Female condom: Overlooked but useful

Although women prefer other methods of family planning, the female condom should also be embraced since it also protects one against HIV/Aids and other sexually transmitted diseases. PHOTO BY RACHEL MABALA

What you need to know:

  • A quick survey reveals that a number of my colleagues have not seen or even used a female condom. Asked why, a number say they are unattractive and the main responsibility of buying condoms falls on the man.

When Phionah Nakirijja, a peer educator, shows a female condom to members of a youth forum on sexual reproductive health rights at Nsanji Health Centre in Wakiso District, almost everyone laughs. Most youth attending the forum confess they have not seen it before, let alone used it.

In fact, the men start asking all manner of questions. You see, Nakirijja was trying to show them an alternative to the male condom.

In public spaces such as offices, toilets and health centres, male condoms take up the space. By large, this has left more women vulnerable to HIV/Aids infection and sexually transmitted diseases.

According to The Joint United Nations Programme on HIV/Aids UNAIDS 2019 HIV/Aids fact sheet, Uganda’s HIV burden stands at 1.4 million people. However, women hold the bigger burden at 770,000 living with HIV.

In a paper titled: “The female condom and Aids- UNAIDS Point of View’, it statistically indicates that at least eight out of every 10 infected women get the virus by having unprotected sex with an infected male partner.

The UNAIDS paper also indicates that a woman’s biological vulnerability to HIV through sexual intercourse is up to four times higher than a man’s yet women often have little control over whether a man uses a condom or not. Infact, in many situations, women are reluctant or unable to say no to sex if the man refuses to wear a condom.

Furthermore, the paper shows that women are about four times more vulnerable than men to sexually transmitted diseases, including HIV. This is largely because of anatomy where by the area of the female genitals exposed to semen and other sexual fluids during sex is four times larger than that of men.

Women are also more at risk of getting infected because semen contains greater amounts of the virus than vaginal fluids.

What’s a female condom?
The UNAIDS paper defines a female condom as a soft but strong sheath made of clear polyurethane plastic about the same length as a male condom but wider. The sheath has two plastic rings at either end. The one at the closed end is used during insertion and to keep the condom in place against the cervix.
The ring at the open end is slightly larger and remains outside the vagina, covering both the woman’s genitalia and the base of the man’s penis. The condoms are equipped with a waterbased lubricant which makes insertion easier and allows for comfortable movement during sex. Meanwhile, they are for single use only.

Joseph Kasaija, the programmes manager at WETalk Series Uganda, a forum championing sexual reproductive health rights among youth, says the female condom is used to protect against sexually transmitted infections, HIV and pregnancy.
Kasaija says: “The female condom was developed to give more control to women so that they have the ability to make the right decision during sex.”

Why it remains unpopular
According to Martha Mbabazi, the prevention programme coordinator at AIDS HealthCare Foundation- Uganda Cares, an non-governmental organisation specialising in condom distribution across Uganda, there have been a number of challenges with the first female condom (FC1) facing mixed reactions from the public resulting into an improved FC2 condom.

However, she says, having control for determining the use of a condom in most cases does not rest with the woman, especially those in rural areas who are mostly uneducated.

She adds that its structure has not yielded good acceptability by the would-be users.
Kasaija says people have misconceptions about the female condom, which reduces its demand. “If there was demand, then we would have more women using female condoms. Government tried to implement them in northern Uganda but the women would remove the rings,” he says, adding: “The information provided on female condoms is so limited while even the government mostly procures more male condoms.”

Nakirijja says: “Women fear the female condom because it takes time to insert creating inconveniences. And sometimes, you need hygienic and short finger nails to use it so that you do not spread unnecessary infections.”

Protection
Mbabazi says the beauty about the female condom is that it can be inserted up to eight hours before intercourse, which helps women not to forget to use one.

The UNAIDS paper indicates that the female condom is safe and can be used without any prescription or medical supervision and provides extra protection to men and women because it covers both the entrance to the vagina and the base of the penis. These are areas where STD sores make it easy for HIV to enter.

“Since it can be inserted hours before intercourse, it can provide protection in situations where consumption of alcohol or drugs may reduce the chances that a male condom will be used. Another practical advantage is that a female condom does not have to be removed immediately after sex,” the UNAIDS paper reads in part.

Precautions
Mbabazi says when buying the condoms, check the expiry date. It is also important to have a feel of the condom if it has air inside. “A good condom should be airy, but if a person finds a depleted condom without air, then it means its quality is compromised,” she says.

“The aspect of hygiene is also paramount. Unclean hands are not good and this could infect the condom. It is important to wash your hands before touching the condom,” she adds.

Research
According to a research paper by the Makerere School of Public Health about the female condom titled: ‘The new female condom (FC2) in Uganda: Perceptions and experiences of users and their sexual partners,’ in October 2009, the Ugandan government introduced the new version of the female condom known as FC2 following the unsuccessful female condom programme that begun in 1998. The failure of the earlier programme was partly attributed to low acceptance of the first type female condom.

The research paper further shows that the women liked the female condom because it had no smell, is not noisy, and does not rupture easily. Meanwhile, the men liked it because of its soft texture and lubrication.