Female condoms range from 'strange' to 'natural'
They've been called noisy, unwieldy and like a plastic bag.
Yet, major health campaigns in Washington, Chicago, Illinois, and New York City are promoting female condoms to curb the spread of HIV/AIDS.
Although the U.S. Food and Drug Administration approved female condoms in 1993, they haven't exactly been embraced.
After a second version of the female condom was approved by the FDA in 2009, HIV/AIDS health campaigns began distributing them in major cities and offering training on how to use them at local salons and community centers.
The condoms are another tool to empower and protect women from sexually transmitted infections and pregnancy, health advocates say. But the question remains: Will women actually use them?
Aside from the mechanics, the products are hard to find and cost more than male condoms.
They're pretty much irrelevant, said Alexandra Katehakis, a certified sex therapist and clinical director of the Center for Healthy Sex in Los Angeles, California.
"It's too convoluted," Katehakis said. "The penis is external. It takes two seconds to put on a male condom. This could take minutes and women have to get into this contortionist act to put the condom on. It's not practical."
The newest version of female condoms called FC2 is cheaper and uses a non-latex material. The device looks like a long sheath with two soft rings at each end. One ring must be pushed with a finger into the vagina, much like a tampon. The other ring remains outside the body.
While the proper use of a male condom is frequently demonstrated using a banana, health workers show how to use the condom using a vagina model or a hand. Watch a demonstration here.
When tampons were first introduced, people cringed at the thought of insertion, but women eventually caught on, said Zoe Lehman, a support services coordinator at the Chicago Women's AIDS project.
"It's the same deal with female condoms - it's not complicated at all," she said. "People have the idea it's more complicated to use it because no one has shown them how to use it."
The device gives women some control in negotiating condom use, said HIV/AIDS advocates.
The reactions from female condom users have varied.
Casandra, a Fort Lauderdale, Florida, health advocate, tried the female condom several times, because she wanted to be able to answer questions about it. She asked that her last name not be used.
"It was a little strange to get it up there," said Casandra, who prefers the male condom. "In terms of inserting it, it was a little bit weird doing it in front of my partner. After it was in, it was OK."
Lynn, from Detroit, Michigan, who also asked that her last name not be used, said female condoms "move around more," didn't have the tightness and texture of male condoms, and had "more of a natural feeling." She and her boyfriend preferred them, but used them only for special occasions because of the price.
A box containing three female condoms cost $6.49. In comparison, a package of 10 male condoms sells for about $5.
Carol Queen of San Francisco, California, said "that some male partners like the extra movement they get" with a female condom. The downside: The condom could get twisted, she said. Queen, who works at a sex toys store called Good Vibrations, said sales of female condoms have increased since 2008.
Earlier this year, Chicago's AIDS organizations started promoting female condoms with the slogan -- "Put a ring on it" borrowing a line from the Beyonce song.
Washington splashed 460 Metro buses with ads to promote and to distribute a half-million female condoms. D.C. health officials used a $500,000 grant from the M.A.C. AIDS Fund to distribute and promote free female condoms. CVS/pharmacy stores also started selling female condoms in their D.C. stores in March.
San Francisco's health department has interest in the campaign too, according to the makers of the female condom, Female Health Co.
"There's nothing wrong with the male condom," said Mary Ann Leeper, senior strategic advisor at the company. "If you use it, fair enough. A lot of people -- male and female -- don't like it and have unprotected sex. What we say is it gives people options and empowers women to initiate a method if he doesn't use a male condom. It empowers her to take care of herself."
Having a female condom option increases the rate of protected sex, she said.
A 2003 study showed that women who were educated and supplied with female condoms were as protected as those who were only supplied with male condoms. But another self-reported study found that female condoms were slightly less effective than male condoms.
The latest public health efforts to promote female condoms are "a great way to start," said Dr. Christine Mauck, a researcher. "It's focusing efforts in places where the device is really useful and hoping the positive effect will spread out."