This piece is about female condoms. I bring them up for discussion because they are currently out of the limelight. When they first appeared, they seemed full of promise – a method of protection against pregnancy and HIV which could be used and controlled by women. In practice they pose problems – including the fact that they are a bit of a joke. So this is a reminder of the key facts and issues.
Overall, their use is slowly increasing. The numbers distributed have tripled since 2005. Female condoms are making some contribution to the proportion of sex acts which are protected; also to a decrease in unwanted pregnancies and the transmission of HIV and other STIs. But they are still used mainly by sex workers.
Are they safe? In research done in laboratories and in the field in Africa and Asia, they have been found to be as safe as male condoms. Consider:
- whether they are effective barriers for sperm, HIV and other STIs. Both kinds of condom reduce the chance of pregnancy, when used really correctly, to about 2% - when used as people normally do, to about 12% (female condom) and 15% (male condom). A model was made by a computer which envisaged a HIV negative female with a HIV positive male partner; they were in the model having sex twice a week for a year. If either male or female condoms had been used correctly, the woman's chances of becoming infected would be less than 10%;
- breakage rates for male and female condoms are about the same;
- both can be used in anal sex by both homosexual and heterosexual couples.
Problems with the female condom
They look and feel “weird” and they are noisy. Male partners (if not too drunk) know that they are there. In the future, it is hoped, methods will be found for women and high-risk men to get ART preventively, without it being visible. These could be via meds or via the vaginal gels now under trial.
Who uses them and for what
Safe sex is a political issue. What is decided and happens just before intercourse depends on who has the power – who can insist on what. Most men will claim that any condom use deprives them of some feeling, some pleasure. If women can negotiate, they usually choose for male condom use; with their intimate parter, they will use male condoms but with casual or financial sex they may use female condoms
For example, a study in Tanzania ran a mass-marketing campaign about female condoms. Then it interviewed 2.712 men and women about their actual or intended use of the female condom. About a quarter of all women interviewed said they would use the female condom in casual sex; one in eight would use it with regular partners, but only one in fourteen would use it with their husbands.
Women using female condoms told of a number of different strategies to persuade men into condom use. They put one on the pillow; they emphasise the additional degree of protection which female condoms give, and that even if they are using oral contraception the condoms are a backup. In Tanzania as in Kenya, men are more afraid of a pregnancy than of infection. So to talk about the risk of pregnancy builds trust and avoids accusations of infidelity. The women tell their men that the female condom does not interrupt the process of sexual play and erection, and that the polyurethane transfers heat well; they also eroticise female condom use by involving the man in the process of putting it in.
Can we promote them more effectively?
Slowing the transmission of HIV/AIDS takes all different kinds of interventions. If more sex workers, more women who are not monogamous use female condoms, that is a good bit of progress. And can I ask anyone working in this field to check whether her/his educational powers are as good as possible? If a new product is promoted – a new pencil, a new potato peeler – then the people promoting it need to be comfortable. They need to have the object around, to play with it, to use it. Then they can argue for using it with confidence. So get a few female condoms from the storeroom, take one out of its packet and feel it: put it over a hand; pass it around; discuss it. Then, talking to any mature woman who is brave and dedicated, I invite them to take one home and insert it. To feel how it feels. To explain its use out of sure knowledge. It does feel weird!