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Design of the Female Condom
The female condom is a thin, soft, loose-fitting polyurethane
plastic pouch that lines the vagina. It has two flexible rings: an inner ring at the
closed end, used to insert the device inside the vagina and to hold it in place, and an
outer ring which remains outside the vagina and covers the external genitalia. Because the
device is made from polyurethane, the female condom can be used with any type of lubricant
without compromising the integrity of the device. This is advantageous in countries where
personal, water-based lubricants are hard to find or non-existent.
Results of User Acceptability Studies
Product acceptability is critical to the correct and
sustained use of any method. FHI studies of the female condom found that many women liked
the device and would recommend it to others. Women tended to accept the device more
favorably than did men. While women in general would recommend the device to other women
and felt fairly positive about it, many of the women in the studies discontinued use due
to partner objections. Overall, difficulties of insertion decreased as experience with the
device increased, and use became more comfortable and acceptable with practice.
The acceptability of the female condom can also be assessed by examining the advantages
and disadvantages cited by FHI study participants.
Advantages
- Female-controlled
- More comfortable to men, less decrease in sensation than with
the male latex condom
- Offers greater protection (covers both internal and external
genitalia)
- More convenient (can be inserted pre-coitus)
- Stronger (polyurethane is 40% stronger than latex)
Historically, contraceptive methods are more effective if
they are controlled by the woman with the support and acceptance of the method by the man.
Women in Cameroon, Kenya, Thailand and Malawi all cited control over their own health as a
positive aspect of the female condom. Female condoms do not constrict the penis as do
latex condoms. As a result, sensitivity of the male partner may not be substantially
reduced; no loss of sensitivity was reported by study participants in Kenya and Malawi.
Since the device covers both the internal and much of the external female genitalia, as
well as providing a barrier between the male and female sex organs, it may offer greater
protection against STD. Participants in Kenya, Thailand, and Cameroon all said STD
protection was important; those in the African studies also perceived the device to be
either durable, strong, efficacious, or an effective alternative to the male condom, or
some combination of the four. Finally, the female condom was perceived as more convenient
because it can be inserted well in advance of intercourse. For a woman at high risk of
STD, the female condom provides a prophylactic option should her partner refuse to use a
male condom.
Disadvantages
- Not aesthetically pleasing
- Difficulties in insertion/removal
The major disadvantages of the device noted by study
participants centered around one of the female condom's major advantages; coverage of the
external female genitalia. This coverage had a decidedly negative impact on the device's
aesthetics and acceptance. Other problems related to aesthetics included dislike of the
appearance of the device, noise associated with use, size and partner resistance. Some
participants noted difficulties associated with insertion or removal of the female condom,
discomfort, messiness and inconvenience associated with use, and movement of the device
during use. A few cases of the penis slipping between the device and the woman's body, and
slippage and breakage of the device itself were also noted. While not a factor in FHI
studies, female condoms are relatively expensive. This may be a factor limiting their
acceptability for large numbers of women.
Conclusions
While condoms are becoming increasingly important as a method
to slow sexually transmitted disease, acceptance of the female condom is limited because
of real and perceived drawbacks inherent in the method. The concept, appearance and use of
the female condom is still unfamiliar to most couples worldwide, and perceptions are apt
to change significantly as the female condom is more widely used. Attitudes may become
more favorable.
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