Pap test be performed after three months of cap usage. Even so, researchers see no health drawbacks to the cervical cap. However, they are quick to note that the newly approved contraceptive will not be for everyone; some women, for example, may find the device difficult to insert and remove and may prefer to use a diaphragm or other form of birth control. Says Gynecologist Gerald Bernstein of the University of Southern California, who led the studies of the cap: "Women must use what they are comfortable with. The important thing here is that they have another choice."

With reporting by Kathleen Brady/New York