Q: How does the FemCap work?

A: It prevents sperm from entering the cervix. The FemCap should be used with a small amount of spermicide or ContraGel natural spermicide to reinforce the mechanical barrier of the FemCap with a chemical sperm-killing agent. About ¾ teaspoon @4mL is plenty.

Q: What are the side effects of the FemCap?

A: There are no known local or systemic side effects.

Q: I am really sorry to bother you, but I think I need your advice. I have bought the Femcap from the Internet. I have tried several times to insert it and I think I have learned it. However, I am not sure how exactly I should check the proper placement, especially how to check if the back is covered properly too.

A: I suggest that you stand with one foot on a chair or toilet and one on the ground. Insert two fingers and feel for your cervix. It will change location throughout your cycle and based on your level of arousal. Once you've located your cervix, wet the FemCap, apply contraceptive gel to the brim and cup (follow instructions) and insert it as high up in the vagina as possible. Then do a finger sweep again to be sure that your cervix is covered by the cap and is not sticking out to one side or the other.

Q: Here is another problem: after the last intercourse, when I was removing the FemCap, there was some fluid in the bowl of the FemCap. It was very runny like water. So I am afraid it could have been the semen. Nevertheless, while removing I felt that the FemCap was still “sucked”.

A: It sounds like your body warmed and "melted" the contraceptive gel. It does not sound like semen got in. It is normal to see watery fluid or moisture from your own body.

Q: What I also found out and I am not sure if it should be like that is the fact that after the insertion, the brim is “sucked” to the muscles (or how to call it) around the cervix. However, after the arousal the vagina changes and the brim is “in the air”, it does not touch the “muscles”.

A: The FemCap is designed to be held in place by the vaginal muscles. so long as it is at the top of the vagina and covering the cervix, you are protected.

Q: I hope you can understand what I mean and you can help me a little. I know that sending emails is not the most convenient way, but in this country, there are not so many doctors who have experience with FemCap, so I am afraid my doctors cannot help me.

A: This is the problem with natural contraception, and having to buy it anonymously on the internet. As a Certified Natural Health Practitioner I provide free consultation and contraceptive counselling to my natural contraception - Fem Cap, Contragel Green and Cycle Beads - clients by phone, email and in person. So feel free to call me.

Q: How about the irritation caused by the (non-natural) spermicide?

A: The currently available spermicide has been sold over the counter for more than thirty years with an excellent safety record. It is true that spermicide can cause irritation when used very frequently and in very high doses. To minimize the irritation caused by spermicide, the FemCap is designed with a unique groove facing the vagina. This groove stores the bulk of the spermicide and minimizes its leakage. The storage of the bulk of spermicide in this groove ensures immediate and prolonged exposure of sperm to the spermicide as soon as it is deposited into the vagina.

Q: Is it easy to use?

A: Yes, it is easy to use. The average woman can learn how to insert and remove the FemCap on her own in a few minutes and master its use in a few days.

Q: What is the effectiveness rate of the FemCap?

A: Effectiveness depends on the motivation of the user and whether she uses the FemCap consistently and properly every time she has sex. There is a wide range of effectiveness among users. It is estimated that the FemCap may achieve up to 96-98% success in preventing pregnancy if used PERFECTLY. The perfect use estimation is based on the fact that if emergency contraception (plan-B) is used alone, it would be 95% effective if used within 24 hours and 89% effective if used within 72 hours in preventing pregnancy.

The seven requirements for perfect use are:
1. The ideal user is motivated to use the FemCap and wants to avoid the use of hormones.
2. The ideal user watches the instructional video very carefully before using the FemCap.
3. A back-up contraceptive method should be used during the learning phase; (few days) e.g. you may use the condom or finish your pack of birth control pills while learning how to master the use of the FemCap.
4. The FemCap must be inserted before any sexual arousal.
5. A small amount (3/4 of teaspoon) of spermicide should be applied to the FemCap and its position should be checked before each use.
6. The FemCap must be left in place at least six hours after the last act of intercourse.
7. Use emergency contraception if you did not use the FemCap at all or used it incorrectly.

In the worst-case scenario, the FemCap (first-generation, obsolete now and not approved by the FDA) was 86.5% successful in preventing pregnancy in the six-month pivotal clinical trials, that involved 800 women. All women who volunteered and participated in the clinical trials were novices and selected at random to cover the entire socioeconomic spectrum. Women in these clinical trials were prohibited from using any back-up method during the learning phase and were not even allowed to watch the instructional videotape. Women in these trials were also prohibit­ed from using emergency contraception even if they admitted to having forgotten to use the FemCap.

Q: Can the FemCap be used during menstruation?

A: No. The FemCap cannot be used during menstruation, as it would impede the natural flow of menstrual fluid.

Q: Will the FemCap be available over the counter in the pharmacies?

A: No. At the moment in the US and UK, the FemCap is prescribed and provided by a nurse practitioner, nurse midwife, physician’s assistant, or a doctor. Future availability in the Pharmacy is pending and would be by prescription from a health care professional. In Canada, the Fem Cap is available through a natural health practitioner.

Q: How is the FemCap cleaned between uses? How often should it be replaced?

A: The FemCap should be washed thoroughly with antibacterial hand soap and rinsed with tap water, then dried and stored in its container. It is recommended the FemCap be replaced every year or sooner if it shows any signs of deterioration.

Q: Does the FemCap need measurement and custom fitting?

A: No. The fit of the FemCap is determined by the obstetrical history of the woman. Women who have never been pregnant will use the 22mm FemCap; women who miscarried even after two weeks of pregnancy or had caesarian section will take the 26mm, and women who have vaginally delivered a full-term baby will take the 30mm FemCap.

Q: Does the FemCap interrupt spontaneity or interfere with natural intercourse?
A: The FemCap does not interrupt spontaneity or reduce sexual pleasure to either partner. The male partner may, rarely, have a sense of awareness.

Q: How well has the FemCap been accepted?

A: The FemCap is highly accepted by women and their partners. In the clinical trials, seventy-five percent of women who had had prior experience with the diaphragm preferred the FemCap.

Q: Does health insurance cover the cost of the FemCap?

A: Yes, if your health insurance covers birth control.
Anarres Natural Health will provide you with proof of payment to submit to your insurance.

Q: Dear Anarres Natural Health, Hello! I am a midwife who is new to FemCap but has been asked by clients to be fitted with them. The old caps required a fitting kit - is there one available for FemCap? How would I get one and can I order directly from you in bulk for a reduced cost?
Thanks,
Lori Serabo, CPM, LM

A: Dear Lori, Excellent that you are interested in helping your clients use the Fem Cap, and hopefully Contragel. In Canada, fitting kits are not used and fittings are not done because the Fem Cap was created for women to fit themselves. A clinical study was done and it was determined that the three sizes selected based on gynecological history gave the best fit. It is completely unnecessary to put a woman through the expense, time and potential discomfort "to be fitted".

In the US, the hormonal contraceptive lobby convinced the FDA to require a fitting and a prescription, one imagines in order to create a barrier to women obtaining non-hormonal contraception.

So if you must because you are in the US, you can buy a fitting kit from the manufacturer Fem Cap, and then you can buy Fem Caps at a practitioner rate. Or you can refer your clients to purchase a self fitted Fem Cap from outside the US. I am in Toronto, Ontario, Canada. As a Certified Natural Health Practitioner, the FDA recognizes me as qualified to "fit" caps, and Health Canada considers the Fem Cap to be over the counter medical devices.

Best, Tracey
Tracey TieF
Certified Natural Health Practitioner

Q: 1) Divine 9 lubricant (water-based) is supposed to be effective at inhibiting HPV transmission. Can it be combined with both the FemCap and Contragel?

A: Yes, you can use water-based lube with cap & gel, although you can use the gel as a lube. There are two dozen strains of HPV. The most effective way of preventing HPV transmission is by using a condom, but the Fem Cap also appears effective because it covers the cervix.

Q: 2) Can the FemCap be used with a retroverted uterus?

A: The FemCap can be used if you can locate your cervix with your fingers. There is a myth that cervixes point straight down into the uterus or there is something wrong. In fact, the cervix moves around according to your cycle, your musculature, your arousal etc.

Q: 3) According to this site (http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for...) "The cap should not be used by women with cervical intraepithelial neoplasia or cervical cancer awaiting treatment.31" What are your thoughts on this as I've found literature to support its use as well.

The concern here is that any device rubbing the cervix might disturb already disturbed cells. Medical grade silicone is considered to be inert in the body.

Q: 4) This is questions is kind of out in left field...I will be putting an IUD back in in a few months and have decided to use the FemCap in the interim. I was considering continuing to use the FemCap after I reinsert my IUD to help with my cervical dysplasia treatments by putting healing gels (green tea extract, trametes versicolor, etc.) that are often used in suppository forms right into the FemCap so that it's in constant contact with my cervix. I will, of course, be doing this under the guidance of an ND. Is an IUD a contraindication to using the FemCap?

A: The trouble is that the string from the IUD can conflict with the FemCap, but if you can make it work, go ahead. I don't favour IUDs because they are essentially a hormonal form of contraception and can wick harmful microbes into the uterus. If the Fem Cap works for you I hope you will choose it over the IUD. If you need extra certainty, consider using Cycle Beads with the FemCap. In any case, the FemCap is more effective than the IUD when used correctly every time. I suggest applying vitamine E (mixed tocopherols) directly to your cervix (no need for a cap here) to help your body shed HPV.

Q: 5) Based on the size of the device and my knowledge of female anatomy, I feel like the FemCap would be easily felt by a male partner. Do you find this to be the case? I'm very petite as well, and my cervix dips pretty low during certain parts of my cycle.

A: I've not had any clients who were too petite to use the FemCap. The size of the cervix has to do with gynecological experience rather than body size.

The cap fits over the cervix at the top of the uterus and is held in place by the muscles of the vagina. It is similar in texture to the cervix but softer. It is far less obtrusive than the diaphragm.

Some partners have felt the cap, particularly the removal strap. This can be carefully removed if it's a problem.

As an advocate for women's health, I believe that a woman's health and well being is far more important than any sensation a male partner might feel. If a male partner would rather his female partner risk her health by using hormonal contraception than feel the presence of a cervical cap, then the problem is not the cap, but rather an abusive disregard in the relationship.