What are they?

The leading female condom – sold as the Pasante Female Condom or Femidom in the UK and produced by the Female Health Company – is a soft, strong, transparent sheath that is about the same length but wider than a male condom. An inner ring aids 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.

The female condom is not made from latex, so is less likely to cause allergic reactions and can be used with oil-based lubricants, though it is supplied ready-lubricated with silicone.

Since it does not fit the penis snugly like a male condom, some men report that it is more pleasurable because it is not constricting. The female condom can be inserted before sexual activity begins and so it may be less of an interference 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 clearly different 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 previous 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 (and comic) 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.

The sound of trapped air in the female condom has irritated some users. Other activities, in particular oral sex, are not feasible with it 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 like a diaphragm).

The first model of female condom (FC1) was produced by the Female Health Company from 1988 onwards, and was made from polyurethane. This material was chosen because it has a better heat conductivity than latex rubber, is odourless, is less likely to cause allergic reactions, is stronger and can be used with oil-based lubricants.

An updated model, initially known as the FC2, has been produced by the Female Health Company since 2005. This is the product that is now distributed in the UK, and the original version is being phased out.

The design and instructions for use have not changed with the new product. However, it is made from synthetic nitrile rubber rather than polyurethane. The material is softer, more flexible and less noisy than polyurethane. It appropriate for people with allergies to natural latex, and can be used with oil-based lubricants.

Synthetic nitrile rubber is a terpolymer of butadiene, acrylonitrile and methacrylic acid, which is widely used for making medical examination gloves.

The FC2 is also considerably cheaper to produce, a major consideration as most female condoms are used in developing countries.

Research was conducted to compare clinical failure modes for the two products. The total clinical failure rate was 97 events from 1910 uses of FC1 (5.1%) and 78 events from 1881 uses of FC2 (4.2%). The comparative trial of failure modes suggests therefore that the two devices are functionally equivalent, when used correctly. Moreover, safety and acceptability data from the trial were reassuring.¹

A technical review by the World Health Organization concluded that the FC2 is manufactured to at least the same standard as the FC1. In addition, the design and physical characteristics of FC2, supported by the clinical data, suggested that the two devices are functionally equivalent when used correctly. Therefore the FC2 was considered acceptable for purchase by UN Agencies.² Since then, more than 22 million FC2 female condoms have been distributed in 77 countries.

The US Food and Drug Administration (FDA) formally approved the FC2 in March 2009.

Medtech Products of India make a female condom in which the inner ring is replaced by a sponge. The condom is made from latex. It is available to purchase from a UK website, marketed under the name VA w.o.w. Condom Feminine. The product is CE marked, but not yet approved by either the Food and Drug Administration or the World Health Organization.

One of the most concerted attempts to develop a more acceptable female condom is being pursued by the NGO PATH. Their 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.  

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 panties; Silk Parasol is pursuing FDA licensing for its product. African entrepreneurs have also tried to come up with female-condom variants.