Female Condom

Female Condom

The female condom is a transparent, loose fitting, polyurethane sheath inserted into the vagina prior to sexual intercourse (either vaginal or oral). A female condom is 17 cm long, and has a flexible ring at each end. One end of the condom is closed and this end is inserted into the vagina to capture male semen during heterosexual intercourse. The other end of the condom is open, and this end remains outside the woman’s vagina during sexual activity, partially covering her external genitalia. The woman’s partner inserts their penis or tongue into the open end of the condom during vaginal or oral sexual activity.

Like the male condom, the female condom is a barrier method, that is, it creates a barrier between the woman’s vagina and her partner’s penis or mouth, which prevents the mixing of fluids during sexual activity. In doing so, the female condom provides users with a high degree of protection against pregnancy and sexually transmitted infection (STI) spread via genital fluids (e.g. HIV). As the female condom provides greater anatomical coverage than the male condom (it covers much of the woman’s external genitalia in addition to the penis and vagina), it may also provide a higher degree of protection than male condoms against STIs spread through skin contact (e.g. herpes).

Female condoms have been available in Europe and the US since 1992, and have been marketed under various names, including Femidom and Reality. They first became available in Australia in 2000, where they are sold as the Female Condom.


History of the female condom

The female condom was developed as an alternative to male condoms, in recognition that the decision to use male condoms was highly dependent on the willingness of the male sexual partner as the male condom is fitted onto the male sexual organ.

As the female condom is applied to the female genital organs, it was hypothesised that women would find it easier to initiate the use of a female condom than they would with a male condom. Because of this, it was thought that the female condom would empower women, who often lack decision making power and control in sexual relationships, to take greater control their sexual health. The female condom has been widely labelled the only “female initiated” method of preventing STIs.


How do female condoms work?

The female condom works by providing a barrier which sexual fluids cannot penetrate and thus protects against both pregnancy and STIs. In terms of contraception, preventing semen and sperm from entering the vagina prevents pregnancy. Sperm cannot fertilise an egg if they are trapped in a condom.

In terms of STIs, the female condom prevents the male partner being exposed to the female partner’s vaginal fluids and the female partner being exposed to the male partner’s semen during heterosexual intercourse. Thus it prevents the spread of STIs which are transmitted via sexual fluids (e.g. chlamydia).

The female condom also covers some of the woman’s external genitalia (e.g. the vulva, labia), and thus should provide a greater degree of protection against STIs spread through skin contact, than the male condom. During oral sex, the female condom also prevents contact between a woman’s vaginal fluids and her partner’s mouth.


When to use a female condom

Female condoms are suitable for use during vaginal and oral sex, but not during anal sex.

In order to protect against pregnancy, female condoms should be used at every act of penetrative vaginal intercourse when another effective contraceptive is not being used.

As an STI prevention device, female condoms should be used both for oral and penetrative vaginal sex, particularly when the partner’s STI status is unknown (most typically with casual partners, but also with some regular partners). The condom should be inserted before any contact between partners’ genital areas occurs.


Who uses female condoms

Female condomDespite their efficacy, female condoms are not widely used and account for only 0.2% of the global condom supply. They are still not readily available in many countries and remain much more expensive than male condoms.In 2008, 34.7 million female condoms were sold worldwide.


Effectiveness of the female condom

Like male condoms, female condoms provide a barrier which is impenetrable by sexual fluids. As female condoms provide greater anatomical coverage than male condoms (they also cover much of the woman’s external genitalia), they are, at least in theory, even more effective in preventing the transmission of STIs than male condoms. However while evidence is somewhat limited, it suggests that female condoms are no more effective than male condoms in practice. This appears to be because they are more difficult to use and are therefore subject to higher rates of mechanical failure (e.g. slippage, breakage).


Effectiveness in preventing pregnancy

In relation to contraceptive efficacy, the World Health Organisation reports an annual incidence of unwanted pregnancy of 5%, when female condoms are used correctly and consistently. This compares to an annual incidence of 3% with correct and consistent use of male condoms.


Effectiveness in preventing STIs

In relation to STI prevention, studies investigating the effectiveness of female condoms have examined rates of breakage and slippage, semen exposure and new cases of STI amongst female condom users. A study examining new cases of STI in female users of male and female condoms found no significant differences in incident STIs between the groups. In terms of mechanical failure, research indicates that female condoms are less likely to break but more likely to slip during sexual intercourse, compared to male condoms (0.1% breakage of female condoms vs 3.1% breakage of male condoms; and 5.6% slipping in female condoms vs 1.1% slipping in male condoms). However, a study investigating semen exposure reported no difference in the proportion of vaginal fluid samples which had been exposed to semen, between users of male and female condoms. This is despite much higher rates of mechanical failure while using female condoms (34% compared to 9% for male condoms).


Effectiveness in empowering women to negotiate condom use

Female condomIn terms of their ability to empower women by enabling female initiation of barrier method use, evidence to date suggests that women are no more able to initiate the use of a female condom without their partner’s consent, than they are a male condom. That the female condom is applied to the female genitalia does not negate the fact that many women lack the power to insist on its use, nor does it do away with the discrimination and stigma a woman might experience for carrying a condom (e.g. women have reported being labelled as promiscuous for carrying condoms).

Some argue that promoters of female condoms have failed to consider the widespread impact of discriminatory gender relations and, that to fulfil its STI and pregnancy prevention potential, the female condom needs to also be promoted amongst men, as a device which can increase their sexual pleasure.


How to use a female condom

Many women find inserting a female condom difficult at first, but research indicates that insertion becomes easier and less mistakes are made with practice. It is therefore recommended that women who wish to use a female condom, practice inserting them several times in a private, comfortable environment, prior to using them during sexual intercourse. It may also be necessary for women to use female condoms during several sexual encounters before they become used to the feel and appearance of female condom.

Women who wish to use a female condom should familiarise themselves with the following instructions about the application of female condoms:

  1. Open the packet carefully and remove the condom. Rub both sides to distribute the lubricant evenly across the condom.
  2. Choose a comfortable position for insertion (e.g. squatting, raising one leg or lying down).
  3. While holding the condom at the closed end, grasp the flexible inner ring and squeeze it with the thumb and forefinger so it becomes long and narrow.
  4. With your free hand, hold the outer lips of the vagina open and gently insert the ring up into the vagina, using the thumb and forefinger.
  5. Place your index finger inside the ring and push the condom up the vagina as far as possible, until it is above your pubic bone. (The pubic bone can be felt as a large lump by putting your finger inside your vagina and moving it up and to the front.) Once the female condom is properly inserted, the pubic bone will hold it in place and prevent it from slipping out of the vagina during intercourse.
  6. The outer ring should stay outside of the vagina.
  7. The female condom should not create any discomfort, and once properly inserted, the woman should not be able to feel it.

When having sexual intercourse using a female condom, women should:

  • Guide the penis with their hand into the open end of the condom, making sure it goes into the condom and not to the side. As the condom is lubricated and slippery it is easy for the penis to slip between the condom and the vagina if the penis is not carefully guided;
  • Ensure there is enough lubricant so the condom stays in place during sex. If the condom is pulled out or pushed in, there is not enough lubricant. You can add more lubricant to either the inside of the condom or the outside of the penis;
  • To remove the condom, twist the outer ring then pull it out. Be careful not to let the semen leak out. If the woman was not upright during intercourse, she should remove the condom from her vagina before standing up, to prevent semen leaking out;
  • Wrap the condom in a tissue and throw it in the bin. Do not flush it down the toilet.

In addition it is important that female condom users are aware that:

  • male and female condoms should not be used together; and
  • the female condom should only be used once.


What to do if a female condom breaks

If the condom breaks during intercourse, the penis should be withdrawn immediately. If the sexual partners still wish to continue having sex, a new condom should be applied prior to any further genital contact.

As a precautionary measure against unwanted pregnancy, women who experience condom breakage should visit their general practitioner and obtain a prescription for an emergency contraception pill. Emergency contraceptives can be used up to 120 hours after intercourse, to reduce the risk of pregnancy.

Both male and female partners should also test for a range of STIs if they experience condom breakage and are unsure of their partner’s STI status. Many STIs are easily treated with antibiotics once detected. However, as many STIs remain asymptomatic for extended periods of time, leaving them untreated can lead to infertility and other complications. For more information see STI.


Benefits of the female condom


STI prevention

Female CondomThe female condom is one of only two biomedical devices (the other being the male condom) which provides a high level of protection against a range of STIs in sexually active individuals. Condoms thus enable individuals who choose to be sexually active, and particularly those who choose to be sexually active with multiple partners, to reduce the risk of adverse health effects associated with sexual activity. They offer a degree of sexual freedom to individuals living in a world characterised by numerous health risks stemming from sexual activity.


Appropriate for temporary or permanent contraceptive use

As female condoms are applied immediately prior to sexual intercourse, an individual does not need to plan condom use in advance as they do for many other methods of contraceptives (e.g. hormonal contraceptive pills must be taken for extended periods). When used consistently and correctly, female condoms provide a high level of protection against unwanted pregnancy.


Made from polyurethane

Female condoms are made from polyurethane – an odourless, soft material, which has a more natural feel than the latex from which most male condoms are made. This is largely because it is thin and conducts heat more efficiently, and thus increases sensitivity.


Heat resistant

Changes in temperature or humidity do not affect the polyurethane from which female condoms are made.Male condoms on the other hand are sensitive to heat and must be stored at room temperature.


Less likely to split

Female condoms are less likely to break than male latex condoms.


Non-allergic

Unlike latex, the polyurethane with which female condoms are made does not cause allergies, thus female condoms are suitable for people with latex allergies.


Lubrication

Female condoms can be used with both oil and water based lubricants, unlike male latex condoms which must be used only with water-based lubricants.


Greater anatomical coverage

The outer ring of the female condom gives protection to the female’s external genitalia. The female condom therefore provides better coverage and protection against STIs transmitted through skin contact than a male condom.


Offers flexibility in the timing of insertion and removal

The female condom can be inserted up to eight hours before intercourse and does not need to be removed immediately after male ejaculation. This gives greater sexual spontaneity than male condoms. In addition, unlike the male condom, use of the female condom is not contingent on the male partner achieving an erection.


Greater female control

As the female condom is applied to the woman’s genital organs, it is theorised that it provides women with a greater sense of control over their sexual health than the male condom, which is applied to the male genital organs. While evidence suggests that women are no more able to enforce the use of female condoms than male condoms, there is also evidence that women do find it empowering to have access to a product which they wear.


Disadvantages and barriers to the use of female condom

Female condomDespite the many advantages of female condoms compared to male condoms, they remain a much less popular method of either contraceptive or STI protection than male condoms. Some of the disadvantages of female condoms which may create barriers to their use are discussed below.


User satisfaction

User satisfaction with female condoms, at least amongst some groups of women is low, and considerably lower than satisfaction with male condoms. For example, one study reported that only 11% of women reported that sex with the female condom felt “good” or “very good”. Women also reported low levels of satisfaction with the female condom amongst their partners.


Appearance

The female condom is large and some women find its overall appearance off-putting. In addition, once inserted, the outer ring is visible outside the vagina, which can make some women and their partners feel uncomfortable.


Noise

Female condoms typically make a rustling noise during intercourse.


Difficult to use

Users of female condoms report far greater incidence of mechanical difficulties (breaking, slipping) than do users of male condoms. Most health practitioners acknowledge that inserting the female condom is difficult and requires practice.


Failure rate

While the polyurethane from which female condoms are made is impenetrable, there is the possibility that the condom will slip up inside the vagina or the penis will enter the vagina and not the condom, and lead to condom failure.

Female condoms are much more likely to slip out of place during sexual intercourse than male condoms (e.g. one study reported 5.6% rate of slippage for female condoms compared to 1.1% for male condoms). Despite the higher rate of slippage, research indicates that the risk of semen exposure is comparable between male and female condoms.


Expense and availability

Female condoms are much more expensive than male condoms and, in Australia are available only from specialty outlets like pharmacies (and not supermarkets and petrol stations). They can also be expensive compared to male condoms. However, some student services do provide free female condoms.


Where to buy female condoms

Female condoms are available from family planning services, community health centres and pharmacies. Some student services also distribute free female condoms.


The future of female condoms

In 2005 a new female condom called FC2 was released by the manufacturers of the female condom. While it has a similar design to the original version of the device, FC2 is made from a material called nitrile. This makes it cheaper to produce than the polyurethane version and also eliminates the noise associated with polyurethane condoms. Female condoms made from latex are also being developed, which has the potential to further reduce costs.

 

More information

Contraception For more information on different types of contraception, female anatomy and related health issues, see Contraception.

 

Sexually transmitted infections (STIs)
For more information on different types of sexually transmitted infections, prevention of STIs, treatments and effects on fertility, see Sexually transmitted infections (STIs).

 

Reference

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  2. United States Department  of Veteran’s Affairs. Tips for using condoms and dental dams. 2008. [cited 2009, March 15] available from: http://www.hiv.va.gov/vahiv?page=sex-condomtips
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  8. Anonymous. The female condom: Still an underused prevention tool. [Editorial] Lancet Infect Dis. 2008;8(6):343.
  9. Avert. The Female Condom. 2008. [cited 2009, March 15] available from: http://www.avert.org/femcond.htm
  10. Macaluso, M. Blackwell, R. Jamieson, D.J. Efficacy of the Male Latex Condom as Barriers to Semen during Intercourse: a randomised clinical trial. Am J Epidemiol. 2007. DOI: 10.1093/aje/kwm046. [cited 2009, March 15] available from:  http://aje.oxfordjournals.org/cgi/content/abstract/kwm046v1
  11. French. P.P. Latka, M. Gollub, E. et al. Use effectiveness of female vs male condoms in preventing sexually transmitted disease in women. Sex Transm Dis. 2003;30(5):433-9.
  12. Attorney General’s Department. National Sexually Transmissible Infections Strategy 2005-08. Commonwealth of Australia. [cited 2009, March 15] available from:  http://www.health.gov.au/internet/main/publishing.nsf/Content/0333DF52D0E2F3EDCA25702A0025132F/$File/sti_strategy.pdf
  13. Kulczycki, A. Kim, D. Duerr, A. et al. The acceptability of the Female and Male Condom: a randomised crossover trial. Perspect Sex Reprod Health. 2004;36(3):114-9.

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