|The Female Condom and AIDS (UNAIDS, 1997, 8 p.)|
|Facts and Figures|
|Can another type of condom really make a difference to the epidemic?|
|What is wrong with male condoms? Nothing, but...|
|The big questions: how does it feel and what does it cost?|
|UNAIDS Best Practice materials|
The traditional condom is cheap, widely available and highly effective if used correctly. It is an essential part of the fight against HIV and AIDS. But it is not always the perfect solution.
Most commercial condoms are made of latex, a soft rubber. Up to 8% of people are allergic to latex, and therefore cannot use it. Because latex is soft, male condoms have to be used carefully in order not to break or tear them. A male condom can only be put on when the penis is erect. For many couples, this means an unpleasant interruption of sexual activity. As well, some men feel that a condom dulls their sexual pleasure, and for this reason prefer not to use one.
If alcohol or drugs have been consumed before sex, it is likely that a male condom will be forgotten or not used because of insufficient erection to put it on. There is also a greater risk that it will be used incorrectly, torn while being taken out of its package, or that leakage will occur from the open end.
Safe and reliable
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 dampness. In contrast, the latex in a male condom can be damaged by heat, light and humidity. The expiry date on the female condom is 60 months (5 years) from the date of manufacture.
Testing of female condoms indicates that semen leakage after sex is less than with a male condom, and that the risk of semen getting into the vagina due to dislodgement is about one-third lower. These tests were done with ultrasound equipment to check the stability of the condom, and various sexual positions were tried.
Other tests have investigated the female condom's risk of causing irritation, or encouraging bacteria or other health problems in the vagina. In some tests, female condoms were used in sex and then left in the vagina overnight, a much longer period than normal. The results showed no complications, indicating that even women with very sensitive skin can use the female condom.
"I don't feel right to refuse sex, because it's sinful. A woman is her husband's property. She is already bought."
A woman in Indonesia
There may be benefits to women who are no longer of child-bearing age. A recent study in Britain indicates that women who suffer pain during sex due to vaginal dryness (particularly women who have passed the menopause) can be helped by the female condom.
Women's lack of bargaining power
Until recently, the traditional male condom has been the only barrier method available to prevent the transmission of HIV during sexual intercourse. If the man refuses to use one, many women do not have the bargaining power to say no to sex. The reasons for this are many. Most frequently it is the result of the lower social status of women in many societies.
Many people think that a woman is only at risk of HIV if she has many sex partners or is a sex worker. Like the myth that HIV is a "homosexual disease," this is far from true. Many women are infected by the only man they have ever had sex with - their husband. It may be difficult for them to argue with his decision, particularly on when and how to have sex.
Women who have more than one partner are often in an even weaker position to insist on protection. Sex workers may be reluctant to argue with a client who does not want to wear a condom, fearing both the loss of income and - far too often - a violent reaction. In recent years, the demand for uninfected sex partners has resulted in growing numbers of adolescent girls being brought into the sex trade. These girls are even less able to insist that a man use a condom.
[See also Reducing women's vulnerability to HIV/AIDS: UNAIDS Point of View.]
Women's physical vulnerability
Women are about four times more vulnerable than men to sexually
transmitted diseases, including
HIV. This is largely because of anatomy: the area of the female genitals exposed to semen and other sexual fluids during sex is four times larger than that of men.
Women are also at more risk of getting infected because semen contains greater amounts of the virus than vaginal fluids. Like men, women run a much higher risk of infection with HIV if they have an untreated STD. But the problem is that STDs in women often cause no symptoms. And women with "silent" gonorrhoea, trichomoniasis or chlamydia may get late treatment or none at all.
More protection for both women and men
Anything that reduces the spread of HIV in women reduces its spread in men and vice versa. One of the main ways of combating STDs for both is to reduce the number of times they have unprotected sex.
A 1995 UNAIDS study in Thailand indicates that the availability of female condoms can indeed reduce unprotected sex. In the study, some groups of female sex workers were given male condoms only, while others were given both male and female condoms. Those given both had less unprotected sex and got one-third fewer STDs than those given only the male condom.
Both women and men's vulnerability to HIV is greatly increased by genital ulcers caused by STDs such as syphilis or herpes. The female condom's greater coverage of the female genitals (vagina, cervix and vulva) and the base of the man's penis adds extra protection for both partners.
Using the female condom will require the agreement of both partners in most cases, but it does give a woman more control. Since it can be inserted hours before intercourse, it can provide protection in situations where consumption of alcohol or drugs may reduce the chances that a male condom will be used.