Male condoms are more likely to break during anal sex than vaginal sex, so some health clinics and workers have been promoting female condoms as an alternative. A handful of studies have found that 35–48 per cent of gay men surveyed in the USA have heard of using female condoms for anal sex and about 13–21 per cent say they’ve actually done so.
The hitch is that female condoms have only been approved for vaginal sex and there isn’t yet convincing evidence supporting their use during anal sex. “Our group did a review of the studies around anal sex and found that there really just weren’t enough solid studies to say whether it was safe or effective,” says Susie Hoffman, an associate professor of epidemiology at Columbia University in New York.
Certain design elements may, in fact, make female condoms inappropriate for anal sex. As a team of researchers wrote in a 2009 review, “The female condom has features specifically designed for insertion into the vagina, most notably a flexible inner ring secured by the cervix. When used in the anus, the female condom may not be easy to insert, comfortable, or even safe.” (Indeed, a small study of gay men conducted in 2003 suggests there may be reason for concern; female condoms slipped more during anal sex than male condoms and men using female condoms were more likely to experience pain, discomfort and rectal bleeding.)
Still, some female-condom advocates recommend the female condom for anal sex because they believe it’s preferable to using no protection at all. “The Chicago Female Condom Campaign does promote it as a risk reduction strategy,” says Jessica Terlikowski, the director of prevention technology education at the AIDS Foundation of Chicago, which is the coordinating partner of the campaign. “We’re very clear about what information does and does not exist,” she says.
While some state health departments agree with Terlikowski and recommend the female condom for anal sex, others specifically caution against it. Among the health departments that endorse the use of the female condom for anal sex, there is disagreement about whether users should remove the inner ring before inserting the device.
These mixed messages highlight the need for more research specifically into how the female condom performs during anal sex, as well as better options for couples, gay and straight, that want to engage in it. The anal condom may be the next frontier – Origami Condoms currently has one in development. If approved, it would become the first method of barrier protection designed explicitly for use during anal sex. “We’re all really excited to see that come out,” Terlikowski says.