Awareness of female condoms and failures reported with two different types in China

A qualitative study on the clinical safety and user experiences of female condoms for anal intercourse among men who have sex with men in Shanghai, China

Objective

This qualitative study aimed to understand the clinical safety, efficacy, and receptiveness of using the female condom (FC) during anal intercourse among men who have sex with men (MSM).

Methods

Subjects for this study were recruited from a two-group crossover trial among MSM in Shanghai. The trial consisted of two phases, each including the use of condoms (FC vs. male condom), questionnaires, and in-depth one-on-one interviews. The two phases were separated by a washout period of 4 weeks. The minimum sample size for this study was determined in accordance with the principle of "information saturation." The qualitative data were organized and analyzed using ATLAS.ti version 7.

Results

A total of 26 participants from the MSM population were recruited for this study, with 10 assuming the insertive role (i.e., "1"), 8 assuming the receptive role (i.e., "0"), and 8 being versatile (i.e., "0.5"). Each participant completed the crossover trial comprising two phases. The cumulative usage of FCs and male condoms (MCs) amounted to 115 and 127 times, respectively. During the reported sexual encounters, no participants reported incidents of condom rupture, slippage, or other malfunctions. A few participants reported experiencing slight chafing pain, primarily put forward by "0" participants. Apart from those reports, no instances of bleeding, swelling, or allergic reactions were reported. The efficiency of FC in disease prevention, the sexual partner's willingness to use FC, the freshness of FC, and positive sexual experiences were the main reasons for the consistent use of FC for anal sex. Discomfort and pain during sexual activity, the loose design and thick material of FCs, and difficulties in placing FCs were the major obstacles to FC use among MSM. The elements referring to the forehead exhibited varied in importance among "1,", "0," and "0.5" participants. Regarding the willingness to use the FC in the future anal intercourse, 61.54% of participants expressed a positive inclination, 23.08% were uncertain, and 15.38% stated that they would not. "A better sense of security during anal sex" was the main factor affecting willingness among "0" participants and "the sexual pleasure that the FC brought" among "1" participants. Improving the design and technology of FCs and increasing the frequency of use and practice might improve the use skills, which will favor the willingness to use FCs among the MSM population.

Conclusion

FCs received positive user feedback from study participants, but distinctions were found in individuals in different sexual roles. Large-scale quantitative studies are needed to evaluate the clinical safety of the FC and its effectiveness in preventing the transmission of STDs during anal intercourse.

Barriers and Enablers Influencing Women's Adoption and Continuation of Vaginally Inserted Contraceptive Methods: A Literature Review

Most vaginally inserted methods have limited availability and use despite offering characteristics that align with many women's stated preferences (e.g., nonhormonal and/or on demand). The objective of this review was to identify enablers and barriers to women's adoption and continuation of vaginally inserted contraceptive methods in low- and middle-income countries (LMICs). We searched three databases (PubMed, Embase, and Web of Science) and 18 websites using keywords related to five vaginally inserted contraceptive methods (diaphragm, vaginal ring, female condom, copper intrauterine device [IUD], hormonal IUD) and terms associated with their adoption and continuation. Searches were limited to resources published between January 2010 and September 2020. Studies eligible for inclusion in our review presented results on women's use and perspectives on the enablers and barriers to adoption and continuation of the vaginally inserted contraceptive methods of interest in LMICs. Relevant studies among women's partners were also included, but not those of providers or other stakeholders. Data were coded, analyzed, and disaggregated according to a framework grounded in family planning (FP) literature and behavioral theories common to FP research and program implementation. Our initial search yielded 13,848 results, with 182 studies ultimately included in the analysis. Across methods, we found common enablers for method adoption, including quality contraceptive counseling as well as alignment between a woman's preferences and a method's duration of use and side effect profile. Common barriers included a lack of familiarity with the methods and product cost. Notably, vaginal insertion was not a major barrier to adoption in the literature reviewed. Vaginally inserted methods of contraception have the potential to fill a gap in method offerings and expand choice. Programmatic actions should address key barriers and enable voluntary use.

Female condom acceptability and use amongst young women in Botswana

Background

The female condoms are a barrier method of contraception. The FC1 female condom is made from soft thin plastic called polyurethane and has been replaced by FC2 female condom, which is made of synthetic latex. The female condom is worn inside the vagina and acts as a barrier to prevent semen getting to the womb. It is about 75% – 82% effective with normal use. When used correctly all of the time, female condoms are 95% effective. Despite evidence of its effectiveness, the use of the female condom has continued to face resistance from both women and men.

Objectives

The objectives of this study were to determine clients’ level of knowledge of female condom, identify predominant methods of contraception, examine young women’s views regarding the female condom and identify barriers to the use of female condoms by young women.

Method

A simple random sampling approach was used to recruit young women between 15 and 34 years in Jwaneng, Botswana. Data were collected using self-administered structured questionnaire from women accessing healthcare services in the three health facilities in 2015. Descriptive statistics, exploratory factor analysis and the chi-square test techniques were applied using the Statistical Package for the Social Sciences (SPSS) statistical programme version 23 for Windows to analyse data.

Results

The findings based on factor loadings show low utilisation of the female condom and highlights the significant challenges about the material, size, shape and timing of insertion. Respondents had stronger views on the structure of the condom. There was no significant relationship between attitude and method of contraception.

Conclusion

Acceptability of the female condom involves complex factors such as women position and decision-making power in a relationship, attitude and knowledge. Attitude, knowledge and power relations play a role in the extent to which women would want to try or use it. Various strategies need to be developed to effectively promote the female condom amongst young women.

Acceptability of Phoenurse female condom and second-generation Femidom female condom in Chinese women

AIM

To compare the acceptability of Phoenurse female condom (PFC) and second-generation Femidom female condom (FC2) among Chinese women.

METHODS

A randomized, cross-over clinical trial was carried out in women aged 20-49 years seeking family service in Qingdao, China, between April and October 2013. Women were classified into two groups using a computer-generated randomized sequence. Participants completed questionnaires at baseline and after using 10 of each type of female condom (FC).

RESULTS

Of 290 women, 247 (85.2%) believed that FC could protect against sexually transmitted diseases and HIV. A total of 152 (52.5%) thought that the female condom (FC) contraceptive failure rate was higher, and 107 (36.9%) thought that FC could be reused before they participated in this study. After the study, 135 (46.6%) and 39 women (13.4%) would have been happy to use FC2 and PFC, respectively. Significant difference was noted between PFC and FC2 for the features color, lubrication and overall fit, rather than length, appearance, smell and application method. A total of 68 (23.5%) and 140 women (49.5%) liked FC2's color and lubrication better than PFC (44, 15.2%; 99, 34.6%). Also, 158 women (54.5%) preferred the overall fit of FC2 compared with PFC (143, 49.5%; P < 0.05).

CONCLUSION

Participants did not have sufficient knowledge about the contraceptive effect and use of FC. Lubrication means the smooth degree of using FC. Length means the size of FC. Appearance means the users' overall impression of the FC.

Knowledge, attitudes, practices and behaviors associated with female condoms in developing countries: a scoping review

Women in developing countries are at high risk of HIV, sexually transmitted infections, and unplanned pregnancy. The female condom (FC) is an effective dual protective method regarded as a tool for woman’s empowerment, yet supply and uptake are limited. Numerous individual, socioeconomic, and cultural factors influence uptake of new contraceptive methods. We reviewed studies of FC knowledge, attitudes, practices, and behaviors across developing countries, as well as available country-level survey data, in order to identify overarching trends and themes. High acceptability was documented in studies conducted in diverse settings among male and female FC users, with FCs frequently compared favorably to male condoms. Furthermore, FC introduction has been shown to increase the proportion of “protected” sex acts in study populations, by offering couples additional choice. However, available national survey data showed low uptake with no strong association with method awareness, as well as inconsistent patterns of use between countries. We identified a large number of method attributes and contextual factors influencing FC use/nonuse, most of which were perceived both positively and negatively by different groups and between settings. Male partner objection was the most pervasive factor preventing initial and continued use. Importantly, most problems could be overcome with practice and adequate support. These findings demonstrate the importance of accounting for contextual factors impacting demand in FC programming at a local level. Ongoing access to counseling for initial FC users and adopters is likely to play a critical role in successful introduction.