Women no longer can make it the responsibility of their partners to provide a condom during sex. They are in need of barrier methods that can decrease their exposure to HIV/AIDS, STIs and unwanted pregnancy.
As one manufacturer explains, the female condom has “a flexible ring at each end; the inner ring at the closed end is used to insert the condom inside the vagina and also hold it in placed during intercourse. The sheath of the condom covers and protects the vagina and cervix. The outer ring at the open end remains outside the vagina and protects the external genitalia.”
The female condom should be viewed as a tool to enhance a woman’s autonomy over her body allowing women to enter into a sexual encounter prepared.
Alarming Statistics
In a recent study supporting the use of the female condom, it was found among young women 15 to 20 years old living in an urban community, approximately 30 percent have had an STI, and 80 percent of 18 year olds have been pregnant.1
In 2010, the CDC reported, women account for 27 percent of annual new HIV infections and 25 percent of those living with HIV.
One solution to assist in combating these alarming statistics is the use of the female condom. Unfortunately, there is limited availability, accessibility and information publicly available about the female condom. The lacking of visible female condom information illuminates an impediment to the progression of decreasing STI and unwanted pregnancy.
Nurses are on the front line, encountering patients in a variety of settings. As patient advocates and educators, nurses who are informed about the proper usage of female condoms are often in a prime position to educate the public about the female condom.
Literature Review
Studies have shown nearly two-thirds of the 12 million STI cases diagnosed annually in the U.S. are among women.2
Informing young women about the benefits and proper usage of the female condom, as an alternative method, should be incorporated in the plans devised to change this public health sector. An estimated 12.9 percent of disease burden, calculated as disability-adjusted life years, have been attributed to HIV/AIDS and STIs, and globally the second highest cause of disease burden is attributed to unsafe sex.3
The female condom has been proven to decrease rates of HIV, STIs and unwanted pregnancy when used correctly.
In 2000-01 at a reproductive health clinic in Alabama, a study was done to determine the comparative levels of protection offered by the male and female condoms. Researchers assessed the prostate-specific antigen (PSA) level in vaginal fluid samples that were collected after intercourse. The PSA level was a determinant verifying whether there was semen exposure during intercourse.
When a male condom was used, 14 percent of the women were exposed to semen, compared to 17 percent of the women who had used a female condom.4 This difference was not statistically significant; as a result, it would appear safety can be maintained with the use of the female condom.
Obstacles to Use
Even with the known benefits of the female condom “current U.S. usage of the female condom is low.”5
Despite the positive implications of the female condom, there are obstacles that prevent its dissemination. The female condom costs more than the male condom; however, they can be found for free in clinics and agencies working to prevent the rising rates of unplanned pregnancies and STIs. The product was initially introduced in the 1990s and was $3-$4 each, compared to male condoms which were 50 cents.6
Since the initial introduction of the female condom, a new and improved version has been made. The newer version of the female condom referred to as FC2 is made of nitrile, a non-latex substance. It is also cheaper than the initial female condom because the FC2 carries a less expensive manufacturing cost (it can be made available for as little as 22 cents per unit).5 The significant decrease in cost of the female condom can increase its popularity which may in turn increase its usage.
To increase the popularity, work needs to be done on the branding of condoms and other protective barriers. Discussing the ways in which the female condom enhances sex, in addition to the safety features, may aid in making the product more accepting.
For example, in an acceptability study about the female condom that was done in Puerta Plata and Santiago, Dominican Republic (which has a high number of female sex workers), most of the women in the study reported “the reaction from their partners was positive.”7 If women are trained on how to use and introduce the female condom, it may improve acceptance of the product.
The CDC determined from a trial done in Thailand that in an area where both male and female condoms were distributed, individuals were less likely to acquire an STI compared to places that only used the male condom as barrier protection.
Study Design
The pilot study “Teaching the Teachers about the Uses of the Female Condom” was done using a convenience sample made up of nursing professionals and students attending a nursing research conference in New England to determine their level of knowledge regarding the female condom.
Rather than trying to reach at-risk women in singular settings, the goal was to reach nurses who have known contact with these individuals and who might be able to reach an even larger population; thus “the teach the teacher” scenario.
A poster presentation was offered to these participants as a way of informing them about the female condom. The tool used was developed by the researcher and had been tested on a group of nurses in a graduate program. The accuracy of the tool was reviewed by a principal investigator at the Institute of Community Research (ICR) in Hartford, CT.
The tool was designed using questions developed on a Likert scale with options none, minimal, moderate and high. The questions were:
• Prior to this poster demonstration how much knowledge did you have about the female condom?
•
Rate your level of knowledge regarding the female condom following a review of this poster presentation.
• How likely is it that you would teach/tell someone else about the female condom?
• How much contact do you have with young women age 18-25 years?
• How likely is it that you would be involved in teaching about the female condom with a group of young women ages 18-25?
At the end of the survey, there was a comment section that provided participants the opportunity to share questions and/or concerns. Anonymous surveys were collected in a closed box. The consent of the participants was designed into the survey, recognizing their decision to participate as consent in the pilot study.
Prior to implementing this pilot study, the approval of the Institutional Review Board was obtained from the University of Hartford’s Human Subjects Committee and approval was also obtained from Sigma Theta Tau, the organization hosting the nursing research conference.
Study Findings
Individuals were receptive to the information provided on the poster. Positive feedback was elicited from individuals who participated in the study. The findings represent 98 completed surveys.
Feedback in the comments section suggested the female condom was a topic that was relevant to public health. This poster session provided a platform that allowed the researcher to dispel misconceptions and inform attendees about the benefits of the female condom.
Most respondents (82) reported having none or minimal knowledge of the female condom prior to viewing the poster. After viewing the poster, most respondents (90) reported they had moderate or high level of knowledge about the female condom.
Sixty-three of the respondents reported having interactions with women ages 18-25. A total of 68 people responded they would teach/tell someone about the female condom. These findings suggest this poster presentation is an effective tool to educate nurses about the female condom.
In the areas designated for comments most responses were positive and supported the dissemination and education regarding the female condom. One of the participants identified herself as “a college health RN x 20 years who thinks the female condom is a good option, giving control for contraception and disease prevention.”
Another participant stated: “the female condom needs to be more readily available and more widely taught. Student reaction is sometimes negative regarding the details of use. Education could help that.”
Implications for Nursing
After being informed of the benefits of the female condom, nursing professionals located in school-based health centers, Planned Parenthood, those active in health fairs, program development or the development of sexual health curriculums in schools can offer another preventive option to the women they encounter.
In addition, these nurses can concurrently respond to questions/concerns that may arise regarding sexual health.
The female condom provides women with another option that could reverse the rising trend of unplanned pregnancies and STIs. Results of this study suggest nurses’ knowledge of the female condom can be increased with a poster presentation and nurses, in turn, can provide young women with the knowledge about female condoms that could be used to reduce the alarming rates of STIs, HIV/AIDS and unwanted pregnancy.
These interventions can ultimately play a role in decreasing women’s anxiety about using female condoms, which can increase its acceptance.
References for this article can be accessed at www.advanceweb.com/Nurses. Click on Resources, then References.
Daileann L. Hemmings is a woman’s health nurse who, with support from ICR in Hartford, CT, executed the pilot study described in this article.
