intercourse; some sources state that insertion prior to sexual arousal decreases the risk of incorrect placement. most sources recommend the use of spermicide with the cap, but some sources say spermicide use is optional. the cap remains in the vagina for a minimum of 6 - 8 hours after the last intravaginal ejaculation. it is recommended the cap be removed within 72 hours (within 48 hours is recommended in the u.s.). other than the disposable oves cap, cervical caps can be washed and stored for reuse. silicone devices may be boiled to sterilize them. reusable caps may last for one or two years. some caps have a pull tab for removal but it is claimed that pulling on it should not be done since it the cap tends to adhere very tightly to the cervix. instead, putting a finger under the rim and pulling with a jerk should easily detach it. acceptability it was reported in the 1980s (during the cervical cap renaissance in the u.s.) that "women overwhelmingly preferred the cap to the diaphragm". on average, women also reported an increase in libido and frequency of sex. the oves cap and the new version of the femcap performed poorly in user acceptability studies. the study on the femcap concluded that the modifications to the femcap significantly increased pain and discomfort among female users and their male sex partners, and that the modifications decreased acceptability of the device compared with the earlier version. the study of the oves cap reported that few women indicated that they would use the cap in the future. a pilot study conducted in britain prior to the lea's shield's approval concluded that the lea's shield "may be acceptable to a highly select minority of women". as of 2002, the cervical cap was one of the least common methods of contraception in the united states. a 2002 study indicated that of sexually active american women, 0.6% are currently using either the cervical cap, contraceptive sponge, or female condom as their primary method of contraception, and fewer than 1% have ever used a cervical cap. history ancient the idea of blocking the cervix to prevent pregnancy is thousands of years old. various cultures have used cervix-shaped devices such as oiled paper cones or lemon halves. others made sticky mixtures that included honey or cedar rosin, to be applied to the os. the modern idea of a cervical cap as a fitted device that seals itself against the vaginal walls is of more recent origin; it emerged within the past century. 19th century in 1838, german gynecologist friedrich wilde created the first modern cervical cap by making custom-made rubber molds of the cervix for some of his patients. these caps were probably short-lived, as uncured rubber degrades fairly quickly. an important precursor to the invention of more lasting caps was the rubber vulcanization process, patented by charles goodyear in 1844. in the 1840s or 1860s e.b. foote, a u.s. physician claims to have invented the cervical cap but it's reported that his patent was denied since the device could be used for obscene purposes. foote claimed that his invention was "widely counterfeited". an occlusive pessary marketed in the united states as the "womb veil" seems to have been an early form of diaphragm or cervical cap. over the next several decades, the cervical cap became the most widely used barrier contraceptive method in western europe and britain. although the diaphragm was always more popular in the united states than the cervical cap, the cap was also common. 20th century many designs were developed in the later 19th and early 20th century in various countries. the vimule cap became available as early as 1927. a book by vimule and co., published in 1898, advertises the vimule cap. the prentif brand cap was introduced in the early 1930s. the dumas cap was initially made of plastic, and was available by the 1940s. lamberts (dalston) ltd. of the uk manufactured these three cap types. other types of caps had stems to hold them in place in the cervix; some of the stems actually extended into the uterus. these stem pessaries became precursors to the modern intrauterine device (iud). margaret sanger in the 1910s brought cervical caps to the u.s. but later on seemingly preferred the diaphragm but never repudiated the cap. this may have been influenced by her visit to the netherlands where the diaphragm (also known as the "dutch cap") reigned supreme. use of all barrier methods, but especially cervical barriers, dropped dramatically after the 1960s introduction of the combined oral contraceptive pill and the iud. in 1976, the u.s. government enacted the medical device regulation act. this law required all manufacturers of medical devices to provide the united states food and drug administration (fda) with data on the safety and efficacy of those devices. lamberts (dalston) ltd., the only manufacturer at that time, failed to provide this information, and the fda banned the use of cervical caps in the united states. in the late 1970s, the fda reclassified the cervical cap as an investigational device, and it regained limited availability. within a few years, the fda withdrew investigational status from the vimule cap, following a study that associated its use with vaginal lacerations. in 1988, the then 60-year-old prentif cap gained fda approval. the feminist movement played a large role in re-introducing the cervical cap to the united states. one paper called its involvement at all steps of the fda approval process "unprecedented". this renewed interest in the cervical cap has been called "the cervical cap renaissance". quality in the 1920s it was reported from england that "careless and hasty construction" could sometimes be found in many brands. some caps had a seam in the dome (two parts of it were welded together making a seam) and the seam might be defective and even contain minute perforations. also the junction between the rim and the dome might be rough and difficult to clean. caps that were seamless avoided the "seam" problem. it was suggested that caps should be inspected for possible defects by the user under a magnifying glass. in popular culture cervical cap is very likely to be the contraceptive that maid anna bates buys for her mistress lady mary crawley in the second episode of the fifth serie of the historical drama downton abbey. mary crawley is inspired by the book married love, from marie stopes. bibliography chalker, rebecca (1988). "recent experience with the cervical cap in the united states". in runnebaum; et al. (eds.). female contraception, update and trends. springer-verlang. pp. 280–285. chalker, rebecca (1987). the complete cervical cap guide. harper & row. stopes, marie (1924). contraception (birth control), its theory, history and practice. london: john bale, sons & danielsson, limited.