What is the female condom?
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. Two types of female condom are available.
The FC / FC2 female condom
The FC (female condom) has been available in Europe since 1992 and was approved by the US Food and Drug Administration (FDA) in 1993. It is available in many countries, at least in limited quantities, throughout the world. This female condom carries various brand names in different countries including Reality, Femidom, Dominique, Femy, Myfemy,Protectiv’ and Care.
The FC female condom is a polyurethane sheath or pouch about 17 cm(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. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.
There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide.
In 2005 the makers of the FC female condom announced a new product called FC2. This has the same design as the original version but is made of nitrile, which may make it cheaper to produce. The FC2 began large-scale production in 2007. The United Nations Population Fund (UNFPA) is already procuring the FC2. The United States Agency for International Development (USAID) plans to switch to the new product if it gains FDA approval.
The VA w.o.w. Condom Feminine
The VA w.o.w. Condom Feminine (or VA for short) has been distributed as part of HIV prevention efforts in South Africa since 2004. More recently it has become available in Brazil, Indonesia and through government clinics in Portugal. Having gained the “CE mark” for European marketing, its manufacturer plans to expand its availability in European shops and clinics. One more trial is needed before the product can gain FDA approval for sale in the USA.
Like most male condoms, the VA is made of latex. When not stretched it is much shorter than the FC – around 9 cm (3.5 inches) – though it is highly elastic. 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.
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 FC or 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 condom in order to ensure that the penis 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 at first. The female condom may feel different and some people find it difficult to insert. Some women find that with time and practice using the female condom becomes easier and easier.
What are the benefits?
- Opportunity for women to share the responsibility for the condoms with their partners
- A woman may be able to use the female condom if her partner refuses to use the male condom
- The female condom will protect against most STDs and pregnancy if used correctly
- The FC or FC2 female condom can be inserted up to 8 hours before intercourse so as not to interfere with the moment
- The FC and FC2 female condoms are made of polyurethane and nitrile, which are less likely to cause an allergic reaction than latex. These materials can be used with oil-based as well as water-based lubricants. No special storage requirements are needed because polyurethane and nitrile are not affected by changes in temperature and dampness. In addition, these materials are thin and conduct heat well, so sensations preserved.
What are the disadvantages?
- The outer ring or frame is visible outside the vagina, which can make some women feel self-conscious
- The FC and FC2 female condoms can make noises during intercourse (adding more lubricant can lessen this problem)
- Some women find the female condom hard to insert and to remove
- It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill
- It is relatively expensive and relatively limited in availability in some countries
- It is recommended that the female condom be used only once
Can I reuse the female condom?
It is believed that limited availability and high cost have led some women to reuse female condoms in some countries. The World Health Organization (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.
WHO does not recommend or promote reuse of female condoms but has released a document together with guidelines and advice for programme managers who may consider reuse of FC female condoms in local settings. There are no guidelines for reusing VA and FC2 female condoms.
Using the female condom for anal sex
Some people use the female condom for anal sex. Although it can work effectively, it is difficult to use and can be painful. There is also the risk of rectal bleeding which increases the risk of contracting HIV. So it’s better to use the male condom for anal sex with plenty of lubricant NOT containing Nonoxynol 9.
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 organizations provide female condoms for free or at subsidized prices as part of their HIV prevention and family planning programmes.
Worldwide use and availability
The female condom is used in public health programmes in more than90 countries and is commercially marketed directly to consumers in ten countries. It is quite widely used in some places where it is actively promoted, such as South Africa, Zimbabwe and Brazil. However in many parts of the world it is hardly available at all.
In fiscal year 2008, the makers of the FC female condom sold 34.7million units worldwide, up from 25.9 million in 2006 and 14 million in2005. Many of these condoms were purchased by donor agencies such as USAID and UNFPA. The VA currently sells in much smaller quantities. Altogether, female condoms account for only around 0.2% of global condom use.
In 2005, nearly two thirds of all female condoms were used in Africa, while the next largest shares went to North America and Europe. Asia accounted for less than 1% of the global total in 2005, though figures for later years may be higher due to growth in India.
Future of the female condom
The two female condom manufacturers hope that demand for their products will grow substantially in the near future. However both are small companies with limited promotional resources, and it remains to be seen whether FC2 or VA will prove much more popular than the original female condom – even if they are cheaper.
New female condoms are being developed by the non-governmental organization PATH and by a Belgian company called MEDITEAM. These are still a long way from becoming widely available and their future prospects are uncertain.
The benefits of expanding female condom use could be very great. A study in 2006 found that countrywide distribution (equivalent to 10% of condom sales) of the FC2 female condom in Brazil and South Africa would be “useful and cost-effective” for preventing HIV. The cost savings could be greatly increased if 300 million FC2s were acquired through a global purchasing mechanism, which would cut the price per condom by two thirds.
Wider use of the female condom in developing countries depends on the commitment of governments and other major donors. To achieve its full potential, much greater efforts need to be made worldwide to promote the female condom, to make it more accessible and acceptable.