Twenty years into the AIDS pandemic, condoms remain the only protection humanity has against the transmission of the HI virus during sex ‘€“ which is why interest in the female condom is growing.

South African television recently started screening advertisements for the female condom, while selected pharmacies are selling it under the brand name, Care, at R5 for two.

There’€™s been a lot of tittering about the female condom (FC). Whispers about how it’€™s big and baggy and somehow weird. But perhaps that’€™s because it’€™s new and its use requires a fairly intimate understanding of the female body.

“The female condom is actually the same length as the male condom,” says Dr Sunanda Ray, who has been involved in introducing the FC into Zimbabwe. “But it is wider.”

It’€™s made of polyurethane which, its test drivers say, makes it feel more like a “second skin” than the latex male condom. But it also makes it a lot more expensive to produce than the male condom.

Mmabatho Mqhayi, from the Reproductive Health Research Unit (RHRU) in Johannesburg, is part of the team working to introduce the FC in this country.

She confidently and patiently explains how the FC works.

“First,” she says, “the package must be sealed. Then you open it and take out the condom. It has been lubricated with an oil-based lubricant.”

The FC has two rings, an outer ring to keep it in place and an inner, flexible ring to anchor the condom in the cervix.

“To insert the FC, you need to twist the inner ring into a figure of eight and push it into the vagina,” says Mqhayi, deftly making a tunnel with one hand to demonstrate insertion. “To be anchored properly, it should be located behind the pubic bone. If you have used a tampon, using the FC can be very easy.

“The female condom can be inserted up to eight hours before sex and once it is in, it acclimatises to the body warmth and clings to the cervix.”

Another plus, says Mqhayi, is that the outer ring provides extra stimulation for the clitoris during sex.

Ray says while women may initially have problems with the insertion, “they should try it at least three times before giving up”.

“In Zimbabwe, the FC was introduced with an organisation called Women in AIDS,” says Ray. “There was a support group for women using the FC, so women discussed their problems. Some women said they were embarrassed because the FC made a noise while they were having sex. Others said they could solve this by using extra lubricant. A healthworker advising a woman would only be able to solve these problems if she had used the FC herself.”

According to Ray, women over the age of 25 are the FC’€™s best fans ‘€“ probably because they are “better educated and more confident” than younger women.

Interestingly, Ray says men like the FC because it does not feel tight, it can be inserted before sex so that it doesn’€™t interfere with the moment of passion and they don’€™t have to withdraw immediately after ejaculation, as they do with the male condom.

Although some have hailed the FC as a “woman-controlled” method of protection against sexually transmitted infections including HIV, Ray urges caution.

“The fact that the FC is visible outside the woman’€™s vagina means that it would be difficult for her to use it if her partner did not approve, except if he were drunk,” says Ray.

South Africans are getting access to the FC thanks to a collaborative project between the Reproductive Health Research Unit (RHRU), Society of Family Health, the Planned Parenthood Association of SA and the Department of Health.

Donor funds have enabled the department to supply the FC free of charge, but Mqhayi concedes that the FC is an expensive contraceptive option.

However, initial research done by Mags Beksinska and others, also from the RHRU, shows that the FC can be washed and re-used up to eight times before developing holes. While the World Health Organisation is the only body which can officially pronounce on the re-use of the female condom, the RHRU research is encouraging for low-income users.

Mitchell Warren, vice president of the Female Health Company, which manufactures the FC says his company distributes eight million to about 70 countries. “Three million of these go to South Africa, so it’€™s a big market,” says Warren.

Warren’€™s company first started making the FC in 1992, when it was launched in Switzerland. The first large scale demand for the FC came from Zimbabwean women in 1997, but the Female Health Company is working with the Joint UN Agency on AIDS (UNAIDS) to make the FC more widely in countries where the HIV/AIDS pandemic is rampant.

“Twenty years into the AIDS epidemic, it’€™s the only new method we have to combat HIV,” says Warren.