Currently, there is only one version of a female condom on the market: the Reality Female Condom. It is a soft, loose-fitting tube or long pouch that is made of a very thin, strong, transparent polyurethane, approximately 3 inches in diameter and 6 to 7 inches long. It looks a bit like a miniature wind sock (Figure 3.1). It is designed to line the inner contours of the vagina and protect a woman against sperm and the bacteria and viruses that cause disease, including AIDS. The female condom has a flexible, narrow ring at both ends. The slightly smaller ring inside the closed end helps to place that end over the cervix and to hold it there. The ring at the open end remains outside the vagina and serves as the entry for the penis. The pouch is lubricated both inside and out. Like the male condom, it is meant for one-time use.

The female condom not only protects the vagina and cervix from sperm and microbes, it is sized so that the open end also covers a woman's external genitals and the base of her partner's penis, offering both of them excellent protection against disease.

Because it is made of polyurethane, the female condom has the advantage of being stronger than latex and less likely to tear or develop tiny holes. It will not aggravate a latex allergy. It is not

affected by oil-based creams or lotions and is less vulnerable to deterioration caused by exposure to heat or lengthy storage. Like the Avanti condom, it transfers body heat easily, which means it quickly feels warm and soft and permits more sensation.

When it was tested in actual use, about one-third of the men said they preferred the female condom over the male condom because it was roomier. Some men noted that it felt more natural to them because the penis could move freely in and out. They liked the fact that they did not have to interrupt their lovemaking to put on a condom. They also could linger as long as they wanted after ejaculation because, unlike using a male condom, they did not have to withdraw while their penis was still erect. You can put the female condom in place up to 8 hours before intercourse and you do not need a spermicide for extra safety. The female condom should be removed before you stand up.

For many women, however, the major advantage of the female condom is that it gives them control over their own protection against STDs, instead of trying to convince their partners to protect them by using a condom.

The female condom can be

FIGURE 3.1 The Female Condom

bought without a prescription and at most drugstores. The package, while not as compact as packets of men's condoms, is small enough to tuck into a purse or pocket.

The female condom does not require a physical examination and a fitting like a diaphragm because it does not have to provide a snug

cover for the cervix. It is protective because all the semen is trapped in its long pouch. However, if you have never used a barrier contraceptive like the diaphragm you may want to seek the help of a health care provider at a women's health center or family planning clinic.

Women's health clinics that offer the female condom report that their clients "either love it or hate it." In studies of the Reality condom, the women who used it said that the biggest disadvantage was the sensation of having something outside the vagina; however, many of those who used this type of condom for a week or two said they soon became accustomed to this and barely noticed it. Some found that the part of the condom that lies outside the body tended to stimulate the clitoris, adding to their pleasure. Although many of their partners reported that they could feel the condom, they did not necessarily find it objectionable.

The Reality condom can be noisy if the lubricant inside is not spread evenly around the outer end or if there just is not enough lubricant. Furthermore, if lovemaking is lengthy, the lubrication may get used up and the polyurethane will become somewhat dry. The solution is to add two drops (or more as needed) of lubricant to the entrance of the condom or on the penis. Extra lubricant is supplied with each starter package of Reality condoms.

Laboratory tests of the polyurethane used in the Reality condom (and in the Avanti male condom) have demonstrated that the AIDS and hepatitis B viruses are not able to penetrate the polyurethane. (Hepatitis B is the smallest virus known to cause an STD.)

A study of the contraceptive effectiveness of the female condom in actual use found that it is as good as other barrier methods-the male condom, the diaphragm, or the cervical cap-in protecting against pregnancy. The rate of accidental pregnancy during a 6 month period ranged from 2.6 percent (for women who used the condom correctly and for every single intercourse) to 12.4 percent (for typical, less-than-perfect use). To arrive at a 12-month failure rate, the FDA doubled the rates from the 6-month study: the failure

rate for perfect users is now listed as 5 percent and, for typical users, as 21 percent.

The results of this clinical study of effectiveness have led researchers to suggest that the perfect use of this condom could also substantially reduce women's risk of acquiring HIV. They estimate that, among women who have intercourse twice a week with an infected man, the annual risk of acquiring the infection could be reduced by 90 percent.

Because it is made of polyurethane rather than latex, the Reality condom is a good choice for the numbers of women (or their partners) who are allergic to latex rubber. In addition, it does not require the use of a spermicide, so it is attractive to those who are irritated by the ingredients in today's spermicides.

Although polyurethane is not as likely as latex to irritate the vagina or the penis, there is always a slight possibility that such irritations might occur. Frequent use of polyurethane condoms may sensitize some individuals to the material although, so far, this complaint has been rare. The symptoms are itching and mild pain.

Female condoms are available chiefly from large drugstore chains, where they are usually stocked near the supply of male condoms. They also can be bought at many women's health clinics.

Because the female condom is so new and looks so different, even someone who has used a diaphragm or a tampon may be nervous about trying it. It helps to have a sense of humor when trying it and to practice with it a few times before actually having sex. Take your time and become at ease with this type of condom before actually using it for protection.

Before you try to insert the condom, read the section on female

anatomy in Chapter 1 and familiarize yourself with your vagina and the location of your pubic bone and cervix. You will be much more relaxed about using any barrier contraceptive—and about sex—if you are acquainted with your own body.

Although the directions for inserting this condom are lengthy because they cover every detail, after a little practice you will find that insertion is quite simple and quick (Figure 3.2). If you have difficulty with it, take a break, relax, and re-read the directions given here or those that come with the package before you try again. Being relaxed and willing to experiment will make the process much easier.

• The closed end of the female condom is designed to fit over the cervix, and the open end stays on the outside of your body.
• The condom can be inserted anytime up to 8 hours before having sex.
• If you are not familiar with your vagina, check it out before you try inserting the condom. Use your middle finger to find your cervix at the upper end. It feels somewhat like the end of your nose, and it is about 3 inches from the vagina's opening. The vagina itself is not very long.
• To be sure the lubrication is spread evenly on the inside of the long pouch, from bottom to top, rub the outside of the condom gently. The lubricant is designed to make the inside of the condom feel similar to the naturally lubricated vagina. If the penis does not slip in and out easily during use, you can add more lubricant from the extra supply in the package.
• Before you try inserting the female condom, find a comfortable position. You can sit on the edge of a chair with your knees apart, or sit on the toilet, or lie down.
• Be sure the inside ring is down at the closed end of the tube. The inside ring is a bit smaller and thicker than the outside ring.
• To make it easier to insert the condom, add a drop or two of extra lubricant to the outside of the closed end of the pouch. Too much lubricant, however, may make it hard to grasp the ring firmly.
• Hold the pouch by the inside ring, with the open end hanging down. Squeeze the sides of the inner ring together to make it narrow

• enough to go into your vagina. It may be easier if you squeeze it between your thumb and middle finger, with your index finger on top of the ring to help hold it steady. Be careful not to tear the condom with your fingernails or rings.
• Use your other hand to spread the outer and inner lips of your vagina and then insert the squeezed inner ring. If it slips from your fingers, let it go and start over. The condom is well lubricated, which can make it a little difficult to manage. If your vagina feels a little dry, however, you may need to add some more lubricant to the condom or to the entrance of your vagina.
• Push the inner ring and the pouch all the way up into your vagina as far as it will go. (Vaginas are about 2 1/2 to 4 inches long.) The easiest guide for doing this is to follow the lower or back wall of the vagina with the folded ring until it stops. This will help the leading edge of the ring to go under and past the cervix and touch the back wall of your vagina where it joins the cervix. The end of the folded ring closest to the vaginal opening should then be just past your pubic bone. You can feel your pubic bone—it is barely a finger's length inside the vagina. Push the ring up behind the pubic bone, which will help hold it in place. (See Chapter 1 for more information about your anatomy.)
• When the condom is in place, it covers your cervix and you should be able to feel the cervix through it. If the condom is not comfortable, it may not be correctly positioned. Remove it (twist the outer ring and gently pull) and try again. It takes a little practice to get it in place behind the pubic bone and over the cervix. Aim the leading edge a little lower so it does not hit the cervix instead of the back wall of the vagina. When you think you have the condom in place, you can check it with your finger to make sure it is over the cervix.
• About 1 inch of the open end of the condom will remain outside your vagina. While this may look unusual, it is this extra material that protects your genital area and the upper part of your partner's penis.
• Use a fresh condom for each intercourse, because the used one may have been torn or contaminated with body fluids. Do not use a

• Reality and a male condom at the same time. They will stick to each other and will not stay in place.
• When you are ready to have sex, make sure the outside ring is lying flat against the outer lips of your vagina. As the penis begins to enter, guide it into the ring. If this entry is not easy, ask your partner to withdraw for a second while you add more lubricant either to his penis or to the inside of the condom. If you do not have Reality lubricant, you can use any gel or oil—polyurethane condoms are not damaged by oils.
• It is normal for the female condom to move around during sex and for the outer ring to move from side to side. It is even okay if it rides up on the penis—this does not reduce your protection because the penis is still covered and the semen stays inside the pouch.
• If you begin to feel the outer ring being pushed into the vagina or if the penis starts to enter underneath or next to the condom instead of into it, stop. You or your partner may need to add extra lubrication to the opening of the pouch and make sure the outer ring is lying flat over the lips of the vagina—this will make it easier for the penis to slide into the condom. The Reality should not bunch up if there is enough lubricant in it. It helps if you make sure the outer ring is lying flat while you guide the penis into it.

To remove the Reality after sex (before you stand up), squeeze the outer ring and twist it to keep any sperm from spilling. Pull gently to remove the condom, wrap it in tissues, and drop it in a trash can. Do not flush it down the toilet and do not reuse it.

The only female condom on the market today is the Reality. Costs range from $7.00 to $8.99 for a package of three, and a package of six is $13.00 or more. Large drugstore chains tend to have the lowest prices.