Female Condom

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When it was introduced in 1993, the female condom was hailed as the first woman-initiated "dual-protection" method capable of preventing both unwanted pregnancy and infection. The first (and to date, only) female condom on the market is manufactured by the Female Health Company, and is known in different countries as Reality, Femidom, Care contraceptive sheath, and Dominique.

The female condom is a polyurethane sheath with a flexible plastic ring at both ends, used intra-vaginally during intercourse. A woman squeezes and inserts the inner ring into the vagina, where it rests behind the pubic bone. The outer ring remains outside the vagina, keeping the female condom in place and providing some protection for the vulva and outer genitalia.

Female condom offers many advantages.

For people who have difficulty using male condoms consistently and correctly¹, the female condom offers certain advantages. It is a woman-initiated method, and can be inserted well before intercourse. Because it is not constricting and the material conducts warmth, some users report that it provides greater sensitivity than a male condom. The female condom can be used with both water- and oil-based lubricants, and polyurethane is sturdier than latex and does not cause allergic reactions. As a contraceptive method, the female condom is 95% effective when used consistently and correctly. Though no clinical studies have determined exactly how effective female condoms are at preventing HIV transmission, data does show that they are at least as effective as male condoms.²

Counseling and support are critical for success.

Over 70 countries have introduced the female condom in interventions ranging from pilot projects to national programs.³ These experiences have led to several observations about the acceptability and sustained use of the female condom. While the level of initial acceptance diminishes as the novelty of the device wears off, in nearly all settings a significant number of women and men report positive responses to the female condom and continue to use it over time. Importantly, many users have reported that introducing the female condom to their partner improved their ability to communicate about safer sex in general, and often resulted in an increase in both male and female condom use in the relationship. Achieving sustained use depends largely on the program and strategy used to introduce the female condom as a new method. The decision to position the device as a contraceptive, a dual-protection method, or as an HIV-prevention method can affect whether people are likely to use it with regular or casual partners. Counseling and support are crucial in helping women learn how to use the female condom successfully, and marketing the device to men as well as women also helps to overcome men's resistance to a new (or any) method.

Can the female condom be reused?

Because it is made of polyurethane rather than latex, the female condom is both sturdier and more expensive to manufacture. Several studies have attempted to determine the safety and acceptability of reusing the female condom in an effort to make it more economical. WHO convened two expert consultations to review the various studies and form recommendations to the field. The statement was released at the XIV International AIDS Conference in Barcelona, July 2002.

The World Health Organization (WHO) recommends use of a new male or female condom for every act of intercourse where there is a risk of unplanned pregnancy and/or sexually transmitted infection, including HIV. Since access to female condoms may be limited and reuse of female condoms has been reported, WHO has convened two consultations to address considerations regarding such reuse. Based on these consultations, WHO does not recommend or promote reuse of female condoms. Recognizing the urgent need for risk-reduction strategies for women who cannot or do not access new condoms, the consultation developed a draft protocol for safe handling and preparation of female condoms intended for reuse. This protocol is based on the best available evidence, but has not been extensively studied for safety and has not been evaluated for efficacy in human use.

Click here to read the full statement.

The Female Health Company and UNAIDS have negotiated a public sector price of US$0.58 per condom. Though less than the commercial price of US$2-3, this is still dramatically higher than the cost of male condoms, and in most developing country settings, the female condom must be subsidised. Modeling studies have shown that the price is cost-effective relative to treating people who become HIV-positive; however, programmers still balk when budgeting scarce prevention resources.