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Internal (Female) vs. External (Male) Condoms: Pros and Cons

  • The Pill Club
    Reviewed By: Shannon DeVita DNP, FNP-BC, CPNP-PC, Julie Lamonoff, CNM, OBGYN-NP
    Updated:

Maybe you've heard about the internal (female) condom, but you're wondering: How is it different from the male condom? Is it better than a male condom? How do I use it?

Let's take a look.

Short answer: How is the internal (female) condom different?

The FC2 is the first and only woman-controlled, single-use internal (female) condom that offers dual protection against unplanned pregnancy and the transmission of sexually transmitted infections (STIs). It's a non-hormonal barrier method of birth control, just like the male condom.

History lesson: Lasse Hessel invented the female condom in 1984. It hit the market in 1993 under the brand name Reality® when the Food and Drug Administration (FDA) approved it for general use.

So, which is it, "female condom" or "internal condom"? In 2018, The FDA officially reclassified the device from "single-use female condom" to "single-use internal condom."

The internal condom is inserted in a woman's vagina. It covers the cervix and forms a barrier between it and the penis to block sperm from entering the uterus.

Unlike the male condom:

  • The female condom can be inserted 2 to 20 minutes before sex.

  • It works for all penis sizes and doesn't require an erection for use.

  • It's safe for people with a latex allergy because it's made from nitrile and polyurethane.

  • You can use it with any water- or oil-based lube, unlike latex condoms which cannot be used with oil-based lubes.

  • It's pre-lubricated with a silicone-based non-spermicidal lubricant on the inside and outside.

  • The internal condom has up to a 5-year shelf life.

If you are not going to use the male condom, you can use the internal condom and other forms of hormonal birth control (like birth control pills or IUDs) for additional protection against STIs.

How effective is an internal condom vs. a male condom?

Experts describe typical use as usage which is not consistent or always correct and perfect use as consistent and correct usage.

Natural rubber latex male condoms are highly effective in preventing STIs, including HIV, if used correctly. Although there haven't been any efficacy studies of the FC2 Female Condom, the Centers for Disease Control and Prevention (CDC) estimates that if in a year 100 women use the internal condom correctly (perfect use), only 5 may get pregnant.

If 100 women use it imperfectly (typical use), it is estimated that it may fail for 21 women. The failure rates are slightly lower than those for male condoms—2% for perfect use and 13% for typical use.

This table compares the failure rates of internal and male condoms:

Usage Internal condom (failure %) Male condom (failure %)
Perfect use 5% 2%
Typical use 21% 13%

Although the internal condom is not as widely known or used as the male condom, women agree that female (internal) condoms are empowering because they put the woman in charge.

The internal condom may not work if:

  • It's torn.

  • It's expired.

  • The thin outer ring gets pushed inside the vagina.

  • Your partner uses an external condom with it.

  • During sex, the penis slips between it and the vagina.

  • It slips out during sex.

  • You wear it incorrectly.

What are the differences between internal and male condoms?

Although the internal and male condoms both offer protection against unplanned pregnancies and STIs, they're very different contraceptive devices.

Here's a round-up of their differences:

Material

The FC2 Internal Condom has a non-latex (nitrile) sheath and outer ring and a soft-plastic (polyurethane) inner ring, stronger than latex and hypoallergenic. The male condom is a thin sheath made out of latex, lambskin, or soft plastic (polyurethane). Most are made of latex, which can cause an allergic reaction to certain individuals.

Failure rate

Internal condoms have a 5% failure rate with perfect use and 21% for typical use. Male condoms have a 2% failure rate with perfect use and 13% for typical use.

Availability

The FC2 Female Condom® is the only FDA-approved brand of internal condoms available in the United States. You can get it for $0 out-of-pocket cost (if your health insurance covers it) with a prescription through an authorized telemedicine provider or other in-office healthcare provider.

It's an over-the-counter product, though, and while certain restrictions may apply, the uninsured or underinsured may get it without a prescription and pay out-of-pocket through the FC2 website. You may also be able to get it for free from a non-profit or through community distribution.

In contrast, you can buy male condoms without a prescription. They are widely available in pharmacies, drug stores, health centers, sexual health clinics, convenience stores, and supermarkets.

Appearance

The internal condom is similar in length to the male condom but is wider because it was created to line the vagina, not the penis. It looks like a lubricated pocket with flexible rings at both ends.

The large ring at the open end holds part of the condom outside the vagina, and the ring at the closed end keeps it in place inside the vagina. The male condom looks like a small rim that unrolls to a thin pouch on the penis.

Cost

When covered by insurance for $0 out-of-pocket cost, the internal condom is cost effective. The male condom is available under different brands and costs around $1 each.

Usage

The internal condom was designed for single use, and the manufacturer of FC2 says most women insert it between 2 to 20 minutes before sex. You can also add any type of lubricant to it since it's latex-free.

You can only wear a male condom on an erect penis, and your partner has to remove it immediately after ejaculation. It works well with spermicide, but you can only use water-based and silicone-based lubricants with it.

Durability

The internal condom provides a shelf-life of five years and should be stored at normal room temperature. The male condom, on the other hand, should be kept in a cool and dry place and has a shelf life of three to five years.

Pleasure

The nitrile sheath of the internal condom lines the walls of the vagina (versus external condoms wrapping an erect penis), warming to the body temperature. This may make sex feel more natural and pleasurable for both partners.

However, the internal condom may feel uncomfortable for some, particularly if it is not correctly in place. For some male condom users, the friction of the condom may affect sexual enjoyment and sex could be less pleasurable because the man must pull out right after ejaculation.

Participants of a 2013 survey of college women described the internal condom as "pleasurable to both," "nonrestrictive," and "tailored to women's bodies." All of these characteristics may make the sexual experience more enjoyable.

Is the internal (female) condom a good choice?

To give you a more objective view of what makes the internal condom a worthy contraceptive choice, let's walk through its pros and cons.

Some of the pros of using an internal condom (in contrast to the external male condom) are:

  • You can insert it before sex.

  • Usage doesn't require an erection.

  • It's latex-free and therefore suitable for those with latex allergies.

  • It's the only woman-controlled method that provides dual protection against unplanned pregnancies and the transmission of STIs, including HIV.

  • It empowers women to be proactive about their sexual and reproductive health.

According to an article in the journal AIDS Patient Care and STDs, women-initiated prevention options "enhance women's power to further reduce their risk of infection or transmission." It can also increase protected sex among partners. Studies have shown that promoting and educating internal condom use can increase safe sex.

"The internal condom 'empowers diverse populations of women, helping them negotiate protection with their partners, promoting healthy behaviors, and increasing self-efficacy and sexual confidence and autonomy.'"

Here are some of the cons of using an internal condom:

  • It needs a bit more practice to prevent mistakes while inserting and using.

  • It's less widely available and more costly compared to a male condom. Some research suggests some HIV prevention or birth planning and reproductive health service providers aren't aware of the internal condom.

  • May cause discomfort during insertion or sex, or pain or discomfort after insertion.

  • It has a higher failure rate compared to the male condom.

The National Institutes of Health says the internal condom is 75% to 82% effective with normal use and 95% effective when used correctly, which is similar to the product label. The male condom, on the other hand, has a lower failure rate of 13% with regular use, according to the CDC. See the full labeling for the FC2, including information on safety and effectiveness and how to use the FC2 here.

At the end of the day, whichever barrier contraceptive device you choose is valid. One is not necessarily better than the other.

How to use an internal condom

Using an internal condom gets easier with practice or experience. Here are some things to note:

You cannot reuse the female condom because it's designed for single use. You also cannot use the male condom and the internal condom at the same time because doing so can cause tearing.

You can add additional lube to prevent it from tearing and slipping and make it more enjoyable to use.

  1. Open the package. Always check the condom package for the expiration date. Try not to use sharp objects like your fingernail or scissors to open the package since you might accidentally tear the condom.

  2. Squeeze the inner ring to make it narrow, and carefully insert it in your vagina the same way you would a tampon. Do not twist the inner ring. Use your finger to push the thick inner ring up until it touches your cervix, but make sure the thin outer ring rests outside the vagina. Be sure the inner ring is up just past your pubic bone.

Use your hand to guide the penis into the vagina until you and your partner become comfortable using the internal condom. Stop sexual activity immediately if you notice the penis falling between the condom and the vagina or if the thin outer ring gets pushed inside the vagina opening.

  1. To remove it after use, twist the outer ring and gently pull it out. Dispose of it immediately.

Takeaways: Internal condom vs. male condom

The internal condom is a hormone-free birth control device that gives women control of their sexual and reproductive health and works well when used correctly and consistently. Using it correctly gets easier with practice, but you can use a hormonal method of birth control like the pill for added protection.

Sources:

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