A scoping review to examine the function, safety, effectiveness, efficacy and acceptability of the female condom used during anal sex

Abstract

IntroductionLimited guidance exists when female condoms are used for anal sex. We evaluated the available evidence regarding the effectiveness, efficacy, function, safety, and acceptability of the female condom for use during anal sex.MethodsWe conducted a scoping review with narrative analysis. We searched PubMed, Ovid (EMBASE, PsycINFO, Global Health, Ovid Medline), Web of Science, Google Scholar, ProQuest, HMSS database, Elsevier/Science Direct, Cochrane, EBSCO Host, and JSTOR. Eligible studies were included if they reported on the use of the female condom during anal sex. There was no restriction on the type of studies.ResultsTwelve studies were identified: seven cross-sectional surveys, three randomised cross-over trials, and two qualitative studies. Function outcomes mainly included slippage and breakage and aside from one study were reported per participant and not by numbers of condoms used. Definitions of female condom failures varied across studies. Slippage was reported by 14.5%-52.5% of users, while breakage reports were under 5.0%. Acceptability outcomes included likeability, pleasure, usage ease, design issues, discomfort, and sensitivity. Participants found usage challenging in general especially difficulties in insertion and placement of the inner ring. Reporting of pleasure was mixed with differing opinions by insertive and receptive partners. Five studies included safety outcomes which included pain, bleeding, discomfort, and irritation. More than half of participants reported at least one safety outcome. No studies reported on female condom effectiveness or efficacy in prevention of STIs/HIV when used for anal sex. The assessment of the data quality overall was poor.ConclusionsDue to the data limitations, is not possible to determine any conclusive findings about the function, safety, acceptability or effectiveness/efficacy in STI/HIV prevention of the female condom use during anal sex. There is an urgent need for quality evidence to inform guidance on female condom use when used for anal sex.