Our Bodies, Ourselves (47 page)

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Do condoms fit all men?
Some men believe that condoms are too small or tight for them.
All condoms can stretch to accommodate various sizes. Larger-size condoms are available, although since the condom needs to be snug, most men should use the regular size.

•
Do condoms often break during intercourse?
Condom breakage is relatively rare, but less experienced users may break condoms more often. To prevent breakage, use water-or silicone-based lubricant with latex condoms, and make sure your partner puts the condom on correctly. Condoms are also more likely to break if they are out-of-date, so check the expiration date on the package.

•
Does a person need to use condoms to protect against STIs when having oral or anal sex?
Yes. STIs can pass from person to person during oral, vaginal, and anal sex. Condoms can be used during any of these sex acts to protect against STIs. Anal sex is a particularly high-risk activity, even more so than vaginal intercourse, because the tissue in the rectum tears easily, giving easy access for the virus to enter the person's blood. Using extra lubricant with a strong, preferably latex, condom is recommended. (For more information, see
Chapter 10
, “Safer Sex.”)

A female condom is a pouch that is inserted into the vagina before intercourse to prevent pregnancy and reduce the risk of sexually transmitted infections. In the United States today there is only one brand of female condom, the FC2.

The FC2 is a thin sheath made of nitrile polymer with a soft ring at each end. One ring, covered with polyurethane, fits over the cervix and rests behind the pubic bone, acting as an anchor. The larger, open outer ring covers part of the perineum and labia.

Like male condoms, FC2 is available over the counter, without a prescription. Because it is not made of latex, it will not deteriorate when used with oil-based lubricants. It can be inserted before intercourse but should be removed immediately after. The FC2 is prelubricated with a silicone-based lubricant and does not contain spermicide. It does not require precise placement over the cervix. Male and female condoms should
not
be used at the same time, because the added friction between the two condoms could cause them to break. Like the male condom, the FC2 female condom is intended for onetime use.

FC2 is 95 percent effective in preventing pregnancy when used consistently and correctly. With typical use, it is 79 percent effective.

Although the research on female condoms is not as extensive as that on male condoms, consistent and correct use of the female condom appears to provide a level of protection against STIs, including HIV, similar to that of the male condom.
3

Image courtesy of The Female Health Company

• Does not require advance planning, clinic visits, or a prescription.

• Provides protection against STIs, including HIV.

• You don't have to rely on a man to use a condom.

• Provides broader coverage than the male condom, covering the labia, the perineal region, and the base of the penis; this may decrease the chance of passing the viruses that cause genital warts and herpes.

• The outer ring may stimulate the clitoris and make intercourse more enjoyable.

• May help you know your body better.

• No systemic side effects.

• Does not affect menstrual cycles.

• Not as effective in preventing pregnancy as hormonal methods or a male condom.

• Costs somewhat more than a male condom and may not be as readily available.

• Requires a brief pause to put on.

• Can take practice before insertion becomes easy.

• Some women find that the rings cause discomfort.

FC2 use can be fun for both partners when it is made part of sex. Discuss condom use
before
you have sex. Insert FC2
before
you have any genital contact.

1.
Carefully open the packet and find the inner (smaller) ring, which is at the closed end of the condom. Squeeze the inner ring together and push it up into your vagina with your finger. The outer ring stays outside the vagina.

2.
When your partner's penis is hard, you will need to guide the penis through the outer ring, to make sure that the outer ring is not pushed to the side of the vagina. If you find that the outer ring is being pulled into your vagina during intercourse, add extra lubrication inside the condom or to the penis. You can use any kind of lubricant, water- or oil-based, with the FC2.

© The Female Health Company

Insertion of FC2 female condom

3.
After sex, remove the female condom (if you are lying down, do this before you stand up). Squeeze and twist the outer ring to keep the man's sperm inside the pouch. The condom should come out easily when you pull. After removing the
condom, dispose of it in the trash; do not flush it down the toilet.

Tip
: Practice inserting a female condom before you use one during sex.

You can purchase FC2 female condoms at some retail drugstores, including CVS and Walgreens, HIV/AIDS outreach clinics, family-planning clinics, and sex shops, and on some college campuses. You can also buy them online, including at Amazon.com. A pack of five condoms costs about $12.

For more information on female condoms, visit AVERT (avert.org/female-condom.htm), which works to avert HIV/AIDS worldwide.

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Does the FC2 come in different sizes? Does it have to be fitted?
No, the FC2 does not need to be fitted. It comes in one size that is designed to fit most women.

•
Can the FC2 be used with male condoms?
No. The FC2 should not be used at the same time as male condoms, because the added friction between the two condoms could cause them to fail.

•
Is the FC2 as effective as male condoms?
The FC2 has efficacy similar to male condoms and other barrier methods.

•
Can spermicides or lubricants be used with the FC2?
Yes. It is perfectly safe and effective to use the FC2 with spermicides and all types of lubricants (oil-, silicone-, or water-based).

The diaphragm is a dome-shaped, soft rubber cup that fits securely in the vagina to cover the cervix. A spermicide is placed in the cup, facing the cervix, to kill or immobilize sperm and prevent them from entering the uterus and fertilizing an egg. Though diaphragms have no systemic side effects like those of the Pill, they are not as effective in preventing unintended pregnancy. They were once very popular in the United States, but few women use them today.

The diaphragm has perfect use effectiveness of 94 percent, which means using it every time you have intercourse and adding additional spermicide if you have intercourse again before removal. In typical use the diaphragm is 84 percent effective.

• Can be inserted up to six hours before sex and left in for multiple acts of intercourse.

• May help you know your body better.

• Does not affect menstrual cycles.

• Can be used during menstruation to contain flow during intercourse.

• Has minimal side effects.

• Your partner may not know it's there.

• Does not provide STI/HIV protection.

• Low typical use effectiveness.

• Requires a pelvic exam and fitting at a clinic.

• May not be available at all practices or clinics.

• Needs occasional refitting.

• May increase risk of bladder infections.

• The spermicide used with the diaphragm can be messy.

Courtesy of Ibis Reproductive Health

Diaphragm

Practice inserting and removing your diaphragm before you have intercourse. It can be awkward at first, but it becomes easy with practice.
You can put the diaphragm in any time within six hours before intercourse or vagina-to-penis contact. If more than six hours have passed, either insert an applicator full of spermicide into your vagina, or remove the diaphragm, wash it out, and start again.

1.
Put about 1 tablespoon of spermicidal cream or jelly into the shallow cup.

2.
Squeeze the diaphragm together by pressing the rim firmly between your thumb and third finger.

3.
Squat, sit on the toilet bowl, stand with one foot raised, or lie down with your legs bent.

4.
Push the diaphragm up to the upper third of your vagina with the cream or jelly facing up. Your vagina angles toward the small of your back, so it may be more comfortable if you push in this direction.