FHI - Female Condoms

Female condoms are a safe and effective method of contraception and STI prevention, although they are slightly less effective at preventing pregnancy than the male condom.
- Within the first year of consistent and correct use, about five percent of women using female condoms will have an unintended pregnancy, compared to three percent for those using male condoms. When not used correctly or consistently, the unintended pregnancy rate has been estimated at 21 percent for the female condom, compared to 14 percent for the male condom.
  - Cates W, Raymond E. Vaginal Barriers and Spermicides. In Hatcher RA, Trussell J, Nelson A, et al, eds Contraceptive Technology, Nineteenth Revised Edition. New York: Ardent Media, Inc., 2007, pp.317-335.
  - Macaluso M, Lawson M, Hortin G, et al. Efficacy of the female condom as a barrier to semen during intercourse. Am J Epidemiol 2003;157(4):289-97. (abstract)
- Laboratory studies have found that the female condom is impermeable to various STIs, including HIV. Because the outer ring partially covers the external genitalia, the female condom may provide more protection against ulcerative STIs, such as herpes and chancroid, than the male condom, although further research is needed to substantiate this hypothesis.
  - Drew W, Blair M, Miner R, et al. Evaluation of the virus permeability of a new condom for women. Sex Transm Dis 1990;17(2):110-12. (abstract)
- Research shows that the new synthetic latex female condom (FC2) performed comparably with Reality (Femidom), the first female condom to be made commercially available. Synthetic latex condoms have lower material and manufacturing costs than the first-generation polyurethane female condoms and have the potential to lower overall retail costs and increase uptake.
  - Beksinska M, Smit J, Mabude Z, et al. Performance of the Reality® polyurethane female condom and a synthetic latex prototype: a randomized crossover trial among South African women. Contraception 2006;73(4):386-93. (abstract)
The female condom is an acceptable form of contraception to men and women, and its use is increasing.
- A 1997 WHO review of 41 acceptability studies on the female condom indicated that acceptance ranges from 41 percent to 95 percent of study participants. Counseling helps overcome women's initial difficulties using the device, and promotional campaigns should be directed toward men as well as women. Over time, use tends to become concentrated among a subset of women or couples with high motivation to use the device. Evidence from South Africa shows some women have succeeded in incorporating the female condom into their sexual relationships. Of the 198 women who had received a female condom, 44 percent reported that the female condom was part of their contraceptive method mix. A recent U.S. study showed an increase in self-reported female condom use did not result in reduced male condom use among women.
- Female condoms are not as widely distributed as male condoms, and are currently more expensive per unit. Worldwide, in 2007, roughly 423 male condoms were produced for every one female condom. Female condoms currently have a unit cost that is about 18 times higher than male condoms. More investment is needed in expanding women's access to this method and in lowering costs. Recent findings from Madagascar confirm that increasing the availability of female condoms has the potential to improve public health.
  - Hoke TH, Feldblum PJ, Van Damme K, et al. Temporal trends in sexually transmitted infection prevalence and condom use following introduction of the female condom to Madagascar sex workers. Int J STD AIDS 2007;18(7):461-466. (full text [PDF, 113 KB])
  - Hoke TH, Feldblum PJ, Damme KV, et al. Randomised controlled trial of alternative male and female condom promotion strategies targeting sex workers in Madagascar. Sex Transm Infect 2007;83(6):448-453 (abstract)
  - Oxfam International. Failing Women, Withholding Protection. Oxfam Briefing Paper 115, August 2008. (full text [PDF, 361 KB])
Adding the female condom to a program that promotes the male condom can result in more protected sex, yet initial research has indicated this does not necessarily lead to a measurable impact on STI rates. More research is needed to determine whether increasing protected sex acts through provision of female condoms can affect STI/HIV prevalence.
- In Zambia, couples who had a choice of using either the male or female condom reported using the female condom more often (28 percent to 47 percent of the time) and reported fewer unprotected sex acts than couples who used the female condom less than 10 percent of the time. These figures suggest that the availability of the female condom in addition to the male condom results in more protected coital acts.
- A study in Thailand showed that STI incidence rates decreased when women had an option to use a female condom if their partner refused to use a male condom. A community intervention trial in rural Kenya suggested, however, that the availability of the female condom, along with the availability of the male condom, did not affect STI rates, compared to the availability of only the male condom.
  - Feldblum P, Kuyoh M, Bwayo J, et al. Female condom introduction and sexually transmitted infection prevalence: results of a community intervention trial in Kenya. AIDS 2001;15(8):1037-44. (full text)
  - Fontanet S, Saba J, Chandelying V, et al. Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: Results from a randomized controlled trial. AIDS 1998;12(14):1851-59. (full text)
  - Musaba E, Morrison C, Sunkutu M, et al. Long-term use of the female condom among couples at high risk of human immunodeficiency virus infection in Zambia. Sex Transm Dis 1998;25(5):260-64. (abstract)
Preliminary research on reuse of the female condom is promising.
- Separate studies by both FHI and the Reproductive Health Research Unit of the University of Witwatersrand, South Africa have found the structural integrity of the female condom (first-generation) after multiple washings (as many as eight times) remained above manufacturer standards for new female condoms.
- Preliminary findings indicate that multiple disinfections, washings, and uses of the female condom do not harm the vaginal wall, cervix, or penis in healthy individuals.
  - Joanis C. Female condom re-use: final results and implications. Presentation at Family Health International, Technical Advisory Committee for Contraceptive Technology and Family Planning Research, Chapel Hill, NC, May 2-3, 2002.
- A WHO expert panel in January 2002 issued a consensus statement that while it is always better to use a new male or female condom, the female condom could be disinfected, cleaned, and used up to five times if it is handled according to a prescribed protocol. This protocol includes soaking the used female condom in a 1:20 dilution of sodium hypochlorite (household bleach) for one minute before washing it with soap and water. Perborate bleaches (i.e., many powdered bleaches or bluing agents) should not be used for this purpose. The active ingredients on the bleach container label should be checked to ensure that a sodium hypochlorite (or chlorine) bleach is used.
  - World Health Organization. WHO/UNAIDS Information Update: Considerations Regarding Reuse of the Female Condom. Geneva, Switzerland: World Health Organization, 2002. (full text [PDF, 102 KB])
- A recent study concludes that as an alternative to bleach, dish detergent appears to offer women a viable option for cleaning used female condoms (first-generation). Dish detergent was as efficacious as bleach in reducing organism counts from female condoms, at a removal rate of 99.99 percent for HIV, gonohorrea, chlamydia and HSV-2. It is not yet clear, however, whether organisms removed or reduced by dish detergent were still viable in the wash water.
  - Joanis C, López LM, Gómez K, et al. Efficacy of a dish detergent in reducing populations of STI organisms in inoculated female condoms. Int J STD AIDS 2007;18(3):198-201. (abstract)

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