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While the female condom is the only available female-controlled method of protection against HIV and other sexually transmitted diseases (STDs), it is relatively expensive and approved for only one act of intercourse. What if research could show that the device could be safely and effectively used more than once?
Investigators coordinated by the World Health Organization (WHO) in Geneva and Family Health International (FHI) in Research Triangle Park, NC, are examining this issue.
There are few advantages to reuse in a developed country setting, notes Carol Joanis, who is serving as technical monitor for a study FHI is conducting on the safety of the reuse of the female condom. Women who chose to use the female condom in these settings are likely able to afford the purchase/use of a new device for each act of intercourse, she says. However, in resource-poor settings or where availability of a continuous supply of devices is not possible, reuse of the female condom becomes desirable, states Joanis. Women in such regions are in dire need of a reliable method of HIV protection. About 16,000 new HIV infections worldwide occur every day; six of every 10 new infections are among women.1
The WHO and the Joint United Nations Programme on HIV/AIDS, based in Geneva (UNAIDS), held a consultation in June 2000 on the reuse issue. Experts reviewed data on both the structural integrity of the female condom when subjected to repeated cleanings and reuse, as well as the potential risks of infection related to such use. (An informational update on the consultation can be found on the WHO Department of Reproductive Health and Research Web page: www.who.int/reproductive-health.)
Given the available data and remaining gaps in knowledge, the experts concluded that providers continue to recommend use of a new male or female condom for every act of intercourse. Since available evidence is not conclusive, reuse of the female condom is not recommended at this time. However, a draft protocol for disinfection, washing, drying, storage, and relubrication has been formulated and is being tested.
The research necessary before the WHO can make a more definitive statement about reuse is under way, confirms Tim Farley, PhD, a scientist in epidemiology and evaluation in the WHO’s Special Programme of Research, Development, and Research Training in Human Reproduction, Department of Reproductive Health and Research.
"Once it is completed, we shall be consulting the expert group for their opinion on the safety of reuse, instructions on how to clean and prepare the used condom, and the programmatic questions related to reuse," says Farley.
Reuse of the female condom reduces the per-use cost of the device. While women in the United States may pay up to $2.50 for the Reality female condom, manufactured by The Female Health Co. of Chicago, the subsidized cost in overseas markets is 60 cents. The subsidized cost reflects The Female Health Co.’s efforts, in conjunction with UNAIDS, to make the Reality condom more available and affordable in developing countries in response to the growing international HIV epidemic. (For more information, see the article in Contraceptive Technology Update, October 2000.) Assuming that women purchase the condom at the subsidized cost and are able to use it five times, the cost of use has been effectively reduced to 12 cents, notes Joanis.
Female condom reuse also is beneficial when access to contraceptive or STD protection is limited or sporadic, says Joanis. With research indicating that the device is strong enough to be reused without compromising the strength or durability of the device, use of a "cleaned, previously worn device" is certainly safer than intercourse without protection, she adds.2,3
One disadvantage to reuse is the cleaning procedure itself, Joanis points out. The process is time-consuming and inconvenient, so some women might be opposed to the process, she notes.
Research of the female condom reuse issue has been launched in the United States, says Joanis. Scientists at Eastern Virginia Medical School in Norfolk, VA, are recruiting 80 couples to test the condoms. Half of the couples will use the condoms as labeled, i.e. five condoms, each used once. The other couples will each use a single condom five times over 15 days, and they will wash the condoms with water and soap after each use. Investigators will check the condoms for rips or tears and examine the participants to make sure that reuse does not cause rashes or irritations.
The laboratory component is being conducted at FHI’s condom testing lab, states Joanis. Scientists have completed five washings, bleachings, rinsings, and pat dryings of 660 female condoms without incidence of water leakage.
Completion of the FHI safety study will determine the impact of reuse on human tissue, states Joanis.
1. Finger WR. Female condom reuse examined. Network 2000; 20:18-22.
2. Pettifor AE, Rees HV, Beksinska ME. In vitro assessment of the structural integrity of the female condom after multiple wash, dry, and relubrication cycles. Contraception 2000; 61:271-276.
3. Joanis C, Latka M, Glover LH, et al. Structural integrity of the female condom after a single use, washing, and disinfection. Contraception 2000; 62:63-72.