Inconsistencies by the U.S. Departments of Health Websites Regarding Anal Use of the Female Condom

Background:  The female condom (FC) is FDA approved to prevent pregnancy and sexually transmitted infections during vaginal intercourse, but not for use during anal intercourse. A number of studies document that a significant proportion of men who have sex with men use the FC for anal intercourse, but its safety and disease prevention efficacy are unknown.

Methods:  Two people independently reviewed the Department of Health (DOH)websites for 50 U.S. states and 29 major cities (population >500,000) regarding messages about anal use of the FC.

Results: Only forty-nine (62.0%) websites mentioned the FC at all, of which only 23 (46.9%) mentioned anal use.  Of those that mention anal use, 15 (65.2%) websites were supportive of this use, 7 (30.4%) were neutral, and 1 (4.3%) discouraged use.  Ten websites (43.5%) provided instructions for anal use of the FC; in 7 cases, the instructions indicated removal of the inner ring while 3 cases recommended leaving in.  Four websites suggested that the FC could be used for anal intercourse either by inserting it into the anus prior to sex or by putting it over the penis as with a male condom.

Conclusions: In the U.S., the state and city DOH websites are an indispensible tool in providing delivery of public health information, in particular, sensitive information such as sexual health. The contradictory messages and divergent use instructions on DOH websites are concerning and highlight the need for research studies to definitively answer questions about safety and optimal methods of use.