The first version of the female condom made a weird noise, fell out, and was expensive, too. Now public health experts are pushing a new and improved version in American cities. Can it overcome its stigma?
Until recently, Leslie Evans, a case manager at Vital Bridges, a nonprofit HIV/AIDS outreach program in Chicago, had never heard of the female condom. "I couldn't even picture one until I saw it," she says. Evans wondered how the female condom worked, who would want to use one, and whether the rings on each end would be uncomfortable. Though her job was to encourage safe sex to her clients, "I never really promoted it," Evans says of the female condom. "Just condoms, condoms, condoms"—and by condoms she means the male version.
Since its 1993 debut, the female condom has suffered from a bad reputation. A larger, baggier version of the male condom, the female condom has a ring at each end, one to secure it inside the body, and another that dangles weirdly outside the body. Google “female condom” and “YouTube” and you can watch a collection of dated and awkward instructional videos, harking back to squeamish sex-ed classes.
Click the Image Below to See Condoms Through the Decades
Made from polyurethane, which is less pliable than latex, the female condom could be uncomfortable and resulted in a less-than-intimate sexual experience. Users complained of a "crinkling" or "squeaking" noise—not to mention a tendency for the condom to slip out if not inserted properly.
But last year's FDA approval of the second-generation female condom, called FC2, has prompted two U.S. cities, Chicago and Washington, D.C., to launch campaigns to reintroduce the contraceptive. Now made of nitrile, the crinkling and squeaking have been nearly silenced, and the FC2 costs 30 percent less than its predecessor did.
Why promote the female condom when the male version is so popular? Public health experts laud the contraceptive for being the only female-controlled method that protects against both unintended pregnancies and sexually transmitted infections. Research from Zimbabwe shows that when both male and female condoms are promoted, occurrences of protected sex increase, STI rates decrease, and 93 percent of women are enthusiastic about the device.
An initiative in Washington, D.C., will see the FC2 stocked in all CVS stores in the District—priced at $6.49 a box, compared to about $5 for a typical box of male condoms. Female condoms will also be distributed for free in beauty salons, liquor stores, and at high schools. Chicago's " Put a Ring On It" campaign has set up a bulk-purchasing plan with the Female Condom Company to make the condoms more affordable, and organizations such as Planned Parenthood are doling them out for free.
Unlike the male condom, which can be grabbed anonymously by the handful and used without much fuss, advocates have realized that an educational component is essential if the female condom is ever to catch on. The D.C. and Chicago initiatives include training on how to use the female condom, especially since many sex-ed curriculums ignore the method. Julia Fedor of the Illinois Caucus for Adolescent Health cites a "three time's a charm" rule for getting the hang of it.
The educators have their work cut out for them; the female condom is woefully unpopular. For one thing, it’s difficult to find. Walgreens stocks only 10 percent of its branches with the contraceptive, and finding one in the store can be difficult—it can be hidden away with the feminine hygiene products. In 2002, only 2 percent of sexually active women aged 15 to 44 had ever used the female condom, compared with an overwhelming 90 percent for the male condom and 7 percent for the sponge, another female-directed method that enjoyed a brief heyday in the 1990s before it was discontinued. The Today sponge was even mourned in an infamous Seinfeld episode that coined the term “sponge-worthy,” while the female condom languished in the shadows.
Manufactured by a small company, the FC1 didn’t have an impactful marketing effort. "For that reason, many men and women are either completely unaware of the female condom, or if they are aware, they don't really know a whole lot about it," says Vanessa Cullins, vice president of medical affairs at Planned Parenthood. Plain economics also sidelined the FC1. Typically priced at nine times the amount of the male condom, the FC1 was too expensive for many users and sexual-health advocacy groups wanting to push the method on a larger scale.
Despite the renewed push around the FC2, stigma and skepticism lingers from the first time around, when it was often described as a "garbage bag" and treated as a joke. General consensus among sexual-health experts is that the female condom has been stigmatized not only because of its initial negative impression, but also because it's often targeted at high-risk populations such as sex workers.
Despite the renewed push around the second generation female condom, stigma and skepticism lingers from the first time around, when it was often described as a "garbage bag" and treated as a joke.
"It communicates the sense that this isn't something for everybody," says Susie Hoffman, an assistant professor of clinical epidemiology at Columbia University's Mailman School of Public Health and research scientist at the HIV Center for Clinical and Behavioral Studies. Advocacy campaigns, such as the ones in D.C. and Chicago, may inadvertently contribute to the stigma when they cite HIV and STI statistics in their encouragement of the female condom. Gay men have also adopted the device for anal sex, though not all organizations and health departments endorse it for such use. A better strategy, says Hoffman and other public health experts, is to promote the dual protection aspect, against pregnancy and STIs, and as an option for women who dislike hormones.
Leslie Evans, the Chicago HIV/AIDS case manager, eventually decided to try the female condom herself, so she could discuss it with her clients. "It was awkward trying to put it in," she says, "but after the second time, I got comfortable." She now uses it more regularly than the male condom, and promotes it to her friends and nieces.
The Female Condom Company is making its way to health departments across the country, hoping to get more programs going. Though advocates are cheering the female condom on, no one expects it to reach parity with its male counterpart any time soon; the first goal is just to make it universally available.
As for whether people will adopt the method, reviews of the female condom on Amazon.com are across the board—"the plastic ring was terribley [sic.] uncomfortable for my girlfriend," wrote one user. Another complained, "These things are horrible they kept falling out…the last one got stuck inside."
Other reviews were more enthusiastic. "It is the best protectant any women [sic.] can use without worrying about "him"!!!!!!!!" and, "These condoms are extremely excellent for those gentlemen with huge penises.”
Evans’ review, too, is promising: “The ring on the outside is the bomb,” she says.
Joyce Tang is a writer based in New York City. Her work has appeared in Mother Jones, Double X, and The Miami Herald.