Female condoms for anal sex

The Reality FC1 condom was approved in the USA in 1992 for vaginal contraceptive use. Although female condoms are essentially not designed for the purpose, some gay men have used them and it seems they do provide an effective barrier during anal sex. Heterosexual couples may also use female condoms during anal sex.

Research published in the March 2003 edition of the journal AIDS assessed the safety and acceptability of the Reality condom for anal sex among gay men.¹ The study enrolled 56 monogamous, seroconcordant, gay male couples who had not used condoms in the past three months. They were randomised to use latex male condoms or the female condom for anal sex. On study entry, the men were given ten female or lubricated male condoms to use with lubricant during the following six weeks. In the second six weeks the couples crossed over and began using the other condom type.

Receptive partners were more likely to report pain or discomfort with the female than with the male condom. Both partners were significantly more likely to report female condom slippage during use or withdrawal. Rates of condom breakage were similar for female and male condoms.

After using both sets of condoms, both active and passive partners were significantly less likely to be willing to use female condoms in the future with partners of unknown HIV status than they were to use male latex condoms; 21% of receptive and 26% of insertive partners would be willing to use female condoms, compared to 61% of both receptive and insertive partners who were willing to use male condoms.

The main reason reported by those who would be willing to use the female condom with future partners of unknown HIV status were that the female condom was more comfortable, easier to use, and perceived to be stronger and safer.

The researchers suggested that gay men who are considering using the female condom might require training relating to slippage and methods for avoiding semen spillage that might expose the anal mucosa. They added "further work is warranted on design modifications, safety and acceptability of the female condom in HIV-negative gay men".

• The easiest way to use the female condom for anal sex is to wear it like a ‘male’ condom. Put lubricant in the female condom and then place it over the penis (or a dildo). Use plenty of lubricant on the outside of the female condom or around the anus before insertion.

• Alternatively, it is possible to insert the female condom in the rectum first, as for vaginal sex. Use plenty of lubricant around the anus, and loosen it with a finger in readiness for the female condom. Make sure fingernails are cut short.

• After removing the female condom from its wrapper, the inner ring is held between thumb, index and forefinger, and squeezed so that it forms an oval. Removal of the inner ring may lead the female condom to become tangled, and could lead to breakage.

• The user pushes the female condom up into the rectum as far as they can, using the inner ring as a guide. This may be easier if one leg is raised, as on a stool. They then put their index finger inside the female condom, until they can feel the bottom of the inner ring, and push it up from the inside. The outer ring should not be inserted.

• The outer ring, and perhaps a small part of the female condom, remain outside the anus. This is meant to happen, and should stop the female condom from slipping inside.

• More lubricant should be used inside the female condom to keep it moist, and added whenever you need it during intercourse.

• Users should check every now and again during intercourse that the outer ring of the female condom hasn't slipped inside the anus, or that the penis hasn't slipped between the female condom and the rectum. If it has, users should stop, remove the female condom, and use a new one before starting again.

• The female condom should not be reused for anal sex. Some gay men have reported using a female condom with multiple partners, but there is no data on whether the condom can stand up to multiple use. It is of course also potentially risky to any new active partner.

• Because the female condom lines the inside of the rectum and is not dependent upon erection to stay in place, the insertive partner does not have to withdraw immediately after ejaculation. The sheath can be removed when it suits partners, making sure that no semen is spilt. The outer ring should be twisted to keep the semen inside, then pulled gently. Throw away the used female condom.