THE FEMALE CONDOM
TRAINING MODEL
CONTENTS
FC female condom
®
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.1
Methods of Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.5
The Female Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.7
Reaching Out to the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.8
Training Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.9
International Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.10
Inserting The Female Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.11
Talking with Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.14
Example Text for Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.18
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.24
Communications
Brochures/Fliers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.25
Masters for Printing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.26
Training Video . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.27
T H E
E M A L E
H E A L T H
C O M P A N Y
515 North State Street
Suite 2225
Chicago, Illinois 60611
312.595.9123 • FAX 312.595.9122
www.femalehealth.com
Dear Health Care Provider:
The FC female condom® is the first and only woman-controlled contraceptive barrier
with the advantage of also providing protection from STDs, including HIV/AIDS.
This Training Model is intended to support providers and counselors in communicating
effectively about the need for and use of the female condom, and addresses:
• how to use the female condom
• most frequently asked questions
• how to discusss the female condom with women and men
This Training Model consists of three parts: background information on the FC female
condom, including a clinical overview; hints on how to talk to patients/clients; and a
video.
We hope that this Training Model is helpful. Educators are providing an important and
necessary service to women and men by introducing the female condom.
If you have any questions please call 800.635.0844.
Sincerely,
The Female Health Company
*FC female condom is FDA approved in the United States. Outside the United States, the female condom is called femidom or
femy and conforms to the EC Directive #93/42/EEC and Medical Devices Regulation 1994:3017 and bears the
CHICAGO USA
/
-Mark.
LONDON UK
I.
OVERVIEW
A. Introduction
◆
Of the top ten most frequently reported diseases in 1995 in the United States,
five were sexually transmitted diseases (STDs).
Source: Centers for Disease Control: Ten leading nationally notifiable infectious diseases- United States, 1995.
MMWR 1996;45:883-4
◆
As of December 2001, UNAIDS estimates that 40 million adults are living
with HIV/AIDS and 25 million adults have already died from AIDS-associated
illnesses.
Source: UNAIDS. HIV/AIDS: the global epidemic. Geneva, Joint United Nations Programme on HIV/AIDS,
2001.
◆
The World Bank estimates that STDs, excluding AIDS, are the second leading
cause of healthy life lost among women between the ages of 15 and 44 in the
developing world.
Source: World Bank. World development report, 1993: investing in health. New York: Oxford University Press,
1993.
◆
Worldwide, the incidence of four curable STDs–gonorrhea, chlamydia, syphilis,
and trichomoniasis–is estimated at 333 million individuals.
Source: World Health Organization. An overview of selected curable sexually transmitted diseases. Geneva, WHO
Global Programme on AIDS, 1995.
◆
Worldwide, an estimated 228 million women who want to delay their next birth
or cease childbearing are in need of an effective contraceptive method. In many
developing countries, at least a third of women need contraceptive services.
Source: Alan Guttmacher Institute, Hope and Realities. Closing the gap between women’s aspirations and their
reproductive experiences. AGI, 1996.
FC FEMALE CONDOM
1.1
OVERVIEW
The world’s first female condom became available in Europe in 1992
(Reality®, femidom®, femy® and FC® are all registered trade names for the female condom).
For five
years prior to its introduction, rigorous clinical studies were conducted in the
United States to assess contraceptive efficacy, effectiveness in preventing infection
of sexually transmitted diseases (STDs), acceptability to women and men, safety,
and reliability.
On the basis of data from these controlled clinical studies, the United States Food
and Drug Administration approved the female condom in 1993 “to help
prevent pregnancy and sexually transmitted diseases including
AIDS (HIV infection).”
Numerous clinical studies around the world continue to confirm the efficacy
and acceptability of the female condom to both women and men in a variety of
cultures.
FC FEMALE CONDOM
1.2
OVERVIEW
B. Studies Show:
There are four primary reasons for the widespread acceptance of the female condom:
1. Contraceptive: The female condom extends the choice of
contraceptive methods available and provides significant protection from
the risk of pregnancy.
Annual Accidental Pregnancy Rates for Consistent and Correct Use
Female
Condom
Male Latex
Condom
Diaphragm
Cervical Cap
Spermicide
5 %*
3%
6%
11 %
6%
*Study completed 1992
Non-consensual sex, fear of violence or abandonment, and inability to negotiate male condom
use restrict prevention options for many women. The female condom offers a viable alternative
barrier method for those women with cooperative partners. It is equally or more effective than
other barrier devices now on the market.
A clinical study completed in Japan using the same protocal as the U.S. study showed the
efficacy and the acceptability of FC to be favorable. Using similar analysis as the U.S. study
above, the Japanese study showed the annual accidental pregnancy rates for consistent and
correct use to be 1.6%.
2. STDs: The female condom provides significant protection from the risk
of infection of STDs.
In vitro studies show that the female condom provides an effective barrier to passage of microorganisms including HIV. Passage of a bacteriophage smaller than hepatitis B, the smallest virus
known to cause an STD, and one-fourth the size of HIV, is blocked by the female condom.
Results of controlled studies of STD transmission in Thailand and Brazil showed that when both
the female and male condoms were available, the rate of STD transmission was reduced by onethird when compared with the STD transmission rate in a similar groups with access solely to
the male condom. These findings suggest that the female condom, where available, provides an
additional measure of protection against STD transmission and HIV infection.
Calculations, based on correct and consistent use, estimate a 97.1% reduction in the risk of HIV
infection for each act of intercourse.
FC FEMALE CONDOM
1.3
OVERVIEW
3. Acceptability: The female condom has a high level of acceptability
among both women and men. More importantly, when the female
condom is available, the number of acts of unprotected intercourse is
decreased by one-third.
Results of a large study including more than 1600 women and their partners in Philadelphia
demonstrated that, when offered a variety of preventive options, 91% chose the female condom.
Similar results were seen in studies in Alabama, Brazil, India, and also Saudi Arabia.
4. Safety:
The female condom has a strong safety record.
Use of the female condom does not alter vaginal flora and does not cause measurable skin
irritation, allergic reactions or vaginal trauma.
C. Summary
The female condom is safe and effective, has high acceptability among both women and men,
and provides significant protection against the transmission of STDs and HIV. Most importantly,
the availability of the female condom leads to a 33% reduction in the number of unprotected sex
acts.
FC FEMALE CONDOM
1.4
II.
METHODS OF PREVENTION
When patients/clients think about methods of prevention, they
may be thinking about pregnancy prevention only. They may not realize that they could be at
risk for STDs. When counseling patients, emphasize that not all birth control methods provide
protection from STDs. For example, birth control pills are excellent for pregnancy prevention,
but provide no protection against diseases. The female condom is unique because it is the only
woman-controlled barrier method that offers protection from unintended pregnancy and STDs.
The goal of this model is to facilitate the incorporation of the female condom into existing
prevention/safer sex programs operative at clinics anywhere in the world. The intent is not to
replace male condoms, but rather to augment the range of protective choices available to women.
Here is a chart that shows different types of protection. Most of them only provide protection
from unintended pregnancy!
Protects against pregnancy and sexually
transmitted diseases
Protects against
pregnancy only
Female condom
Male condom
Diaphragm
Cervical Cap
Oral Contraceptive Pills
Injectables (Depo-Provera)
Implants (Norplant)
IUD
FC FEMALE CONDOM
1.5
PREVENTION
Choices!
Many women and men can’t or won’t use a male condom. There are many reasons for this,
including partner refusal, inability to negotiate, allergies to latex or products containing
nonoxynol-9, and denial of risk.
The female condom is latex-free
and does not contain nonoxynol-9, which may irritate
some women. The female condom is made out of polyurethane, and the lubricant on the female
condom is silicone based. The female condom has a strong safety record and does
not alter the vaginal flora.
Female condoms, while they require cooperation from the male, do not require the type of
initiative that a male condom does. In other words, a woman can put the female condom into
her body, either minutes or hours before sex. She can take control because the female condom
is in her control.
Additionally, this product may be inserted ahead
interruptions or timing issues during the sex act.
of time, thus eliminating any
Talking With Men
Male patients/clients/partners have many questions about the female condom. Men are just as
curious about it as women. We encourage discussions with men about using the female condom.
When talking with men about the female condom, advise them that many men have tried the
female condom and like it. Reasons for this positive response include: the female condom can be
inserted ahead of time; the female condom is not tight or constricting; and the female condom
conducts heat, so sensation is not dulled.
Some men are unable to maintain an erection while putting on a male condom. The female
condom can be inserted up to eight hours ahead of time, so that there do not have to be any
interruptions. Men might ask about the size of the female condom. Remind them that the female
condom fits into their partner, and is designed for her body, not his. Also, emphasize that
because the female condom is designed for her to wear, it can be quite comfortable for him. The
female condom is made from polyurethane, a very thin material that conducts heat. This material
is very different from latex, and is quite pleasurable for both partners. Also, any lubricant oilbased or water-based, may be used with the female condom.
Some women may be uncomfortable approaching their partner about the female condom for
many reasons. Including men in counseling about the female condom may lead to higher levels of
acceptability of the female condom and may increase overall protected sex acts.
FC FEMALE CONDOM
1.6
III.
THE FEMALE CONDOM
The female condom is a loose fitting polyurethane sheath about 6.5 inches
long with a flexible ring at each end. Polyurethane is a soft, thin, supple plastic which is
approximately 40 times stronger than latex. Polyurethane also conducts heat, so when inserted, it
is immediately body temperature. Sex feels very pleasurable and natural with the
female condom.
FC female condom acts like a strong, thin second skin between partners.
It adheres to the wall of the vagina during intercourse for barrier protection against
HIV/STD transmission and unintended pregnancy.
outer ring
The inner polyurethane ring is firmer than
the outer ring. The inner ring is used to insert the
female condom and helps keep the female condom in place.
The inner ring slides in place behind the pubic bone, acting
like an anchor for the condom.
The outer ring is soft and remains on the outside of
the vagina during insertion and sexual intercourse. It covers
the area around the opening of the vagina (the vulva), and
also provides some protection for the labia and urethra.
FC female condom is prelubricated with silicone.
inner ring
In addition, a glycerin-based lubricant is provided for
additional lubrication. Extra lubricant enables a smooth
entrance for the penis into the vagina. It is water based
and does not contain spermicide.
While there is no spermicide in the female condom because
some women are sensitive to nonoxynol-9, spermicide
can be used with the polyurethane female condom. Also, because oil-based
lubricants or medicines will not cause damage to the sheath, any type of lubricant can be used
with the female condom, including petroleum jelly, baby oil, or lotions.
If there is not enough lubricant on the inside of the condom or the outside of the penis, the
condom may be pushed inside of the vagina during sexual intercourse. Caution patients/clients
that if this happens more lubricant is needed on the outside of the penis and/or the inside of the
condom.
Most problems people have in using the female condom can be fixed by
adding more lubricant to the inside of the female condom, or to the penis.
If there is not enough lubrication on the inside of the female condom between the penis and the
female condom, it can adhere to the penis when he withdraws. To avoid this, it is advisable to
put a few drops of lubricant on the inside of the condom as well as on the outside of the penis to
reduce friction between the two surfaces. If the condom is pulled out of place, extra lubricant is
needed either inside the condom and/or on the outside of his penis.
FC FEMALE CONDOM
1.7
IV.
REACHING OUT TO THE COMMUNITY
To increase women’s access to the female condom, outreach to the community
is essential. Using a point person within the organization to coordinate the outreach
effort is highly recommended. The following are highlights from the Female Condom Initiative,
implemented by the Philadelphia Department of Public Health. This list is an example of
approaches to take and can be modified to fit the specific needs of your community.
professional education and staff training
sessions about the female condom to health care providers in other
◆ offer
departments, divisions, and programs
◆
give material out to community organizations
(see enclosed fliers)
◆ approach community based organizations (CBO’s) with an interest in
health promotion
grassroots leaders
◆ anticipate questions: Provide details regarding distribution of the
◆ look towards
female condom, including phone numbers to call (see enclosed fliers)
◆ send a
press release about the female condom to radio and television
media, include a contact person and specifics about availability of the female
condom
◆ arrange for
public service announcements on local radio and
television stations, include a hotline phone number
◆ send draft news releases about the community outreach program to community
newspapers
◆ rely on people who are not traditionally considered health workers but are
leaders in their communities
We have included examples of fliers which can be posted, circulated and distributed in various
public areas and clinics to alert the reader about availability, efficacy, use and helpful hints.
These fliers can be found in the communications section of this manual.
FC FEMALE CONDOM
1.8
V.
TRAINING STAFF
Introducing the female condom presents certain challenges. There may be existing biases against
this method, either on the part of the provider or the client. Providers may think that this
method is too complex for women to understand, may doubt the efficacy of this product, or
may assume that this method will not be widely accepted. Patients/clients may be intimidated by
its appearance, or may lack basic information about their anatomy, disease transmission, or
negotiation skills. Preliminary research indicates that the manner in which the female condom
is introduced can influence its acceptance among users. Here are some hints that may help
train staff:
1. Identify a key trainer. This person can coordinate training,
facilitate problem solving, and play a role in community outreach.
2. Identify any existing biases to the female condom among staff.
Discuss them upfront before starting the program.
3. Establish a protocol for how female condoms will be distributed to
patients/clients, including frequency, presentation and quantity (such as
six female condoms, lubricant, instructions).
FC FEMALE CONDOM
1.9
VI.
INTERNATIONAL EXPERIENCE
Much research and work on the female condom is ongoing. Leading public health officials are
examining issues such as advocacy, availability and sustainability. Included in this section
are newspaper articles highlighting research on the female condom, information from the Joint
United Nations Programme on HIV/AIDS (UNAIDS), and examples of social marketing
approaches from various countries.
In Zimbabwe, Population Services International [PSI] developed a social marketing program
based on marketing research that positioned the female condom in a unique manner. The
product is positioned as a “contraceptive sheath for couples who care”. Acceptibility increased
when the program focused on increased delivery armed with the acceptibility study. PSI
undertook discrete lobbying activities with the National Aids Control Program and other
national bodies combined with initiating a press campaign
to include a petition drive garnering 30,000 signatures to
demand access to the female condom
However, in Bolivia, cultural norms dictated a different
approach. The goal of the social marketing program in
Bolivia is empowerment for women to show her that she
has options and choices.
This is an example of PSI marketing
in Zimbabwe.
This is an example of PSI packaging in Bolivia.
FC FEMALE CONDOM
1.10
VII.
INSERTING THE FEMALE CONDOM
Hints:
◆ The female condom may be slippery to work with at first, but becomes easier with
practice.
◆ The female condom can be inserted up to 8 hours before sex.
◆ The female condom should be inserted prior to any genital contact.
◆ Jagged fingernails may tear the female condom.
◆ Advise the client to get comfortable! She can stand with knees apart and squat down,
sit on the edge of a chair with knees apart, lie down, or stand and place one leg on a
chair or bed.
◆ Inserting a female condom is similar to putting in a tampon– use a similar position.
Who Can Use The Female Condom?
◆ Women who are concerned about unintended pregnancy and STDs.
◆ Women who are menstruating.
◆ Women who have recently given birth.
◆ Women who have a retroverted uterus.
◆ Women who have had an hysterectomy.
◆ Women who are peri and postmenopausal.
◆ Women who are allergic/sensitive to latex.
◆ Women who are allergic to nonoxynol-9.
FC FEMALE CONDOM 1 . 1 1
INSERTING THE FEMALE CONDOM
Steps to put in the female condom:
discuss each step
1
Be careful when you open the package.
Note the blue arrow on the top right of the package.
2
Choose a position that is comfortable: squat, raise one leg, sit . . .
3
Look at the condom and make sure it is completely lubricated on
the outside and the inside.
4
While holding the sheath at the closed end, grasp the
soft, flexible inner ring and squeeze it with the thumb
and middle finger, or thumb and second finger, so it
becomes long and narrow.
5
With the other hand, separate the outer lips of the vagina.
6
Gently insert the inner ring into the vagina.
Feel the inner ring go up and move into place.
FC FEMALE CONDOM
1.12
INSERTING THE FEMALE CONDOM
7
Next, place the index finger on the inside of the
condom, and push the inner ring up as far as it
will go.
Be sure the sheath is not twisted.
The outer ring remains on outside of the vagina.
8
The female condom is now in place and ready for
use with a partner. The sheath adheres to the
vaginal wall. It lines the inner vagina.
Gently guide the penis into the sheath’s opening
with your hand, to make sure that it enters properly.
Be sure that the penis is not entering to the side of
the sheath. Use enough lubricant so that the
condom stays in place during sex. If the condom is
pulled out or pushed in, there is not enough
lubricant. ADD more to either the inside of the
condom or the outside of the penis.
9
10
To remove the condom, twist the outer ring and
gently pull the condom out. Try to do this before
standing up.
Throw the condom out in the garbage.
FC FEMALE CONDOM
1.13
VIII.
TALKING WITH PATIENTS
At first glance, the female condom may look scary or hard to use. It is a different method,
and many will be seeing it for the first time. Patients/clients may be apprehensive
about this method...explain that it is safe, and will not harm their bodies. Take a male condom,
and unroll it. Hold the two next to each other. Most people have never seen an unused, unrolled
male condom.
Most clients/patients have never touched a female condom. Pass a lubricated female
encourage participants to feel how thin and strong the polyurethane is.
condom around,
Introducing the female condom can be done either in group, couples, or
in one-to-one sessions. Group sessions offer a friendly setting where women can share
information and ideas. With one-to-one sessions, you can tailor the message to fit the needs of
the patient/client. Humor, maintaining a nonjudgmental attitude, covering basic concepts, using
plain language, and encouraging patient/client interaction all enhance counseling.
Step 1. Counseling
First, establish how much the patient knows about safer sex, her body,
and the female condom. The last thing you want to do is alienate or embarrass members
of a group. Instead, general, broad questions should be asked. Topics to probe are anatomy and
other methods of pregnancy prevention and STD protection, particularly the female condom.
This provides baseline information on what the patients know which will help deliver the safer
sex message. For example, many women are not clear on how diseases are transmitted. Some may
falsely assume that you can always know when a disease is present. This is not the case–some
diseases are not always detectable.
Step 2. Counseling Approach
Provide a brief overview of disease transmission first. Often, patients do not
understand how diseases are spread. They may not understand that people with STDs do not
necessarily have symptoms. If they do not understand how diseases are spread, then they may not
understand that they could be at risk for getting a disease.
As more studies are published, we’ve learned that having STDs can increase the risk of
contracting HIV. This is an important link of which many patients may be aware Also, chronic
diseases like infertility and cervical cancer may over time result from an untreated STD. Again,
patients may be unaware of this connection, and not understand the implications of contracting
an STD. When a patient/ client is aware of the risks associated with having an STD, he/she will
better understand why it is important to practice safer sex.
FC FEMALE CONDOM
1.14
TA L K I N G W I T H PAT I E N T S
Next, an overview of the reproductive system is recommended. Patients may not
understand their anatomy, and may have unfounded concerns about using the female condom.
For example, some women have expressed concerns that the female condom will “float up”and
become lost in their body. They do not understand that the vagina is like a closed pouch, and
that they can insert and remove the female condom, using their fingers, and not harm or hurt
themselves.
Major anatomy points as they relate to the female condom include:
◆ the difference between the vaginal canal and urethra
◆ the vagina is a closed pouch
◆ the location of the cervix and pubic bone
The female condom can be inserted up to eight hours ahead of time. It is important to stress that
the vaginal canal and urethra are separate. The misconception here is that the two are linked,
and that other bodily functions such as urination will not be possible when the female condom
is in place. Explain that the female condom will not interfere with normal bodily
functions.
If a client complains of discomfort while the condom is in place, it is probably because the inner
ring is not inserted high enough. Review what and where the pubic bone is, so that the patient
understands how to solve any discomfort problems.
Let the patient/client touch the female condom. If you are working with the dry
demonstration model located in the back pocket of this book, be sure to show the lubricated
condom, too. Otherwise, patients may assume that the condom in the wrapper is dry too. Have
clients rub the condom between their fingers to get a sense of how thin it is. Let them tug on it,
to see that it is strong.
Questions will be numerous, and most patients will be quite curious about the female condom.
Remember that this is a different method, and it needs to be explained just like
any other new device. Encourage questions, and address concerns. For example, some women
assume that if they use the female condom together with a male condom, they will have twice
the protection. While this may be sound reasonable, it is not the case. Indeed, both products may
fail if used simultaneously due to friction.
When explaining insertion, use your fist to simulate a vaginal canal. It is also helpful if you have
a male penis model, so that you can show how the penis should go into the condom.
FC FEMALE CONDOM
1.15
TA L K I N G W I T H PAT I E N T S
Lubricant is the problem solver for the female condom.
1. If the female condom gets pushed in or pulled out during sex, explain that more
lubricant is needed.
2. The lubricant should be added either to the inside of the female condom or directly
onto the penis.
3. If the female condom “squeaks” add more lubricant.*
Lastly, try to use simple terms. Many women are not familiar with the medical language,
or abbreviations like STDs. Plain language in a relaxed environment is a great combination.
The female condom is unlike any other method. It helps to talk about the female
condom comparing it to a male condom. Instead of illustrating how these methods are similar,
compare and contrast them. For example:
Male Condom
Female Condom
Worn by the man
Worn by the woman
Latex
Polyurethane
Fits snugly on penis
Fits into vagina: conforms to her body
Lubricant:
may include spermicide
can use water based only
goes on outside of condom
can not use oil based
Lubricant:
no spermicide included
can use water based and oil based
goes on inside of condom
can use oil based
Requires erect penis
timing crucial
Does not require erect penis
can be inserted up to 8 hours ahead
Remember the female condom is a unique product.
* NOTE: Extra lubricant may be provided or any water or oil-based lotion may be used including
mineral oil and vegetable oil.
FC FEMALE CONDOM
1.16
TA L K I N G W I T H PAT I E N T S
Practice, Patience and Communication
Major themes to incorporate into your counseling sessions are practice , patience and
communication. Emphasize that each patient/client should practice putting in the female
condom prior to using it during a sexual act, when she is alone and has privacy. Remind her that
this is a new method, and she may need practice to learn how to insert it.
Tell your patients/clients that they may laugh at first; it’s a different method and may be awkward
when using it the first time. Also, inserting the female condom may take longer the first time,
because it is lubricated and may be slippery. It takes getting used to! Encourage the patient/client
to practice inserting the condom ahead of time. Remind them that insertion becomes easier with
practice. Emphasize that it may take up to three tries before they become comfortable with
inserting the female condom.
And, just as this is a new method for your patient/client, it will probably also be a new method to
her partner. Just as she had questions about the female condom, so too will he. It may be a good
idea if they talk about the female condom before having sex.
Time
The female condom is a method that many patients and clients are unfamiliar with and may
have many questions about. Each clinical setting is different, and time constraints may vary.
However, even in the busiest of clinics, a few minutes spent with a patient is time well invested.
On average, couple and group sessions will likely be longer than individual sessions. The
interaction of couple/group members is one factor. Approximately 30 minutes is needed to
introduce and discuss the female condom with a couple or group.
One-to-one sessions vary in time, depending largely upon what the patient/client knows. For
example, if the patient/client has used tampons or diaphragms in the past, she will likely require
less explanation about the female condom than the client who feels uneasy touching herself.
Topics discussed when introducing the female condom may include anatomy points, facts about
disease transmission, risk factors and more. These topics, while related, are not unique to the
female condom.
FC FEMALE CONDOM
1.17
IX.
EXAMPLE OF TEXT FOR COUNSELING
The text on the following pages is an example only. Feel free to modify and make
changes! Tools that may be useful include a diagram of the female reproductive system, a female
pelvic model and a model penis. These items will reinforce anatomy points and help when
demonstrating insertion and use of the female condom.
Overall key points about the female condom are:
◆ Made of polyurethane: thin, but very strong, conducts heat
◆ Worn by the woman: positioned by the pubic bone
◆ Can be inserted up to eight hours before sex
◆ Can not be used simultaneously with a male condom
◆ Extra lubricant may be needed: add to inside of
female condom or to penis
◆ May take 2-3 times to be fully comfortable using the female condom
EXPLAIN PROTECTION
First, we are interested in discussing methods that protect against pregnancy and sexually
transmitted diseases (STDs). Pregnancy happens during your “fertile” time of the month.
Now let’s go over how you get diseases. If you are having sex with a man who is infected with a
disease, he will carry that disease on his penis as well as in his semen. But, you can’t necessarily
tell if a man is infected by looking at him. Often, there are NO sores, NO cuts, NO rashes,
and NO drip. You also can’t tell if a man is infected by asking him how he feels, because many
men have no symptoms, and feel fine.
HIV and sexually transmitted diseases [STDs] are easier to catch for women then they are for
men. If a woman is infected with an STD, the results can be serious, and lead to things like
cervical cancer and infertility. HIV is much easier to catch man-to-woman as compared to
woman-to-man.
So, the safest way to protect yourself from pregnancy and STDs is not to have sex at all—which
is a choice that some women make. But, if this is not your choice and you are going to have sex,
the safest forms of protection you can use are barrier methods like condoms.
FC FEMALE CONDOM
1.18
EXAMPLE TEXT
DESCRIBE THE FEMALE CONDOM
“This is the female condom” [SHOW lubricated one and non-lubricated one—ASK women if
they have seen it/heard of it/used it. GAUGE their level of comfort with their body by finding
out if they’ve used tampons in the past].
[Take the demo model of the female condom and have women feel it– let them rub it between
their fingers]. “See how thin this is? It is thinner than a male condom. This condom is made of
polyurethane, which is very strong. Grab the condom by both ends and pull—pull hard. See how
strong it is?”
There are two rings, the outer ring and the inner ring. The outer
ring remains outside your body and covers part of your lip area.
The inner ring acts like a guide to insert the female condom and
helps hold it in place. It is soft and flexible, and won’t hurt when
you put the female condom in or take it out. Also, the female
condoms are lubricated, and may come with extra lubricant. This
lubricant is water based, and will not irritate you or your partner.
Since this condom is made of polyurethane, it is totally different
than a male condom. With the female condom ANY type of
lubricant is OK...vaseline, baby oil, lotion...none of these things are going to cause damage to
the female condom. Medicines (particularly oil-based) do not harm the female condom.
FC FEMALE CONDOM
1.19
EXAMPLE TEXT
REVIEW FEMALE ANATOMY
And now, for a quick anatomy lesson. Your vagina is where your partner goes when you are
having sex (this is also the same place your tampons go). This vaginal canal is a closed pouch.
What I mean by that is that the female condom cannot float up into your body. There is a very
small opening in your cervix. Bacteria and viruses can travel through, but nothing big like
tampons or condoms can get through. [POINT to cervix, using the enclosed flier] Your cervix
feels like the tip of your nose, and acts like a stop sign, so that the
Uterus
female condom will not float past it. Things like tampons and
Bladder
condoms will be blocked by your cervix, but sperm and diseases
Cervix
(which are very small) can pass by your cervix. That’s why
Vaginal
protection is so important. This is your pubic bone [POINT to it],
canal
and the inner ring of the condom is going to go behind that pubic
bone. This is your uterus [POINT to uterus], this is where a fetus
grows. [option: these are your fallopian tubes, they look like
Urethra
hands and hold your eggs; each month an egg is released, it goes
into the uterus, and the outcome is either pregnancy or period]
FC FEMALE CONDOM
1.20
EXAMPLE TEXT
EXPLAIN PROPER USE & DISPOSAL
So, how do you put the female condom in? Well, it may take some practice, and it could be
somewhat difficult the first try because it is slippery. In fact you and your partner may laugh
when trying it for the first time. That’s why we suggest that you practice putting it in when you
are alone.
Take the female condom out of the wrapper and hold it by the inner ring so that the condom is
upside down [have her use her non-dominant hand]. Squeeze the inner ring between your thumb
and middle finger, the ‘fingers that you snap with’. [EXPLAIN that if she grabs the inner ring
too high, her fist is going to get in the way when she goes to insert the condom]
Insert the inner ring into the vagina, and feel the inner ring
‘pop’ into place behind the pubic bone. Push the condom so
that the outer ring is as far as it can go—use the index finger.
[EMPHASIZE that they’re not pushing the inner ring...but
just pushing the condom itself up higher into place and also
EMPHASIZE that they can not hurt themselves. It can’t go
too far!] There are three things that you should pay careful
attention to when you are using the female condom. [SHOW]
First, your partner needs to go into the center of the condom,
not around the side like this [SHOW] So, you’ll need to guide
your partner’s penis into the condom. If he’s not in the condom,
his skin will touch your skin, and you won’t be protected. Do this
guiding until you are both comfortable using the female condom.
Next, the female condom may get either pushed in or pulled out
during sex. This is caused when there is not enough lubricant on
the inside of the condom. If the condom is getting pushed in or
pulled out, extra lubricant should be added either directly to his
penis, or to the inside of the female condom. You can use any type of lubricant, like baby oil or
lotion. The thing to remember is that each woman is different...some may need a lot of extra
lubricant, others may need none.
FC FEMALE CONDOM
1.21
EXAMPLE TEXT
In order to remove the female condom you’ll want to take it
out before you stand up. First, twist the outer ring like this, so
that you seal the condom. Next, pull and the condom will
slide out. Throw it away in the trash.
EMPHASIZE PRACTICE & PATIENCE
The condom is slippery, and may be hard to insert. Practice inserting the female condom a few
times prior to using it during intercourse. Be patient—-with time, using the female condom
becomes easier and easier. You will become more and more comfortable with it, each time you
use it, and so will your partner. You will be surprised how quickly you will be able to use it
without thinking about it.
FC FEMALE CONDOM
1.22
TA L K I N G W I T H PAT I E N T S
Step 3. Rules
Do not use the female condom simultaneously with a male condom—if you are wearing your
condom, he cannot wear his. You can put in the female condom up to 8 hours prior to having
sex—it won’t hurt you, or stop you from going to the bathroom. Most couples put it in just
before becoming intimate.
[ASK women what questions they have or what are their concerns...let them try to insert the
demo female condom into the pelvic model...ASK if they think they could/would use this...
Relax with them...laugh with them]
The success of women learning to use this method depends a lot on the
counseling they get.
Some last points to keep in mind: this is a method that is accepted by men and
women all over the world. Many women and men have learned how to use the
female condom, and a majority report liking the female condom. The female
condom provides protection from unintended pregnancies and STDs, including
HIV/AIDS. It is a valuable option for people of all countries and all cultures.
FC FEMALE CONDOM
1.23
X.
SUMMARY
The FC female condom is an important contraceptive option for women and men. Studies show
that the availability of the female condom results in overall reduction in the number of
unprotected sex acts. Additionally, studies conducted by WHO/UNAIDS showed that the female
condom is an effective tool in reducing the incidence of STDs.
The successful implementation of this program requires
1. A key trainer and point person who will coordinate staff training.
2. A full understanding of the female condom.
3. A marketing strategy that will appeal to your community.
4. A sustainable method of providing the female condom to your
community.
DIRECTOR 1 . 2 4
XI.
BROCHURES/FLIERS
Enclosed are a few of each of the brochures provided in the master section. Please use the master
copies of the brochures for your duplicating purposes. The masters are intended to be copied front
and back and folded in half.
C O M M U N I C AT I O N S
1.25
XII.
MASTERS
Enclosed here are master brochures. These masters are to facilitate making copies of the
brochures. We recommend that you use brightly colored “astrobright” paper for your copies.
These brochures are not covered by copyright laws; we encourage you to make numerous copies
and distribute them to your patients/clients. Please reference the fliers section for copies of each
master brochure. The masters are intended to be copied front and back and folded in half.
C O M M U N I C AT I O N S
1.26
XIII.
TRAINING VIDEO
The enclosed video reviews technical points on how to talk about the female condom. It is
designed to help counselors, health care providers (MDs, RNs, CNMs...) and trainers learn to
provide counseling to women and men about how to use the female condom.
The video is a supplement to this Training Model. We suggest review of the video after looking
over the written materials. Examples of training sessions conducted in the US and internationally
are included. (A spanish language version of the Traing Video is available.)
FC FEMALE CONDOM
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