Does the PATH to safer sex run through Seattle?

Harborview STD clinic staffers Susannah Herrmann and Sue Szabo discuss the drawbacks of earlier models of the Female Condom. (Photo by Mali Main)

Condom.

Did you just picture an erect penis?

Me too. That’s because female condoms aren’t as popular as their male counterparts.

Frustrated with the limp response to past designs, Seattle-based global health non-profit PATH has designed a new female condom with input from couples in developing countries.

They say they’re determined to raise the female condom’s public profile.

“Even though we are the developers of one type of female condom, we are trying to improve the image of all female condoms,” says Maggie Kilbourne-Brook, Deputy Director of the Woman’s Condom Project at PATH.

Part of that effort is the “Female Condoms Are____” film contest running now through March 1st. PATH invites contestants to submit short films about female condoms, named by filling in the blank with a word or phrase that captures the message of the film. Winning films will debut in May at the Women Deliver conference in Kuala Lumpur.

The more mainstream the product becomes the more it will be accepted. This is especially important in countries outside the US where there are more women than men dying of HIV/AIDS, reports say.

“Many women are not in control of the protection,” explains Kilbourne-Brook.

Women are more likely to contract HIV during sex than they are to transmit it, but using a male condom means they have to rely on their partner to protect them from infection.

PATH’s condom is currently available in China under the French-inspired brand name O’Lavie, with a tagline that translates roughly to ‘beloved said ok.’ Right now, PATH is working on ways to distribute their condom in sub-Saharan Africa, home to almost 80 percent of all HIV-positive women in the world, according to UNAIDS.

“We developed this product to expand access to protection for women in low-resource settings,” says Kilbourne-Brook. Eventually, they would like it to be available to women everywhere.

Until then, Seattleites probably won’t miss it.

There is only one type of female condom available in the U.S., the FC2 (an acronym for Female Condom 2).

The Female Health Company has held a monopoly on female condoms since the mid-‘90s when the U.S. FDA and the World Health Organization (WHO) approved the FC for global distribution. (The company modified its design and released it under the name FC2 several years ago.)

At the Harborview STD Clinic the staff tells me women rarely request the female condom. They hand them out mostly to gay men.

But one nurse practitioner, Susannah Herrmann, 42, says she gives female condoms to sex workers. “I think it’s a particularly good option for those folks,” she tells me, “so they can have a little bit of control.”

She remembers the first time a sex worker came into her exam room. She smiles, “I gave her an armload.”

The Female Health Company’s FC2, long the only Female Condom on the market, comes with a dizzying instruction sheet. (Photo by Mali Main)

But her smile fades quickly.

“So few women ask for them,” she says. She thinks most women don’t even know they exist.

“The woman I gave a female condom to today – she had no understanding of it. She thought they were for women who have sex with women.”

Herrman has been at Harborview since May, but she also works at Aurora Medical Services, where she talks to her patients about female condoms. “But, I’ve never had any takers,” she says, “Not in the ten years I’ve been there.”

Sue Szabo, a physician assistant at Harborview for 32 years, brought out an FC2 with the instructions, which fold out to an 8.5×11 inch page crowded with pink and purple text in what looks like 7-point font.

Szabo demonstrates the FC2. There’s a removable inner ring that you have to pinch into a figure eight to insert. Once inside it springs back into shape and anchors the condom against the cervix. Standing in the brightly lit exam room, I can only maintain the figure eight for a few seconds before it pops out my fingers. The condom is greasy with lubrication.

And it rustles like a damp Bartell’s shopping bag.

In contrast to the slippery awkwardness of the FC2, PATH’s new female condoms are un-lubricated. The product is packaged with a separate “sachet” of water-based lubricant.

PATH created a prototype based on suggestions from internationally-held focus groups. They established testing sites in Thailand, Mexico, South Africa and the United States and perfected the prototype through rounds of user feedback.

“A lot of the improvement that happens in the design comes directly from the user,” says Kilbourne-Brook.

Because some women said the inner ring was uncomfortable, PATH scientists replaced it with four soft, oblong foam shapes heat-welded to the outside of the condom.

To address the problem of the initial impression –“both men and women were a little daunted by the size of it,” says Kilbourne-Brook – PATH scientists gathered most of the pouch into a capsule, about the size of an OB tampon. This also made it easier to insert.

The condom comes out of the package in a tidy bell shape, dry and silky. All you have to do is insert the tampon-sized capsule, which dissolves in moisture. So once you’ve pushed it in place, the pouch unfurls and the foam shapes cling lightly to the vaginal walls and stabilize the condom.

“Keeping the pouch in place eliminates most of the performance issues,” says Kilbourne-Brook. “It doesn’t slip, there’s no noise, and women don’t have to worry about holding it in place.”

Widespread use of any female condom model in the US still seems pretty unlikely. Retailers I spoke to at adult stores Babeland and Wild at Heart confirmed they were pretty unpopular.

But PATH believes they’re making progress where it really counts: in the developing world.

“When [the female condom] was first introduced some policy-makers and researchers and health care providers said ‘women will never use that'” says Kilbourne-Brook.

“When you go to developing countries, those women are motivated to try and find protection. They see their family members dying, their friends are dying and right now they don’t have protection. We have got to listen to the women in those countries. They want protection and the male condoms aren’t working.”

 

How to use the PATH Woman’s Condom

Mali Main is studying Journalism and Quantitative Science at the University of Washington. She is the Newsletter Intern at the Division of Occupational Therapy in the UW Department of Rehabilitation Medicine and works as the Development Assistant at the St. James ESL Program. She has also covered art, astrophysics and healthcare reform.

2 COMMENTS

  1. Very well written and informative article about an important public health issue. I hope to read more by this reporter.

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