Another Kind of Condom

Written by Roxy Munro

Tuesday, 09 June 2009

Remember sitting in health class and learning to use a condom by placing it on a banana? If you never had this experience (which would certainly apply to anyone who went to a Catholic school), maybe you remember that episode of Degrassi Junior High when the Degrassi crew was doing it.  Either way, it is safe to assume that most people recognize condoms and understand their purpose. It’s probably also safe to say that most people would have some idea about how to use it. But what do you know about the “female” condom? According to local sexual health education providers, knowledge about the female condom among different age groups is generally limited. This isn’t surprising. After all, the traditional, that is, “male,” condom, is what you generally hear about or see on TV, in movies, or in mainstream magazines. Public health safer sex messaging also largely focuses on the male condom. On the one hand, this is perfectly OK. The male condom remains an effective barrier for HIV and other STIs, while also effectively preventing the possibility of pregnancy for women having sex with men. Male condoms are also relatively inexpensive or free in many places (e.g., sexual health clinics, doctor’s offices, your local Planned Parenthood), making them ultra-accessible. On the other hand, since the widespread safer sex campaigns geared to the heterosexual population focus on the male condom, social barriers faced by women to negotiate safer sex aren’t taken into account. Therefore, it is critical to STI/HIV prevention efforts to raise awareness around the male condom’s worthy alternative, the female condom. The Female Condom Even though it is typically called the “female” condom, this name is actually a misnomer because the baggy polyurethane sheaths can be used during anal sex as well. This means both men and women can opt to use this form of protection. Available in Canada since 1994, the female condom provides important benefits. Like all options for safer sex, the female condom has its so-called advantages and disadvantages, but, more importantly, the female condom has the potential for empowering women around the world, including right in your own neighbourhood. Advantages Practically speaking, the female condom is useful for those with latex allergies since the types available in North America are either made with polyurethane (known as the “FC Female Condom”) or nitrile polymer (“FC2,” a later development which is not yet available in Canada). Unlike latex, these materials aren’t affected by temperature and dampness, so storage isn’t an issue like it is for traditional latex condoms. The absence of latex also means oil-based lubricants can be used with the FC or FC2. Since both materials are thin and conduct heat well, sensation is maintained (bonus!). Another distinct feature of the FC and FC2 is that they can be inserted up to 8 hours before intercourse so there doesn’t have to be any awkward fumbling in the heat of the moment (or some sudden passionate decision to just skip the condom). In terms of protection, if used perfectly, the FC or FC2 can actually protect women against more STIs than the traditional male condom. A portion of the condom rests outside the vagina, essentially protecting the vulva from STIs passed through skin-to-skin contact. Disadvantages There are some noted downsides, however. Female condoms are sometimes described as being difficult to insert and remove. Any uncertainty or discomfort with use could end up decreasing the effectiveness of the condom. Some people complain about noise, but the design of the FC2 reduces the amount of noise, making it less of an issue. Generally, female condoms also cost more, making them less accessible. The material of FC2 also makes it cheaper to produce, which will result in significant cost savings. Shared Responsibility While female condoms may have been designed to “enable women to share the responsibility for the condoms with their partners” (emphasis mine), they serve to help empower women take control of their own pregnancy and STI/HIV prevention. While promising work is being done on the development of microbicides, the female condom remains the only female-controlled method for STI/HIV prevention. So it’s about more than allowing women a shared responsibility for safer sex; it’s about providing women the opportunity to guarantee safer sex for themselves because they no longer need a man’s consent to protect themselves. The importance of this cannot be underscored – globally, women make up almost half of those infected with HIV, and they make up more than half (58%) in sub-Saharan Africa. In Canada, there has been a steady increase in the HIV infection rates for women. According to the Public Health Agency of Canada, before 1998 women represented 11.9% of all positive HIV test reports. By 2006, this percentage had climbed to 27.9% — the highest it has been since the beginning of the epidemic. Rates for STI infections are also increasing among women. Rates for Chlamydia infections, the most frequently reported STI in Canada, are highest among women, particularly young women (15 – 29 years old). The development of female-controlled safer sex methods is critical because women’s anatomy and the wider social context make them more vulnerable to STIs/HIV than men. Biologically, women are more susceptible to STI/HIV transmission by an infected partner than men. Women also face a greater degree of economic, social, and cultural disempowerment than men (although this is to varying degrees among women, depending on a range of factors). Amaro and Raj, researchers at Boston University School of Public Health, have explored how women’s HIV risk level from heterosexual transmission is entrenched within a context of gender, race/ethnicity, and class oppression. Their research shows that within intimate sexual relationships, gender-related factors such as the power dynamic within the relationship, sexual communication, abuse, and gender roles affect women’s abilities to engage in safer sex. Consequently, the key STI/HIV prevention strategies, such as abstinence, monogamy, and male condom use are not as feasible for many women because they often lack the ability to negotiate safer sex. For example, a woman in her 30s sought the advice of an Ottawa-based sexual health organization because her partner refused to wear a condom. Even though she perceived the relationship to be monogamous, she was fearful of acquiring STIs or HIV since they can go undetected for a time. Her partner insisted he didn’t like wearing condoms, and she felt she couldn’t change his mind.  The advice given to the woman was to try using a female condom. She later reported being able to use it with her partner and has expressed relief at having this other option for protection available to her. Canadian AIDS Society postcard African nations and other developing countries facing high rates of HIV/AIDS necessitate separate studies because the intersections of gender, race, and class are so particularly acute.  In Canada, however, while undoubtedly not as dire a situation, women remain vulnerable to STIs/HIV because gender, race, and class oppression transcends geographic boundaries. The fact that HIV infections are rapidly increasing for Canadian women through heterosexual contact is frightening, especially when HIV is preventable.Amaro and Raj note how public health STI/HIV prevention efforts need to take into account the particular context within which women’s heterosexual relationships are situated.  Increasing awareness around the female condom is a smart public health strategy because the female condom can favourably alter the safer sex negotiations for women. Before the advent of the female condom, women had to negotiate for the use of something they ultimately had no control over because they couldn’t wear it. Even though social barriers remain, the female condom represents an attempt to provide women with some leverage in safer sex negotiations. In fact, since female condom can be inserted before intercourse gets underway (or before the date or hook-up even begins), women may not even need to insist upon its use. There is an important caveat, however. When there is violence or the threat of violence in a relationship, any condom use is dangerous to negotiate for many women. For this reason, research on microbicides is promising because microbicides will enable women to protect themselves against STIs and HIV in a way that would be largely undetected. For now, the female condom is a monumental step in the right direction for public health prevention efforts. It could be of benefit to you or someone you know. Check out your local drugstore or inquire at your local sexual health centre and discover another way of protecting yourself. For more information: Amaro, H. and Raj, A. (2000). On the margin: Power and women’s HIV risk reduction strategies. Sex Roles, 42(7-8), pp. 723-749. Brown, H. (2003). The Female Condom: Women Control STI Protection. Population Reference Bureau. Washington, D.C. Hardwick, D. (2002). The effectiveness of a female condom intervention on women’s use of condoms. Canadian Journal of Human Sexuality, 11(2), pp.63-76. McKay, A. and Barrett, M. (2008). Rising reported rates of Chlamydia among young women in Canada: What do they tell us about trends in the actual prevalence of the infection? Canadian Journal of Human Sexuality, 17(1-2), pp.61-69. Public Health Agency of Canada. HIV and AIDS in Canada. Surveillance Report to December 31, 2007. Surveillance and Risk Assessment Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 2008. AIDS Committee of Toronto The Canadian Women’s Health Network Sexualityandu.ca culturemagazine.ca