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A female condom is a device that is used during sexual intercourse to prevent pregnancy and reduce the risk of sexually transmitted infections (STIs—such as gonorrhea, syphilis, and HIV). Invented by Danishmarker MD Lasse Hessel, it is worn internally by the receptive partner and physically blocks ejaculated semen from entering that person's body. Female condoms can be used by the receptive partner during anal sex.

The female condom is a pouch with flexible rings at each end. Before vaginal intercourse, the ring inside the pouch is inserted deep into the vagina, holding the condom in the vagina. The penis is directed into the pouch through the ring at the open end, which stays outside the vaginal opening during intercourse. Female condoms have been available since 1988.

Versions and materials

Reddy brand female condom
The female condom was first made from polyurethane. This version is officially called the "FC Female Condom". A newer version is made of nitrile rubber and called "FC2" (this material change was announced in September 2005).The newer nitrile condoms are less likely to make potentially distracting crinkling noises. It is hoped the nitrile condoms will also allow for significant reductions in female condom pricing. This line of condoms is manufactured by the The Female Health Company, USA. FC1 and FC2 are the only female condoms approved by the World Health Organization (WHO) for purchase by UN agencies. They are sold under many brand names, including Reality, Femidom, Dominique, Femy, Myfemy, Protectiv and Care.

A recent version of the female condom is made from natural latex, the same material used in male condoms. This condom does not make the noises some experience with plastic condoms. This type of female condom is manufactured by Medtech Products Ltd, India. It is sold under various brand names, including Reddy, V Amour, L'amour, VA WOW Feminine condom, and Sutra. One more clinical trial is required before it can be considered for FDA approval in the United States.

The global health nonprofit Program for Appropriate Technology in Health (PATH) has developed a female condom tailored for use in developing countries.

Effectiveness

Some early tests suggested the female condom offered better protection than male condoms, but real-world tests found the original Female Condom to be less effective than male condoms at preventing pregnancy for most people:

Early tests:
  • A presentation at the 1990 International AIDS conference concluded, "exposure to semen was significantly less (p = .001 and p = .03) when WPC-333 was used than when the male condom was used."
  • A presentation at the 1989 International AIDS conference concluded that "WPC-333 had significantly fewer water leaks than the male condom at a p-value of .001. The combined probability of risks of leaks, tears and spillage inside the vagina using WPC-333 was 3.3%; the combined probability of risks using the male condom was 11.5%."


Real-world experiments:
  • The 1992 U.S. FDA approval of the Reality female condom required the label to compare the pregnancy rate for the female condom at 26% per year to a 15% annual rate for the male latex condom. This was based on a U.S. study of 200 women who used the device for six months. In the study, the six-month pregnancy rate was approximately 12.5 percent, or an estimated 26 percent per year. (This includes incorrect and inconsistent use of the condom.)
  • According to Contraceptive Technology: Eighteenth Revised Edition, the typical use failure rate for the first-generation female condoms lies at 21%. This means that of the women who used female condoms as their only form of birth control, 21 out of 100 became pregnant within one year. Of the women who used the female condom correctly, and used one at every act of intercourse, 5% became pregnant after one year. In comparison, the typical use failure rate for male condoms was 15%, while the perfect use failure rate was 2%.


The effectiveness of the female condom at preventing STDs has not been studied to the same extent as male condoms, however it has been put forth that it should have similar effectiveness to preventing pregnancy. Female condoms are better at preventing some STIs than the traditional condom. This is because they cover more skin, which is the main way skin-to-skin viruses are contracted, such as herpes. Sensitivities to silicone or polyurethane may also be a problem.

Costs and "reuse" of the (polyurethane) original FC

The per unit price of female condoms is higher than male condoms but there is some evidence to suggest that polyurethane female condoms can be washed, disinfected, and reused.

Re-using the polyurethane female condom is not considered as safe as using a new one, however the WHO says, "Batches of new, unused female condoms were subjected to seven cycles of disinfection, washing, drying and re-lubrication, reflecting the steps and procedures in the draft protocol, but at considerably higher concentrations of bleach and for longer durations. All female condom batches met the manufacturing quality assessment specifications for structural integrity after the test cycles. ... Disinfection, washing, drying, re-lubrication and reuse of the device were not associated with penile discharge, symptomatic vaginal irritation or adverse colposcopic findings in study volunteers." A presentation at the 1998 International AIDS conference concluded that "washing, drying and re-lubricating the female condom up to ten times does not significantly alter the structural integrity of the device. Further microbiological and virological tests are required before re-use of the female condom can be recommended."

Lubrication

As with all barrier contraceptives, water or silicone-based lubricants are safe to use with a female condom. Oil damages latex and should not be used with a female condom made of latex. Oils should not directly harm a polyurethane (or nitrile) female condom but may cause other health problems (which could weaken defenses against more serious STDs), or make it more difficult to clean and disinfect (without further weakening it).

Advantages

The plastic female condoms have the advantage of being compatible with oil-based lubricants as they are not made of latex. The external genitals of the wearer and the base of the penis of the inserting partner may be more protected than when the male condom is used, however see studies below. Inserting a female condom does not require male erection.

Worldwide use

Sales of female condoms have been disappointing in developed countries, though developing countries are increasingly using them to complement already existing family planning and HIV/AIDS programming. Probable causes for poor sales are that inserting the female condom is a skill that has to be learned and that female condoms can be significantly more expensive than male condoms (upwards of 2 or 3 times the cost). Also, reported "rustling" sounds during intercourse turn off some potential users, as does the visibility of the outer ring which remains outside the vagina.

In November 2005, the World YWCA called on national health ministries and international donors to commit to purchasing 180 million female condoms for global distribution in 2006, stating that "Female condoms remain the only tool for HIV prevention that women can initiate and control," but that they remain virtually inaccessible to women in the developing world due to their high cost of 72¢ per piece. If 180 million female condoms were ordered, the price of a single female condom was projected to decline to 22¢.

In 2005, 12 million female condoms were distributed to women in the developing world. By comparison, between 6 and 9 billion male condoms were distributed that year.

Similar prophylactics that may not be available

  • The Barrier
    • Coverage / How it is held in place: It fits over the vulva and perineum and is held in place with thick elastic straps that encircle the women's upper legs. The tube-shaped pouch is about 1 1/2 times larger and 2 times thicker than a male condom. The penis never directly touches the woman's outer or inner genitalia
    • Material: latex
  • The Bikini Condom
    • Coverage / How it is held in place: "looks like a G-string panty"
    • Effectiveness: thicker and less slippage than male condoms, a breakage rate of 0.5%, compared to 1-2% for male condoms
    • Advantages: condom pouch can be automatically introduced into the vagina with coitus, reported heightened sensation for women
    • Cost—reuse: "can be used 5-10 times"
  • Women's Choice Female Condom
    • Coverage / How it is held in place: Has a 2-inch diameter flexible ring that covers the introitus, and a thickened dome of latex resembling a diaphragm at the deep end
    • Pre-lubrication / Spermicide: silicone lubrication


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