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Female Condom

What is a female condom?

A Female CondomHave you ever used a female condom? If not, why not learn about the little known, but proven, safer sex tool, using AVERT's 'How to Use a Female Condom Infographic'.

The female condom is a thin sheath or pouch worn by a woman during sex. It entirely lines the vagina and helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV.

What female condoms are available?

The FC and FC2 female condoms

The FC2 female condom is a nitrile sheath or pouch 17cm (6.5 inches) in length. At each end there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. The other end of the sheath stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath from moving up inside the vagina.

There is a silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide.

The original version of the FC female condom (brand names included Reality, Femy and Femidom), was made of polyurethane. As this was a relatively expensive material to use, the makers of the FC female condom released the FC2 version, using the cheaper nitrile material. Large-scale production of the FC2 began in 2007. Production of the original FC condom has now stopped.

The FC2 female condom received FDA (Food and Drug Administration in the U.S.) approval in March 2009. 1

Other types of female condom

A recent trial has shown that relatively new models of female condom are non-inferior to the established FC2 model. These new models were developed with the belief that a greater choice of contraception for women and their partners could lead to more consistent use of female condoms, resulting in fewer sexually transmitted infections and unwanted pregnancies. 2

The VA w.o.w Condom Feminine (or VA for short) is made of latex. At around 9cm (3.5 inches) it is shorter than the FC2. It has a rounded triangular frame at the open end and a sponge inside the closed end, which helps to anchor it inside the vagina. The VA is lubricated and does not contain spermicide. Oil-based lubricants should not be used with this female condom as they can damage latex. The VA received the CE mark for distribution in the European Union, but has not received FDA approval. It is currently being reviewed by the World Health Organisation (WHO). 3

PATH’s Woman’s Condom is similar in design to the VA, but is held together by a rounded cap which dissolves once it is put in place, in order to make insertion easier. A 2013 US study is assessing the effectiveness of the Woman’s Condom in preventing pregnancy. If supportive, the results could lead to approval by FDA, as well as the WHO and the United Nations Population Fund (UNFPA). 4 

The Cupid condom has been approved by WHO and UNFPA. It is already available in South Africa, Mozambique, Indonesia, India and other countries, and is cheaper than the FC2. 5

A recent trial has ranked the FC2, the VA w.o.w., PATH’S Woman’s Condom and the Cupid female condom, comparing each in several categories. 6 The results are summarised below, from highest to lowest score:

  • Failure rate: VA w.o.w. (2.5%), FC2 (2.9%), PATH Woman’s (3.1%), Cupid (3.9%). 
  • Feel and sensation: PATH Woman’s, Cupid, VA w.o.w., FC2. 
  • Ease of insertion: FC2, PATH Woman’s, Cupid, VA w.o.w. 
  • Each model’s appearance was scored positively by 80% of women. 

How do you use the female condom?

Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. Make sure the condom is lubricated enough.

If you are using the FC2 female condom, make sure the inner ring is at the closed end of the sheath, and hold the sheath with the open end hanging down. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently insert the inner ring into the vagina and feel it go up. Place the index finger inside the condom and push the inner ring as far as it will go. Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina.

To begin inserting the VA, hold the sponge and frame close together and place the closed end in front of the vagina. Use two fingers to push the closed end containing the sponge inside the vagina as far as it will go. Make sure the sponge is opened up flat once it has been inserted. The frame should remain on the outside of the vagina.

The penis should be guided into the female condom in order to ensure that it does not slip into the vagina outside the condom. Use enough lubricant so that the condom stays in place during sex. The female condom should not be used at the same time as a male condom because the friction between the two condoms may cause the condoms to break.

If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.

To remove the condom, twist the outer ring or frame gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet. It is generally recommended that the female condom should not be reused.

The female condom may feel unfamiliar and may be difficult to insert at first. Some women find that with time and practice using the female condom becomes easier.

What are the benefits?

  • It provides an opportunity for women to share the responsibility for condoms with their partners.
  • A woman may be able to use the female condom if her partner refuses to use a male condom.
  • The female condom will protect against most STDs and pregnancy if used correctly.
  • The FC2 female condom can be inserted in advance of sexual intercourse so as not to interfere with the moment.
  • The FC2 female condom is made of nitrile, which can be used with oil-based as well as water-based lubricants. No special storage requirements are needed because nitrile is not affected by changes in temperature and dampness. In addition, nitrile conducts heat well, so sensation is preserved.

What are the disadvantages?

  • The outer ring or frame is visible outside the vagina, which can make some women feel self-conscious.
  • The FC2 female condom can make noises during intercourse (adding more lubricant can lessen this problem).
  • Some women find the female condom hard to insert and remove.
  • It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill.
  • In some countries it can be relatively expensive and limited in availability.

Can I reuse the female condom?

The World Health Organisation (WHO) recommends use of a new male or female condom for every act of intercourse for those people who use condoms for pregnancy prevention and/or STD/HIV prevention. The FDA state that the FC2 and FC are designed and intended to be used only once. 7

WHO does not recommend or promote reuse of female condoms but has released guidelines and advice for programme managers who may consider reuse of FC female condoms in local settings. 8

Using the female condom for anal sex

Some people use the female condom for anal sex, although it has not been officially approved or recommended for this use. More research is needed to determine whether the female condom is effective at preventing STD and HIV transmission during anal sex.

Support for the female condom

WHO and UNAIDS are encouraging wider access to the female condom as a method of preventing both pregnancy and sexually transmitted infections. Many governments and non-governmental organisations provide female condoms for free or at subsidised prices as part of their HIV prevention and family planning programmes.

Worldwide use and availability

Vending machines for both male and female condoms in FranceThe availability and distribution of female condoms has increased significantly in the past few years. In 2009 around 26 million female condoms were provided through international and nongovernmental funding sources, compared to 10.7 million in 2006. 9 However, the global distribution of female condoms is still far less than that of male condoms. 10

The FC2 female condom is distributed by donor groups and public health organisations in around 100 countries across the world. 11 It is directly marketed to the United States and is sold through distribution agreements to countries such as Canada, Mexico, Spain, India and Brazil. In fiscal year 2009, the makers of the FC2 female condom sold 40.2 million units worldwide, up from 34.7 million in 2008. 12 Many of these condoms were purchased by donor agencies such as USAID and UNFPA.

Future of the female condom

A number of new female condoms, such as PATH's Woman's Condom, 13 are currently being developed. The aim of these is to address the common disadvantages of current female condoms on the market. However, these female condoms are still a long way from becoming widely available and their future prospects are uncertain.

With women and girls accounting for just over half of all people living with HIV worldwide, female HIV prevention initiatives are still desperately needed. The female condom is the only female-initiated HIV prevention method presently available and it has the potential to empower women to protect themselves from the risk of HIV infection.

However, wider use of the female condom in countries with severe HIV/AIDS epidemics depends on the commitment of governments and other major donors. To achieve its full potential, much greater effort needs to be made worldwide to make the female condom more affordable, accessible and acceptable.

Global Female Condom Day

Every year, 16 September is Global Female Condom Day. A day to take action and raise awareness of female condoms!

You can also read our exclusive interview with Judy Silwana, a leading advocate for female condoms, currently working with one of AVERT's partner organisations in South Africa.

 

References

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