Female condom

Female condom
Polyurethane female condom
Background
Birth control type	Barrier
First use	1980s
Failure rates (first year)
Perfect use	5%
Typical use	21%
Usage
Reversibility	Immediate
User reminders	To avoid risk of incorrect use, read the instructions carefully prior to use.
Advantages and disadvantages
STD protection	Yes
Benefits	No external drugs or clinic visits required

A female condom (also known as a femidom) is a device that is used during sexual intercourse as a barrier contraceptive and to reduce the risk of sexually transmitted infections (STIs—such as gonorrhea, syphilis, and HIV) and unintended pregnancy. Invented by Danish MD Lasse Hessel, it is worn internally by the receptive partner and physically blocks ejaculated semen from entering that person's body. Female condoms can be used by the receptive partner during anal sex.^[1][2]

The female condom is a thin, soft, loose-fitting sheath with a flexible ring at each end. They typically come in various sizes. Size should be carefully selected as not to cause any user discomfort, as well as to prevent errant sperm from bypassing the condom. For most vaginas, a moderately sized condom is adequate; women having recently experienced child birth should try a large first. The inner ring at the closed end of the sheath is used to insert the condom inside the vagina and to hold it in place during intercourse. The rolled outer ring at the open end of the sheath remains outside the vagina and covers part of the external genitalia.

Versions and materials

Reddy brand female condom

The FC1 female condom was first made from polyurethane. The second generation female condom is called the FC2 and is made from synthetic nitrile.^[3] (this material change was announced in September 2005,^[4] and full transition of the product line to FC2 was done by October 2009 ^[5]). The newer nitrile condoms are less likely to make potentially distracting crinkling noises. FC2 was developed to take the place of FC1, providing the same safety and efficacy during use, but at a lower cost. It is hoped the nitrile condoms will also allow for significant reductions in female condom pricing.^[4] FC2 is manufactured by The Female Health Company. The FC2 is the only available product under a woman's control that is approved by the U.S. Food and Drug Administration (FDA). Moreover, The World Health Organization (WHO) has cleared FC2 for purchase by U.N. agencies and the UNFPA (a U.N. agency) has incorporated the female condom into national programming.^[6] They are sold under many brand names, including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv and Care.

A recent version of the female condom is made from natural latex, the same material used in male condoms. This condom does not make the noises some experience with plastic condoms. This type of female condom is manufactured by Medtech Products Ltd, India. It is sold under various brand names, including Reddy, V Amour, L'amour, VA WOW Feminine condom, and Sutra. One more clinical trial is required before it can be considered for FDA approval in the United States.^[7]

The global health nonprofit Program for Appropriate Technology in Health (PATH) has also developed a female condom tailored for use in developing countries. The Woman's Condom is manufactured by Shanghai Dahua Medical Apparatus in China and is currently undergoing clinical trials.^[8]

Costs and "reuse" of the original FC and FC2

The per unit price of female condoms is higher than male condoms but there is some evidence to suggest that polyurethane female condoms can be washed, disinfected, and reused.

Re-using the polyurethane female condom is not considered as safe as using a new one, however the WHO says, "Batches of new, unused female condoms were subjected to seven cycles of disinfection, washing, drying and re-lubrication, reflecting the steps and procedures in the draft protocol, but at considerably higher concentrations of bleach and for longer durations. All female condom batches met the manufacturing quality assessment specifications for structural integrity after the test cycles. ... Disinfection, washing, drying, re-lubrication and reuse of the device were not associated with penile discharge, symptomatic vaginal irritation or adverse colposcopic findings in study volunteers."^[9] A presentation at the 1998 International AIDS conference concluded that "washing, drying and re-lubricating the female condom up to ten times does not significantly alter the structural integrity of the device. Further microbiological and virological tests are required before re-use of the female condom can be recommended."^[10]

Research suggests that the FC2 female condoms are a cost-effective method of HIV prevention even at low levels of use. The data shows that the cost-effectiveness would increase significantly at higher levels of use. A study conducted in 2005 by Dr. David Holtgrave, Chair of the Department of Health, Behavior and Society at Johns Hopkins University's Bloomberg School of Public Health, examined the projected public health impact that the FC2 female condom would have at different levels of use in two developing countries: South Africa and Brazil. The study concluded that FC2 use would generate significant cost savings at all levels of implementation by preventing thousands of HIV infections and saving millions of dollars in health care costs.^[11]

Lubrication

As with all barrier contraceptives, water or silicone-based lubricants are safe to use with any female condom. Oil should not be used with a female condom made of latex.

FC2 Female Condom comes pre-lubricated with a non-spermicidal, silicone based lubricant. The FC2 is made of nitrile so oil-based (or water-based) lubricants can be added on the inside and outside of FC2 Female Condom or on the penis.

Advantages

FC2 Female Condom gives women control and choice over their own sexual health; women can protect themselves when their partner does not want to use a male condom; female condoms provide enhanced sensation for men as compared to male condoms ^[12]; female condoms may provide enhanced sensation for women as compared to male condoms ^[13]; FC2 is hypo allergenic and is safe to use with people who are allergic to rubber latex; FC2 may be inserted hours before intercourse; female condoms are not dependent on the penis being erect for insertion and does not require immediate withdrawal after ejaculation; FC2 is not tight or constricting; FC2 is highly lubricated and the material warms to body temperature.^[14]

The external genitals of the wearer and the base of the penis of the inserting partner may be more protected (from skin-to-skin transmitted STDs such as herpes and HPV) than when the male condom is used, however see studies below.

Worldwide use

Sales of female condoms have been disappointing in developed countries, though developing countries are increasingly using them to complement already existing family planning and HIV/AIDS programming.^[15] Probable causes for poor sales are that inserting the female condom is a skill that has to be learned and that female condoms can be significantly more expensive than male condoms (upwards of 2 or 3 times the cost). Also, reported "rustling" sounds from the original version of the female condom during intercourse turn off some potential users, as does the visibility of the outer ring which remains outside the vagina.^[16]

In November 2005, the World YWCA called on national health ministries and international donors to commit to purchasing 180 million female condoms for global distribution in 2006, stating that "Female condoms remain the only tool for HIV prevention that women can initiate and control," but that they remain virtually inaccessible to women in the developing world due to their high cost of 72¢ per piece. If 180 million female condoms were ordered, the price of a single female condom was projected to decline to 22¢.^[17]

In 2005, 12 million female condoms were distributed to women in the developing world. By comparison, between 6 and 9 billion male condoms were distributed that year.^[17]

Similar prophylactics that may not be available

• The Barrier
  • Coverage / How it is held in place: It fits over the vulva and perineum and is held in place with thick elastic straps that encircle the women's upper legs. The tube-shaped pouch is about 1½ times larger and 2 times thicker than a male condom. The penis never directly touches the woman's outer or inner genitalia ^[18]
  • Material: latex
• The Bikini Condom
  • Coverage / How it is held in place: "looks like a G-string panty"
  • Effectiveness: thicker and less slippage than male condoms, a breakage rate of 0.5%, compared to 1–2% for male condoms
  • Advantages: condom pouch can be automatically introduced into the vagina with coitus, reported heightened sensation for women
  • Cost—reuse: "can be used 5–10 times"
• Women's Choice Female Condom
  • Coverage / How it is held in place: Has a 2-inch-diameter (51 mm) flexible ring that covers the introitus, and a thickened dome of latex resembling a diaphragm at the deep end
  • Pre-lubrication / Spermicide: silicone lubrication

References

1. ^ Female condoms for anal sex
2. ^ How to Put on a Female Condom (For Anal Sex)
3. ^ Product
4. ^ ^{a b} "Female Health Company Announces International Availability of Second — Generation Female Condom at Significantly Lower Price" (PDF) (Press release). Female Health Company. September 29, 2005. http://www.femalehealth.com/InvestorRelations/investor_pressreleases/press_2005_09_21_2ndGenerationFC_Announcement.pdf. Retrieved 2006-08-03. (PDF)
5. ^ "Female Health Company". Female Health Company. http://www.femalehealth.com/. Retrieved 2011-06-12. 
6. ^ http://www.unfpa.org/hiv/female.htm
7. ^ The Female Condom
8. ^ PATH's woman's condom
9. ^ WHO information update: Considerations regarding Reuse of the Female Condom
10. ^ McIntyre J, Pettifor A, Rees VH (June 28–July 3, 1998). "Female condom re-use: assessing structural integrity after multiple wash, dry and re-lubrication cycles". 12th International AIDS Conference. abstract no. 33124. http://www.aegis.com/conferences/iac/1998/33124.html. 
11. ^ Dowdy, DW; Sweat MD, Holtgrave DR. (2006 Oct 24). "Country-wide distribution of the nitrile female condom (FC2) in Brazil and South Africa: a cost-effectiveness analysis.". AIDS 20 (16): 2091–8. doi:10.1097/01.aids.0000247567.57762.fb. PMID 17053355. http://www.ncbi.nlm.nih.gov/pubmed/17053355?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum. 
12. ^ "Understanding The Finer Nuances Of The Female Condom". Women's Health Line. 2009. http://www.womenhealthline.com/understanding-the-finer-nuances-of-the-female-condom/. Retrieved 2011-06-12. 
13. ^ Dawn Stacey, M.Ed, LMHC (2009). "Fc Female Condom". About.com. http://contraception.about.com/od/overthecounterchoices/gr/fc.htm. Retrieved 2011-06-12. 
14. ^ "The Product". FC & FC2 Female Condom. Female Health Company. 2005. http://www.femalehealth.com/theproduct.html. Retrieved 2006-08-03. 
15. ^ "Global Consultation on the Female Condom". Baltimore, MD: PATH. September 26 to 29, 2005. http://www.path.org/projects/womans_condom_gcfc2005.php. Retrieved 2006-08-03. 
16. ^ Boston Women's Health Book Collective. Our Bodies, Ourselves : A New Edition for a New Era. New York, NY: Touchstone. ISBN 0-7432-5611-5. 
17. ^ ^{a b} "Statement of Dr. Musimbi Kanyoro, General Secretary, World YWCA" (Press release). PRNewswire. November 21, 2005. http://www.prnewswire.co.uk/cgi/news/release?id=158769=. Retrieved 2006-08-03. 
18. ^ "Two female condoms close to entering U.S. market". Contracept Technol Update 10 (4): 49–50. April 1989. PMID 12342200. 

External links

• Detailed Guide to use Female Condom How to use and take out safely a female condom
• Prevention Now! Expanding Global Access to Female Condoms
• "Female Condoms: Sexual Freedom Doesn't Come Free" posted on Alternet
• "Whatever happened to the Femidom?" in Guardian
• PATH's woman's condom
• How to put on a female condom An illustrated guide from Canadian health experts
• Planned Parenthood with an explicit video on what it look like and how to use it