A variation is the Janesway female condom, a cotton panty that has a latex pouch built into its crotch. The panty covers the entire external female genital area and is intended to prevent any exchange of fluids or touching of genital areas between partners (254, 450). The Janesway condom is under development by HHH Development and the California Family Health Council (196).

The Reality female condom is made of polyurethane. It is a soft, thin, loose pouch with two flexible rings, one at either end. The ring at the closed end is used to insert the condom into the vagina and hold it in place. The outer ring stays outside the vagina and covers part of the external genitals (158, 324). Although designed for use by women, the female condom has also been used by men having anal sex with men (70, 262, 353).

In laboratory tests polyurethane female condoms have proved to be impermeable to sperm and to infectious organisms including HIV (163, 371). Although data from clinical studies on both efficacy and disease prevention are few, contraceptive effectiveness and disease prevention rates seem comparable to those for male condoms (193, 507).

The Female Health Co.

Many women find that the female condom can provide a way to communicate their wish to have safer sex. Since 1992 about 30 million female condoms have been sold, and UNFPA is seeking donor funding to purchase female condoms for developing countries.

One important advantage of the female condom is that women have more involvement in initiating use (10, 187). Women find the new female condom empowering, according to reports from Costa Rica, Indonesia, Mexico, Senegal, Tanzania, and Zimbabwe. Many say it gives them a better way to communicate their wish to have safer sex (6, 163, 249, 436). In Philadelphia, American women said they liked the female condom because it provided them protection, a natural feel, and the power to initiate protection (455).

Still, power issues, communication skills, and the complex skills of negotiation and joint decision-making are important for successful use of the female condom, as with the male condom (12, 31, 72). Studies report that men's objections have led to discontinuation of use by some women (68, 370, 604). Many studies are currently underway about negotiation and other aspects of the use of female condoms (365).

The female condom also has disadvantages. The fact that it covers the external genitalia makes it unattractive to some. Also, it can be noisy, and some women find it painful to use, especially due to the inner ring. It can be difficult to manipulate and insert, especially for inexperienced users. It can be displaced during intercourse. It may not appeal to some women if they associate it, like the male condom, with prostitution and infidelity (31, 98, 281, 419).

High cost may be the biggest drawback of the female condom. The commercial retail price of the female condom, which ranges upward from US$1, makes it unaffordable for many people in developing countries (163). To lower the price of female condoms to the consumer, the Joint United Nations Program on HIV/AIDS (UNAIDS) in 1996 negotiated a 3-year contract with FHC for a reduced price of about US$0.62 per condom for bulk purchases (10, 249, 430). (The price for male condoms in bulk on the world market is currently below 3 US cents apiece (200).) Also, many of the female condoms provided under the contract are distributed through social marketing programs, which further lower prices to the consumer (see Chapter 6.3 Reducing Prices Increases Access).

Female condoms would be more economical if they could be reused. Like male condoms, however, it is recommended that the female condom be used only once and then immediately discarded (163). Reuse would be risky if disease organisms remained, and the condom might lose its structural integrity (604). Nevertheless, some women are reusing female condoms (576).

Several studies of multiple use of female condoms are under way (130, 163, 206, 432). A laboratory study of the effects of washing, drying, and relubricating female condoms 10 times found no significant deterioration in their structural integrity (347). USFDA has not approved the female condom for reuse and could take up to five years to do so, if at all (10).

Acceptability and use. The few studies conducted to date, for example in Kenya and Brazil, indicate that many people like female condoms and will use them (31, 455). In Brazil 75% of women said they liked the female condom "very much," while only 5% said they did not like it (281). Commercial sex workers, who tend to be acutely aware of the dangers of infection, often are eager to get female condoms (98, 163, 331).

Distribution of the female condom has grown rapidly in the past few years, especially in developing countries. Since 1992, about 30 million female condoms have been sold worldwide (313). The Female Health Company reported that total sales from October 1997 through April 1998 were 4.2 million female condoms compared with 1.3 million for the same period one year earlier (429). The numbers of female condoms produced, distributed, and used, however, are still quite small compared with the numbers of male condoms.

South Africa, Uganda, Zambia, and Zimbabwe have had substantial sales of female condoms (152, 273). Social marketing programs are now providing female condoms in many countries in Africa, Asia, and Latin America, primarily under the auspices of Population Services International (PSI) (14, 143, 428-430).

In Zimbabwe in 1996, 30,000 women petitioned the government for access to female condoms. In 1997 the government relaunched a condom social marketing program managed by PSI, which introduced the female condom (584). Sales were expected to be only 4,000 a month, but in the first two months 80,000 were sold (583). Reflecting rising interest in the female condom, the United Nations Population Fund (UNFPA) has begun a campaign to raise awareness about it among its field staff, sending out samples and print materials to every UNFPA office and seeking donor funding to procure female condoms for developing countries (200).