Cover Image
close this bookThe Female Condom: a guide for planning and programming under (UNAIDS, 2000, 81 p.)
View the document(introduction...)
View the documentAcknowledgement
View the document1. Introduction
View the document2. What is the female condom?
View the document3. What we know about the female condom
View the document4. Cost-effectiveness of the female condom
View the document5. Planning strategically for the introduction of the female condom
View the document6. Steps to introduce and integrate the female condom into reproductive health programmes
View the document7. Explaining the female condom to potential users
View the document8. Resource materials

3. What we know about the female condom

The female condom, a male latex condom and a diaphragm - as the consistency of use of barrier methods increases, the risk of STI infection decreases.


Figure

Source: The Female Health Company

The female condom is safe and effective if used correctly and consistently, and has high acceptability among both women and men in many countries.

This Section synthesizes the main research and programme findings from international experience.

A wide range of acceptability studies in many countries and in many different social and economic settings has shown that the female condom is acceptable to a considerable number of men and women. Some men prefer the female condom to the male condom in that it does not interrupt sexual activity and feels more similar to unprotected sex.

The female condom has been the subject of extensive research, both in clinical settings and in “real life” projects. A large amount of information has been collected, and several extensive reviews of the research have been conducted (see the “Resource materials” section for a list of these reviews). The following facts and figures summarize the research results.

1. Protection against unwanted pregnancies

The female condom is a reversible, barrier method of contraception that extends the choice of contraceptive methods available and provides protection from the risk of pregnancy.

Estimated annual accidental pregnancy rates for consistent and correct use

Female condom

Male latex Condom

Diaphragm

Spermicide

5%

3%

6%

6%

2. Protection against the transmission of STIs

A clinical study has demonstrated that the female condom prevents re-infection with Trichomoniasis. In vitro studies confirm that the female condom provides an effective barrier to organisms smaller than those known to cause STIs. On the basis of these studies, the female condom, with correct and consistent use, is expected to provide protection against other STIs, including HIV. Clinical studies of its protection against the transmission of other STIs are underway.

3. Expanding choice increases protection

A controlled study of STI transmission amongst sex workers in Thailand showed that when both the female and male condoms were available, the rate of STI transmission was reduced by one-third of that in a similar group with access solely to the male condom. The female condom, when available, provides an additional choice for protecting against STI transmission and HIV infection.

A different study in Philadelphia, USA, demonstrated that providing women with the female condom resulted in an overall reduction in the number of unprotected acts of sexual intercourse.

4. The female condom is acceptable to a wide range of women and men

The female condom has a high level of acceptability among both women and men. Studies in numerous countries and in many different settings show that, on average, 50% to 70% of male and female participants found the female condom to be acceptable. Satisfied couples reported that use of the female condom did not interfere with sexual sensitivity and pleasure.

Women and men of all ages can use the female condom. It is particularly attractive to women who experience side-effects from hormonal methods; people who want to protect themselves from both STIs, including HIV/AIDS, and unwanted pregnancy; people who do not like (or whose partners do not like) the male condom; and people who are allergic to latex. The female condom can be used in conjunction with the IUD, hormonal methods and sterilization.

5. The female condom is safe

Because of the polyurethane used to make it, the female condom is both strong and durable. No special storage arrangements have to be made because polyurethane is not affected by changes in temperature and humidity. The expiry date on the female condom is 60 months (five years) from the date of manufacture.

Research confirms that the female condom has no serious side effects. It does not alter the vaginal flora or cause significant skin irritation, allergic reactions or vaginal trauma. Some users have reported mild but transient irritation. The polyurethane does not produce irritation or allergic reactions in people sensitive to latex, the material from which most male condoms are made.

6. Practice makes female condom use easier

A consistent finding in all female condom programmes is that practice makes a great difference in how women feel about the female condom. Most programmes now suggest that women try the female condom three times before deciding whether they like it or not. The occasional complaints about the female condom – it seems too long, it is a little difficult to insert the first time, etc. – were mostly reduced or solved by continued use. Practice can also make a difference in how providers promote the female condom.

7. The female condom provides additional emotional comfort, sense of security and control

Acceptability of the female condom does not only depend on physical feeling. In several studies it was found that women who feared that they were at a high risk of STI infection seemed more inclined to accept the female condom. A group of female sex workers tested in France said they felt reassured with a female condom because they knew that polyurethane is stronger than latex and therefore felt confident there would be no breakage.

In many places, women have little or no say in sexual matters, and they are in no position to ask their partner to abstain from sex with others or to use a male condom. The female condom is a method providing dual protection against STIs and pregnancy over which women themselves exercise some control. The female condom, therefore, contributes to women ’s sense of personal control and empowerment, increases women’s knowledge about their bodies and STIs, and improves communication between men and women.

8. The female condom can be a cost-effective addition in prevention programmes

Perhaps the most important new research to emerge about the female condom is the cost-effective role that it can play in reproductive health programmes. UNAIDS and other organizations have been engaged in research to measure the cost-effectiveness of introducing the female condom. The findings from these various studies indicate that the female condom is not only a cost-effective but also a cost saving addition to prevention programmes, particularly when specifically targeted to people who practise high-risk behaviours. (See Section 4 for more information.)

9. The female condom needs to be introduced strategically

The female condom is an important new technology that can play a vital part in reproductive health programmes and needs to be introduced strategically to provide the greatest public health impact. Based on experiences from all over the world, the following key programming lessons have been learned:

· There is a significant demand for the female condom amongst women and men, although some of this may be “novelty demand”.

· It is important to assess the actual use of the female condom over time.

· Although the female condom is more expensive than a male condom, the female condom can be a cost-effective intervention as it increases protected sexual acts.

· It is important to prioritize the target audience (or audiences), especially if there are limited female condom supplies.

· It is important to target distribution to ensure that female condom users have the opportunity for an on-going, consistent supply.

· Practice makes perfect – there is a need to provide samples of the product and good education on correct use of the female condom.

· Female condom use is not complicated, so it is important not to over-complicate the introduction.

· Service providers may have a bias against barrier methods and the female condom, so it may be necessary to de-sensitize providers and prevent these biases from negatively influencing potential users. This can be achieved through training clinicians, educators and programme managers.

· It is crucial to involve men in the introduction of the strategy.

· A comprehensive introductory outreach programme and distribution strategy should be developed at the same time as plans for the procurement of the female condom are initiated.

10. Common questions, problems and concerns about female condom use

There are a number of common issues that have emerged in many female condom programmes that arise with female condom use, particularly for first-time users. These issues and how to address them are included in Section 7: Explaining the female condom to potential users.

The female condom is an important new technology that can play a vital part in reproductive health programmes and needs to be introduced strategically to provide the greatest public health impact.