1. The Power of the Provider to Promote Female Condoms

2. 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

3. 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?

4. A word about language
People who are not female-identified may be turned off by the name “female condom”
Other names for FCs include…
Internal condom
Receptive partner condom
Bottom condom
Insertive condom
Manhole cover
Catcher’s mitt
What other terms have you heard?

5. 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!

6. 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

7. 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!

8. 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?

9. 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

10. 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.

11. About the FC2 FDA approved FC2 early 2009
What’s different between FC1 and FC2?
Non-allergenic for people with latex allergies
Softer
Seamless
Quieter
More affordable
Warms to body temperature

12. 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

13. 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

14. 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

15. 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

16. 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?

17. Why promote female condoms
Women and men need options
Prevention and protection
Empowerment
Pleasure

18. Female condoms are for:
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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Pop quiz! Why should providers talk with their clients about pleasure?
How can FCs enhance intimacy?
Are FCs comparable in protection to male condoms?

25. 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

26. 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
Critical provider feels comfortable & confident with FC
Negative provider bias=reduced client intent to use

27. 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

28. Critical components of FC education
Talk through vaginal & rectal anatomy, using model or pictures
Demonstrate insertion
Have client demonstrate back to:
Make sure comfort with insertion
Correct mistakes
Create space for questions
Compare to learning something new--tampons, contacts, etc.

29. External female anatomy
Mons pubis
Pubic bone
Clitoris
Urethra
Vaginal opening
Labias (Lips)
Anus

30. Internal female anatomy
Ovaries
Fallopian tubes
Uterus
Cervix
Vaginal canal

31. Penis anatomy

32. Anal anatomy
Anus
Rectum
Male
Female

33. 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

34. 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

35. 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

36. 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

37. How to insert FCs for vaginal sex
Squeeze inner ring between thumb and middle finger.
Insert inner ring into vagina and use index finger to guide inside.
Put finger inside FC and gently push into vaginal canal. Inner ring will fit behind the pubic bone, over the cervix.

38. 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:
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 1 2 3

39. 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!

40. 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

41. 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

42. 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?

43. 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.

44. 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

45. 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?

46. 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

47. 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.

48. 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?

49. Role plays
Role plays: We’ll read through sample scenarios provide suggestions for what a provider should/could say to the clients.

50. Where to get FCs FHC FC2 finder
Text“findFC2” to
Individuals can buy FCs at select Walgreens
Visit stores near that stock them
Order them online
Agencies, clinics, Chicago businesses, & others who participate in the Chicago Community Condom Project
s/svcs/get_free_condomsatoneofourstispecialtyclinics.html

51. 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?
If so, does it stock FC2s?

52. Getting FCs for your community
IDPH-go through lead agent
Chicago Community Condom Project
Run by CDPH
Access MCs and FCs for free!
Contact Marguerite Harrold at to learn how your organization can participate!

53. 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

54. 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

55. Chicago Female Condom Campaign
Available resources:
Trainers
Brochures
Palmcards
Tips for providers
PowerPoint
RingOnIt.org
Facebook & Twitter

56. 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

57. 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?

58. 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!

59. Post-test Let’s see what you learned today!
Write your same number at the top of the test.

60. Post-test
The female condom is a barrier method that reduces a person’s risk of unplanned pregnancy and sexually transmitted infections (STIs), including HIV.
TRUE
The FC2 female condom is latex-free and pre-lubricated with a silicone-based lubricant.
The female condom can be used together with the male condom.
FALSE

61. Post-test
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.
The U.S. Food and Drug Administration (FDA) approved using the FC2 female condom more than once.

62. 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.
9. The FC2 is currently the only female condom available in the U.S.

63. What do you think of FCs now?

64. Thank you! Jessica Terlikowski AIDS Foundation of Chicago Sara Semelka
Sara Semelka
AIDS Foundation of Chicago