Female Condom Use Still Has Barriers

From the WebMD Archives

Nov. 11, 1999 (Chicago) -- For psychologist Wendee Wechsberg, PhD, the female condom isn't just a device to prevent pregnancy -- it's a part of a personal crusade to help women in the most desperate situations. Wechsberg counsels prostitutes and drug addicts about strategies that she hopes will turn their lifestyles around from destructive to constructive. She is uniquely qualified to do the research, having overcome her own addiction to barbiturates and amphetamines.

"The female condom is one piece of the whole picture. We have to intervene with these women and get them off the streets -- and help them to kind of help themselves," says Wechsberg of the Research Triangle Park Institute in North Carolina. With funding from the National Institute on Drug Abuse, Wechsberg is conducting a behavioral study on what in two years will become a group of about 1,000 women from the Raleigh-Durham area.

One goal is protection from sexually transmitted diseases, most notably HIV, and that's where the female condom can be effective. But Wechsberg says the device, first approved in the U.S. in 1993, has drawbacks. "The problem with the technology is ... it's not accessible. It's costly, and unless my outreach workers give it to [the women], and we do an intervention to teach them how to use it, it is hard to get into that community of people," she says.

The female condom is made of a thin plastic that lines the inside of the woman's vagina. The biggest advantage is that it provides protection against many sexually transmitted diseases. Other advantages include the fact that no prescription is needed, it can be inserted several hours in advance of sexual activity, and it is safe and fairly effective at preventing pregnancy. But the device has noted disadvantages: it takes practice to be able to use it correctly, it cost more than the male condom, and it can be difficult to find in stores.

Still, in a presentation here at the 127th annual meeting of the American Public Health Association on Tuesday, Wechsberg made it clear she's having a bit of success, even with this most troubled clientele. For example, in her first follow-up study, she found that the rate of those using any kind of condom had doubled from 22% to 44% over a 90-day period.

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Interviews with the women showed that more than two-thirds had used the female condom, with 46% trying it twice or more. This is progress, says Wechsberg, but more is needed. "With a female condom, it's 'Oh, how do I insert it? How do I deal with touching myself?' Some of these women may be out there trading their bodies, but they're really unaware of their sexuality," Wechsberg tells WebMD.

Another study, from the University of Massachusetts on attitudes of African-American and Puerto Rican women toward the female condom, shows the will to use the device is there -- but not necessarily the way. While interest in this kind of protection was high, women had trouble finding answers to their questions about the approach or where to get the device for free. So more education about female condoms is needed for both women and health care providers.

University of Michigan researchers studied the female condom in male-female relationships. Researchers found that the duration of a relationship is less important than the quality of sexual communication when it comes to success with the female condom. Based on interviews with women and their male partners, those who used the device consistently could talk openly about the experience. Inability to have frank discussions about sex proved to be a hallmark of failure.

How a person presents the female condom to her partner is also an important consideration, says Ana Penman, MPH, of the University of Alabama at Birmingham. Women in this study were coached on presentation techniques and given a video for illustration. Successful women, says, Penmen, tried a variety of approaches. If at first, they didn't succeed, they tried something else. For example, suggesting the condom as a novelty, as this excerpt from a study participant interview illustrates:

"Do you want to try something different? And he said, 'What?', and I said, 'a female condom.' He said, 'Yeah, I'll try [it]. I don't have to do nothing?' And [I] said, 'No, I'll do all the work.'"

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