What are female condoms?

The original and most widely available female condoms are made by the Female Health Company of Chicago (see www.femalehealth.com). The original FC1 female condom – sold as Femidom, Reality, the Care Contraceptive Sheath and Dominique in different countries – was a soft, strong, transparent polyurethane sheath about the same length but wider than a male condom.

An inner ring helps insertion into the vagina and is designed to sit on the cervix like a diaphragm. An outer ring protrudes outside the vulva, aiding removal and preventing slippage. Unlike the male condom, it can be inserted several hours before sex and can remain safely in place after ejaculation.

Polyurethane was used because it has a better heat conductivity than latex rubber (so sex feels more natural), is odourless, is less likely to cause allergic reactions and is somewhat stronger. Unlike latex, it can be used with oil-based lubricants, though it is supplied ready-lubricated with silicone.

The newer FC2 condom has essentially the same design but is made of a softer nitrile rubber which is cheaper to manufacture than polyurethane. It is more similar to the latex rubber used for male condoms, but can still be used with oil-based lubricants. It lacks one widely disliked characteristic of the original Femidom, that of being noisy when used.

Since it does not fit the penis snugly like a male condom, several men report that the Femidom is more pleasurable because it is not constricting, and because the female condom can be inserted before sexual activity begins, may be less of an interruption of sexual activity than the male condom.

It has been suggested that some women (for example, sex workers) would find the female condoms an easier way of practising safer sex, by keeping it in for a period of time. However, women who have tried this report that it can be uncomfortable, and it is also important to check the female condom at regular intervals for tears in the plastic. Using a female condom on a number of occasions may present few problems with a single sexual partner, but it is risky if used for multiple partners (e.g. for a sex worker). There would be risks to multiple partners who came into contact with infected semen in the female condom deposited by other men.

There are some reported problems with using the female condom. Some women report losing the inner ring inside their vagina whilst others fear that, because the female condom is seamed, it may be more liable to tearing. Some cases of tearing have been noted.

Trials not sponsored by the Female Health Company have tended to show a lower rate of acceptability. The female condom is very visible, and many women find it unattractive because the appliance hangs down beyond the labia. Some women experience irritation to the vulval area because of the outer ring, which fits over the labia to hold the device in place. Some men have found the inner ring uncomfortable as they thrust into it – this problem can be solved by either removing the inner ring, or inserting the female condom on the penis (rather than the woman inserting it in the vagina). And some other sexual activities such as cunnilingus (male-to-female oral sex) are not feasible with it in place.

(Taken from the FC2 information leaflet)

• Find a comfortable position, for example, lying down, sitting with your knees apart, or standing with one foot up on a chair.

• Open the female condom packet by tearing down from the notch, and remove the product. You will see that the female condom is pre-lubricated. Make sure that the flexible inner ring is at the closed end of the female condom.

• Squeeze the lower half of the inner ring between your thumb, index and middle fingers. This should give you a confident grip and narrows the inner ring to ease insertion.

• With the other hand, spread the labia (folds of skin around your vaginal opening). Insert the squeezed ring of the female condom into the vagina, and push inside as far as you can.

• Then put your finger inside the female condom until you can feel the bottom of the inner ring. Push the ring up into the vagina.

• You can tell if it is in place when the inner ring is up past the pubic bone. You can feel your pubic bone by curving your finger (towards the front) when it is a couple of inches inside your vagina.

• The outer ring and a small part of the female condom will stay outside your vagina. This is quite normal so don't worry.

• Another method is to use the female condom as a penile (male) condom. It may be best to leave the inner ring at the far end of the female condom, as this will hold it around the cervix. Since the ring helps to guide the device when it is inserted first into the vagina, and it can cause discomfort, another option is to remove the inner ring. This method could also be used for anal sex.

• Add extra lubricant during sex if one of you needs it. If the outer ring is being drawn into the vagina, or if the penis starts to enter between the vagina and the female condom, then stop. The man should withdraw and add extra lube to the inside of the female condom.

• Removing it: because the female condom lines the inside of the vagina the man doesn't have to withdraw immediately after coming. You can remove the sheath when it suits you, making sure that no semen is spilt. Twist the outer ring to keep the semen inside, then pull gently. Throw away the used female condom. Do not throw it down the toilet as it may cause a blockage.

The VA w.o.w. (Worn-of-Women) Condom Feminine or Reddy Female Condom is manufactured by Medtech Ltd (see www.medtechproducts.net/), and also under licence by Hindustan Latex Ltd, which also manufactures the FC2 condom in India. It has been used in HIV prevention programmes in South Africa since 2004 and more recently in Brazil, Portugal and Indonesia. It is CE marked (see www.medtechproducts.net/pdf/VA_study.pdf) and the manufacturer plans to expand its availability in Europe. The VA condom is shorter than the Femidom but more flexible as it is made of latex like the male condom and therefore cannot be used with oil-based lubricants. It has an integral ‘frame’ (a flattened ring) at the open end and instead of a removable ring at the closed end it has an expandable sponge.

In a self-commissioned usage and acceptability study,¹ a total of 64 failures in 1110 uses of the condom (5.8%) in 222 couples were reported. Fifty-four per cent of users pronounced themselves ‘very satisfied’ with the condom and only 3% ‘dissatisfied’, although there was some difficulty in usage (without barrier failure) in 23.4% of cases, involving occurrences like slippage.

The Colombian Natural Sensation Company and the Silk Parasol Corporation both make Panty Condoms, in which the condom pouch is incorporated into a fairly standard-looking pair of women’s underpants; Silk Parasol is pursuing FDA licensing for its product. Hindustan Latex Ltd of India makes a latex female condom in which the inner ring is replaced by a sponge. African entrepreneurs have also tried to come up with female-condom variants.

The most concerted attempt to develop a more acceptable female condom is currently being pursued by the non-government organisation PATH. Its female condom is narrow at the base, only the width of a tampon, to aid insertion. This narrow base is held together by a gelatine capsule which dissolves when inserted into the vagina and expands to fill the vaginal cavity. It also includes external sponge pads which are designed to gently grip the vaginal walls, obviating the necessity for an external ring.