The Honey Cap

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An AFP report on the healing properties of honey in diabetic ulcers made me think of the potential contraceptive effects of honey.

As you probably already know, honey was used in antiquity as a spermicide. But did you also know that, to this day, honey is still employed as a birth control method by women (mainly in the UK) who use the Honey Cap.

The Honey Cap is just a regular diaphragm [usually a smaller size one, like the 60 mm] used in combination with honey, instead of a regular spermicide. The honey is added to the inside of the dome, and the diaphragm is soaked in honey before use. [When not in use it's kept in a jar of honey.] The Honey Cap can be left in place for up to three days, as opposed to a maximum of 24 hours for the diaphragm-with-spermicide method. Since honey is not toxic, the hope is that the extended wear would not result in an increase in the incidence of vaginal irritation or infection.

The Honey Cap method was developed in the U.S. several decades ago, and the initial experience with it appeared promising, although, according to the Margaret Pyke organization, no clinical trials on the efficacy rate, or the adverse side effects were conducted.

Because of the lack of data we don't know how well the Honey Cap works, how safe it is, or what the continuation rates are. So, if you're interested in the Honey Cap, how do you decide if you should use it or not? [If you live in the UK, your MD might have some clinical experience with this method.]

Well, one way to go about it is to look at data from studies of a somewhat similar method to use as a guideline. Your main concerns/unknowns with the Honey Cap are (1) efficacy [since you're not using a regular spermicide, are you more likely to become pregnant? True, honey does have spermicidal qualities, but we don't know how effective it is.], and (2) safety [will the extended use cause more problems--UTIs, lesions, discharge, etc.?].

From studies comparing the effectiveness, safety and acceptability of the diaphragm with and without a regular spermicide, the unanimous conclusion is that further research is needed but, at present, there's no evidence to change the commonly recommended practice of using the diaphragm with [a regular] spermicide.

Looking at studies of women who used the diaphragm continuously without spermicide (CU), one retrospective review found that (a) [p]atient and total failure rate were significantly lower in the CU (0.6 and 2.8), in comparison with the [traditional use] sub-group (6.5 and 9.8), (b) [t]he discontinuation rate for urinary infection or other medical reasons was not greater in the CU group, and (c) 84.84% continued use for 12 months, in the CU group.

Another pilot study found that (a) [t]he 12-month life table accidental pregnancy rate for all participants during typical use was 24.1/100 women. The pregnancy rate was 29.5/100 women without female barrier experience and 17.9 among women with barrier experience., (b) [p]roduct-related problems related to insertion, retention and removal were few at both the 6- and 12-month follow-up visits, most commonly odor, and (c) ~10% of the women discontinued use because of lack of confidence in the method.

Bottom line: Don't use the diaphragm, to begin with, if pregnancy is unacceptable to you. If you do choose this method, use the information from studies of continuous use of diaphragm without spermicide to help you decide if you should use the Honey Cap.