CTU: Why do you believe the female condom is not more widely used in the United States?
Mantell: This is for a number of reasons. First, the cost of the female condom in the United States and elsewhere is higher than that of the male [external] condom. Second, the female condom has not been adequately promoted to create consumer demand. For example, a 2014 study revealed that only 48 of the 79 municipal and state departments of health websites examined referred to the female condom.1
In a 2012 New York state study of the female condom, we suggested that subsidizing female condoms and helping agency directors understand the need for the female condom and development of action plans may increase promotion of the female condom.2
Some discourse has marginalized the female condom due to its cost and the need to obtain partner cooperation. Policymakers and frontline providers often become enthusiastic about new prevention technologies and may promote then more vigorously than methods that have been around for a long time. Given that men may lack detailed information about the female condom and how it works, female condoms need to be promoted to men. Most importantly, women often do not appraise that they are at risk for HIV and do not adopt any prevention measures. This also may be an underlying factor in women’s underutilization of oral PrEP [pre-exposure prophylaxis] in the U.S.3
Smit: The cost of female condoms is higher compared to male condoms.4 There also may be difficulties in accessing female condoms.5
CTU: If you were discussing the study results with American family planning clinicians and gynecologists, what would you want them to know that might better inform their own practices?
Mantell: Choices matter. No one contraceptive method is the perfect fit for all women and their partners. There is a need for multiple methods of family planning and disease prevention with options counseling to enable family planning and OB/GYN clients to choose what works best for them. These choices are likely to change over the lifetime as a function of age, achieving fertility desires, and partner status. OB/GYN practitioners should suggest women talk with their male partners about using the female condom for disease and pregnancy prevention.
Smit: Across the world, there are an array of contraceptive methods and an increasing number of HIV prevention methods available, but only condoms provide protection against STIs — the rates of which are persistently high. Female and male condoms are the only methods that provide simultaneous protection against STIs, HIV, and pregnancy — triple protection, if you like.
Female condoms offer another option to male condoms: they are a female-controlled method and it may be easier for women to initiate use of female condoms than male condoms, sometimes introducing them as a contraceptive method rather than a disease prevention method.
Female condoms are preferred to male condoms by some couples, and some men and women find that they enhance sexual pleasure. Female condoms do not require a prescription to purchase, and can be made available in public places for easy access. There are several designs of new female condom products which have made them more attractive, acceptable, and pleasurable.4
- Ventura-DiPersia C, Rodriguez K, Lelvin EA. Failure of many United States Department of Health web sites to provide accurate information about the female condom. Contraception 2015;92:40-45.
- Exner TM, Tesoriero JM, Battles HB, et al. A randomized controlled trial to evaluate a structural intervention to promote the female condom in New York state. AIDS Behav 2012;16:1121-1132.
- Huang YA, Zhu W, Smith DK, et al. HIV preexposure prophylaxis, by race and ethnicity — United States, 2014-2016. MMWR Morb Mortal Wkly Rep 2018;67:1147-1150.
- Beksinka M, Wong R, Smit J. Male and female condoms: Their key role in pregnancy and STI/HIV prevention. Best Pract Res Clin Obstet Gynaecol 2020;66:55-67.
- Hsu R, Tavrow P, Uysal J, et al. Seeking the female (internal) condom in retail pharmacies: Experiences of adolescent mystery callers. Contraception 2020;101:117-121.