What we are going to cover
 The field of female condoms
 Why female condoms matter
 How to use female condoms
 Effective promotion strategies
 The provider’s role
 Hands-on practice and role plays
 About the Chicago Female Condom Campaign
 Next steps
 Resources
But first, let’s talk ground rules
 We’re all here to learn
 Listen actively and respect others when talking
 Participate to the fullest of our abilities
 Speak from own experiences with “I” statements
 Sit by someone you don’t know!
 Promise that what is said here, stays here
 Ask questions
 Anything else?
A word about language
 People who are not female-identified may be
turned off by the name “female condom”
 Other names for FCs include…
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Internal condom
Receptive partner condom
Bottom condom
Insertive condom
Manhole cover
Catcher’s mitt
What other terms have you heard?
A word about language and gender
 Best practice to affirm & respect clients’
gender expression & identity
 Don’t make assumptions about a
person’s gender
 Ask their preferred pronoun such as:
she/her, he/him, ze/hir, they/them, etc
 Don’t be afraid to ask! Just be
respectful
 Tell them yours too!
Pre-test
 Help us assess what you
know and think about FCs
before the training
 Take post-test after
completing training
 Show you AND us what you
learned today
Let’s get to know each other!
Your name, agency, role, & preferred gender
pronoun
• 1=Never heard of FCs
• 2=Heard of FCs, but haven’t talked at
length about them
• 3=Feel pretty confident talking about
FCs, but have more to learn
• 4=Very knowledgeable & comfortable w/ FCs
• 5=Know tons about FCs; talk about them with everyone I
meet!
Your thoughts on FCs
 What do YOU think about FCs?
 What do you think when you see them?
 Do you think FCs are effective prevention tools?
 What do you say when they are mentioned?
 Do you think they enhance pleasure?
Renewed energy & interest in condoms
 CDC prioritization of condom distribution
 Gates recent RFP for “Next Generation Condom”
 Several female condom products on the market today,
and additional products in development
 Promotion of FC2 for receptive partners of all genders
 Folding silicone male condom in clinical trials
 First RAI condom in acceptability trials
The field of female condoms
 Female Health Company’s FC2
• Nitrile (synthetic latex)
• Pre-lubricated with silicone-based
lubricant
• Does not contain spermicide
• Most widely distributed FC around the
world
• Only FC available in U.S.
About the FC2
 FDA approved FC2 early 2009
 What’s different between FC1 and FC2?
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Non-allergenic for people with latex allergies
Softer
Seamless
Quieter
More affordable
Warms to body temperature
Anatomy of the FC2
 6.5 inches long
 Has 2 flexible rings—inner and outer
 Inner ring stays inside of FC when used for vaginal sex
 Inner ring enables insertion into vagina and up to cervix
where it locks into place
 Outer ring at FC opening lays outside of vagina against
the vulva or outside of the anus
 Outer ring helps acts as guide for penetration, which
prevents bunching
The field of female condoms
 The Woman’s Condom
• Polyurethane with capsule
applicator
• Capsule dissolves upon insertion
• Foam shapes hold it in place
• Commercially available in China
The field of female condoms
 Cupid
• Latex
• Sponge assists with insertion
• Outer ring helps keep it in place
during sex
• Available EU, Brazil, Portugal, and
South Africa
• Pre-qualified by WHO
The field of female condoms
 Panty Condom
• Polyethylene sheath pre-lubricated w/ Vaseline
• Limited distribution in Colombia, under review for
WHO pre-qualification
 Phoenurse
• Polyurethane, silicone lubricated
• Insertion tool
• Limited availability in China & Brazil, under review
for WHO pre-qualification
Pop quiz!
 What FC is available in the U.S.?
 Are all FCs made out of the same material?
 Of what material is the FC2 made?
 What is the function and purpose of the inner ring?
 What is the outer ring’s function & purpose?
 Can you take inner ring out for vaginal sex?
Why promote female condoms
Women and men need options
Prevention and protection
Empowerment
Pleasure
Female condoms are for:
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Women
Men
Youth
Transgender people
Queer people
Straight people
Pregnant women
Pre or post-menopausal
People living with HIV
People who are HIV—
People who have had a hysterectomy
Why promote FCs—more options
 People need variety of tools for different
times and situations
 Non-hormonal contraception is limited
 No side effects
 Offer post-menopausal women solution
to vaginal dryness
 No biomedical combination
contraceptive and HIV prevention tool yet
exists
Why promote FCs—prevention & protection
 Only tool that offers women dual
protection against pregnancy, STIs, & HIV
 Comparable to male condoms in
reducing risk of STIs, pregnancy, HIV
 External genitalia coverage reduces
skin-to-skin STIs
 Hopkins economic analysis showed
DC’s FC program prevented 22 HIV
infections in first year, saving $8m in future medical costs
Why promote FCs—empowerment
 Receptive partners of all genders need array of
tools to take active role in their own health
 Women need tools to help control if/when they
have children
 Provides additional option when male condom
negotiation is not possible or safe
Why promote FCs—pleasure
 FC feels more “natural”, allows for
increased sensation and heat
 Receptive partners can take charge
of own health
 FC2’s rings double partners’ pleasure
 Enables spontaneity because FC isn’t
reliant on erect penis
 Don’t have to pull out right away
 FCs can be used in sexual play
Most importantly
 Protected sex acts INCREASE when FCs are offered
alongside male condoms
 Consistent condom users often switch between
methods when both male and female condoms are
available
Pop quiz!
 Why should providers talk with
their clients about pleasure?
 How can FCs enhance
intimacy?
 Are FCs comparable in
protection to male condoms?
Giving people the right tools
 Essential to provide education
along with FCs to ensure client
comfort and confidence
 Study showed intensive training
increased FC use and decreased
unprotected sex overall by 10-25% among U.S. women
 NYS study found that intent to use FCs among clients was
significantly associated with provide FC knowledge, FC
attitudes, and self-efficacy for FC promotion
The power of the provider
 Health care providers are trusted info sources
 People who learn about FCs from providers or clinics are
more likely to use them
 Provider perspective translates to client
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Critical provider feels comfortable & confident with FC
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Negative provider bias=reduced client intent to use
Critical components of FC education
 Use positive and affirming language to
introduce FCs
 Highlight pleasurable aspects
 Help clients/patients become familiar
with FCs
• Take the FC out of the package
• Explain FC construction and purpose
• Inform them that practice makes perfect
Critical components of FC education
 Talk through vaginal & rectal anatomy, using model or pictures
 Demonstrate insertion
 Have client demonstrate back to:
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Make sure comfort with insertion
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Correct mistakes
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Create space for questions
 Compare to learning something new--tampons, contacts, etc.
External female anatomy
 Mons pubis
 Pubic bone
 Clitoris
 Urethra
 Vaginal opening
 Labias (Lips)
 Anus
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Internal female anatomy
 Ovaries
 Fallopian tubes
 Uterus
 Cervix
 Vaginal canal
Penis anatomy
Anal anatomy
 Anus
 Rectum
Male
Female
Use FCs to…
 Alternate who wears the condom
 Enhance intimacy by having
partner stay inside after climax
 Have safe sex even when a
partner refuses to wear a
condom
 Keep the spontaneity going
 Take care of self and partner
When not to use female condoms
 When using a NuvaRing
 When using a diaphragm
 When using male condom
 With a pessary – a device to
hold a pro-lapsed uterus’s in
place
 If it feels uncomfortable or hurts
Female condoms for vaginal sex
 MUST keep inner ring inside
for vaginal sex
 Enables FC to stay in place
by locking behind pubic
bone
 DO NOT remove inner ring
when using FC for vaginal sex
 Can be inserted prior to sex
A note about FCs and anal sex
 Anal sex, it’s not just for gay men!
 Women have anal sex, it’s usually unprotected
 FCs can open important dialogue on anal sex
 FC2 is NOT FDA approved for anal sex (neither are MCs)
 Inconclusive safety and NO efficacy data on FCs for
anal sex
 Campaign promotes FCs for anal sex as risk reduction
strategy
How to insert FCs for vaginal sex
1. Squeeze inner ring between
thumb and middle finger.
2. Insert inner ring into vagina
and use index finger to guide
inside.
3. Put finger inside FC and gently
push into vaginal canal. Inner
ring will fit behind the pubic
bone, over the cervix.
How to insert FCs for anal sex
 FCs for anal sex is a risk reduction strategy
 Insert at time of sex act
 Options for use:
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Insert FC into anus like similar to vaginal use
Remove inner ring, place FC on penis or dildo
 Use lots of lube and enter the anus slowly
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After FC insertion
 Make sure FC is not twisted
 FC should be smooth against walls of vagina or anus
 Outer ring must be outside vagina or anus, covering
external genitalia/anus
 Add lube for increased pleasure and easy movement
 Hold FC in place; guide penis into FC so as not to push FC
to the side
 If FC gets twisted, comes out, or bunches, use a new one!
A note about lube
 FC2s pre-lubricated w/ silicone-based lubricant
 Nitrile, like polyurethane, tolerates oil-based
lubricant
 Important to be careful about messaging to
ensure client doesn’t think oil-based lube can
be used with all condoms
 Oil-based lube DESTROYS latex condoms
 If clients prefer oil-based lube, FC2s may be a
good option for them
When finished
 To remove FC, twist outer ring to
keep the semen inside
 Gently pull FC out, and throw
away
 Use a new FC with every sex act
 NEVER use a male condom and
a FC at the same time
Troubleshooting with the FC
What should you do if the FC is pushed inside the
vagina?
What should you do if the FC sticks to the penis?
What should you do if the penis slips between the FC
and the vaginal wall?
Down and dirty of FCs
 FCs reduce risk of HIV, STIs, and unintended pregnancy.
 Just one gets it done. Never use FC & MC at same time.
 Inner ring must remain inside for vaginal use.
 FC must be inserted for anal sex at point of the sex act.
 Outer ring lies over lips of the vagina or anal opening.
 Put lube inside FC to increase pleasure and make sure FC
doesn’t stick to penis.
 FCs can increase pleasure for both partners.
 Practice makes perfect.
Make your FC pitch!
 Take 5 to 7 minutes to draft your
own pitch about female condoms
 Think about the main points that
MUST be made and what
information to include to increase
a person’s intent to use the female
condoms
 We will regroup to share pitches
Pop quiz!
 What are the essential components of FC education?
 How are female condoms used for vaginal sex?
 Can female condoms be used with male condoms?
 Can female condoms be used for anal sex?
 When must a person start with a new female condom?
 What about lube is important to talk about with
clients?
How to use model correctly
 Must be right side up
 Cover cut out with hand
 NO adjusting through cutout
 Use vaginal opening to insert FC
Full demonstration: vaginal and anal
 Let’s put it all together!
 Full Demonstration: Talk
your partner/group through
a FC demonstration for
vaginal and anal use from
expiration date to removal
as if they have never seen
one before.
Demonstration feedback
 How’d it go?
 How was it for you to practice inserting
the FC?
 What challenges did you encounter?
 What additional information do you
need to coach a client to correctly
insert the FC?
 What additional resources might you
need?
Role plays
 Role plays: We’ll read
through sample scenarios
provide suggestions for
what a provider
should/could say to the
clients.
Where to get FCs
 FHC FC2 finder
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Text“findFC2” to 877877
 Individuals can buy FCs at select Walgreens
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Visit www.Walgreens.com stores near that stock them
Order them online
 Agencies, clinics, Chicago businesses, & others who
participate in the Chicago Community Condom Project
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www.cityofchicago.org/city/en/depts/cdph/provdrs/sti_hiv_aid
s/svcs/get_free_condomsatoneofourstispecialtyclinics.html
Insurance coverage of FCs
 Private health insurance and Illinois
Medicaid cover female condoms
 HOWEVER, commercial availability is
woefully limited
 Select Walgreens stores stock FC2s
 Does your organization have a clinic or
pharmacy?
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If so, does it stock FC2s?
Getting FCs for your community
 IDPH-go through lead agent
 Chicago Community Condom Project
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Run by CDPH
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Access MCs and FCs for free!
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Contact Marguerite Harrold at
marguerite.harrold@cityofchicago.org
to learn how your organization can
participate!
Chicago Female Condom Campaign
 Mission: Increase awareness, access, and use of FCs
 Broad-based coalition including HIV, reproductive health
and justice, harm reduction, domestic violence, LGBT,
women’s health, youth, and others!
 Achieve mission through provider trainings, resources,
media, & advocacy
 Trained 400 providers on effective FC promotion
 Part of a national movement
The FC movement is growing
 Chicago is one of 7 cities with an FC program and is
leading advocacy and education efforts
• Atlanta
• Houston
• Los Angeles
• New York
• San Francisco
• Washington, DC
Chicago Female Condom Campaign
 Available resources:
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Trainers
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Brochures
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Palmcards
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Tips for providers
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PowerPoint
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RingOnIt.org
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Facebook & Twitter
When you return to your agency
 Assess how your agency makes FCs available
 See how visible FCs are
 Ask your colleagues how they talk about FCs
 Determine if staff near the FC bin know FC basics
 Pair information gathered with what you learned
today to create a pro-FC culture at your agency
Create pro-FC culture at your agency/clinic
 Make FCs visible
 Include FCs in prevention conversations
 Make FC materials available
 Share what you learned with colleagues;
 Encourage participation in FC trainings
 Global Female Condom Day!
 What will you do with what you learned
today?
Next steps
 What next step do you commit to taking when
YOU return to your agency?
 How will you share what you learned today?
 Complete training evaluation
 Pick up materials
 Endorse the campaign!
 Be a part of Global Female Condom Day!
Post-test
 Let’s see what you learned today!
 Write your same number at the top of the test.
Post-test
1. The female condom is a barrier method that reduces a person’s risk
of unplanned pregnancy and sexually transmitted infections (STIs),
including HIV.
 TRUE
2. The FC2 female condom is latex-free and pre-lubricated with a
silicone-based lubricant.
 TRUE
3. The female condom can be used together with the male condom.
 FALSE
Post-test
4. The FC2 female condom can be used safely for vaginal sex
without the inner ring.
 FALSE
5. The female condom is Food and Drug Administration (FDA)
for both vaginal and anal sex.
 FALSE
6. The U.S. Food and Drug Administration (FDA) approved
using the FC2 female condom more than once.
 FALSE
Post-test
7. Understanding the female reproductive system and the location of
the cervix helps women properly insert a female condom.
 TRUE
8. The FC2 female condom is inserted properly into the vaginal
opening by squeezing the inner ring with your thumb and middle
finger or twisting he outer ring into a figure 8.
 TRUE
9. The FC2 is currently the only female condom available in the U.S.
 TRUE
What do you think
of FCs now?
Thank you!
Jessica Terlikowski
AIDS Foundation of Chicago
jterlikowski@aidschicago.org
Sara Semelka
AIDS Foundation of Chicago
ssemelka@aidschicago.org