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For female condom users, use of a new female condom for every act of
sexual intercourse continues to be recommended by the World Health
Organization (WHO).1 Likewise, the female condom (a potential
alternative for the male condom) is approved only for one-time use by
the U.S. Food and Drug Administration. Such positions by public health
experts reflect, in part, concerns that women may be unable to clean the
device adequately to make its reuse safe.
However, female condom reuse has been reported in a number of
settings, likely because many women cannot afford to buy multiple female
condoms. Recognition that reuse is occurring — and may be acceptable,
feasible, and safe in some circumstances — led WHO to declare in July
2002 that "the final decision on whether or not to support reuse of
the female condom must ultimately be taken locally."2
This declaration came six months after WHO released a female condom
cleaning and handling draft protocol based on two expert meetings to
discuss the reuse issue.3 The protocol, which outlines steps
for preparing female condoms for reuse, stated that a single female
condom may be used up to five times as long as it is:
- Disinfected by soaking it, as soon as possible after use, for one
minute in a 1-to-20 dilution of sodium hypochlorite (liquid
household bleach) in water; and
- Washed, dried, stored, and relubricated — following protocol
procedures — before being used again.
WHO recommends that, on the local level, program managers not
recommend female condom reuse until they have adapted the protocol
(retaining all the procedural steps) to local conditions and then tested
the protocol's feasibility, efficacy, and usefulness in their settings.4
WHO will provide guidance for program managers on programmatic
implications of reuse. This protocol only applies to the polyurethane
female condom manufactured by the Female Health Company. The product's
brand names include FC Female Condom, Reality, Femidom, Dominique, Femy,
Myfemy, Protectiv', and Care.
WHO does not yet promote female condom reuse, in part because the
female condom cleaning and handling protocol has not been extensively
studied for safety or evaluated for efficacy in humans. But, with
funding from WHO and the United Kingdom's Department for International
Development (DFID), the Reproductive Health Research Unit (RHRU) at the
University of Witwatersrand in South Africa is conducting research in
South Africa to explore the structural integrity of female condoms
disinfected, washed, and reused in accordance with the protocol, as well
as users' ability to follow the protocol correctly.
Meanwhile, female condom reuse issues have been explored in numerous
studies, many of which have been conducted by FHI and RHRU with funding
from the U.S. Agency for International Development (USAID). Research has
found that the female condom remains structurally sound after repeated
cycles of bleach disinfection and washing.5 A USAID-supported
study by FHI found that couples who disinfected, washed, dried,
relubricated, and reused the same female condom four times after first
use experienced no more adverse effects in the vagina, on the cervix, or
on the penis than did couples who used five female condoms one time
each.6 And a WHO-supported study of the effect of
disinfection on common STIs found that the female condom must be soaked
at least one minute in a 1-to-20 dilution of bleach in water to kill the
organisms that cause gonorrhea, chlamy-dial, herpes, and HIV infections.7
Since some women may not have access to bleach, research is under way to
assess the safety and feasibility of cleaning used devices with only
detergent and water. This USAID-supported study, to be conducted by FHI
and completed by July 2003, will test the effect of Sunlight- and Omo-brand
detergents on the organisms that cause gonorrhea, chlamydial, herpes,
and HIV infections.
"These products were chosen for their widespread
availability," says Carol Joanis, an FHI associate director and the
study's principal investigator. "Sunlight dishwashing liquid is
available worldwide, and Omo is available in most developing countries,
except for certain parts of Latin America and Asia. Notably, where Omo
is unavailable, Surf detergent — which is identical in formulation —
is commonly offered."
— Emily J. Smith
References
- World Health Organization. WHO information update: considerations
regarding reuse of the female condom. Unpublished paper. World
Health Organization, 2002. Available online.
- World Health Organization.
- World Health Organization. The safety and feasibility of female
condom reuse: report of a WHO consultation. Unpublished paper. World
Health Organization, 2002. Available online.
- World Health Organization. WHO information update: considerations
regarding reuse of the female condom.
- Potter B, Gerofi J, Pope M, et al. Structural integrity of the
polyurethane female condom after multiple cycles of disinfection,
washing, drying and relubrication. Contraception
2003;67(1):65-72; Joanis C, Latka M, Glover LH, et al. Structural
integrity of the female condom after a single use, washing, and
disinfection. Contraception 2000;62(2):63-72.
- Joanis C, Ballagh S. Female condom re-use: in vivo safety. WHO
consultation on re-use of the female condom. Geneva, Switzerland,
January 28, 2002; Ballagh S, Joanis C. Reuse of Reality female
condom: colposcopy and adverse events. WHO consultation on re-use of
the female condom. Geneva, Switzerland, January 28, 2002.
- Ballard R, Fehler G, Htun Y, et al. Re-use of the female condom
— effectiveness of disinfection procedures. WHO consultation on
re-use of the female condom. Geneva, Switzerland, January 28, 2002.
For more information, visit Family Health International's Website at www.fhi.org
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