Problems With Use

May or may not be due to the method.

• Problems with condoms affect clients’ satisfaction and use of the method. They deserve the provider’s attention. If the client reports any problems, listen to her concerns and give advice and support. Make sure she understands the advice and agrees.
• Offer to help the client choose another method—now, if she wishes, or if problems cannot be overcome—unless condoms are needed for protection from STIs, including HIV.

Difficulty inserting the female condom

• Ask the client how she inserts a female condom. If a model is available, ask her to demonstrate and let her practice with the model. If not, ask her to demonstrate using her hands. Correct any errors.

Inner ring uncomfortable or painful

• Suggest that she reinsert or reposition the condom so that the inner ring is tucked back behind the pubic bone and out of the way.

Condom squeaks or makes noise during sex

• Suggest adding more lubricant to the inside of the condom or onto the penis.

Condom slips, is not used, or is used incorrectly

• ECPs can help prevent pregnancy (see Chapter 3).

• Refer for possible post-exposure prophylaxis against HIV and possible presumptive treatment against other STIs (see Chapter 14 – Male Condoms, Question 7). If the client has signs or symptoms of STIs after having unprotected sex, assess or refer.
• If a client reports slips, she may be inserting the female condom incorrectly. Ask her to show how she is inserting the condom, using a model or demonstrating with her hands. Correct any errors.

Difficulty persuading partner to use condoms or not able to use a condom every time

• Discuss ways to talk with her partner about the importance of condom use for protection from pregnancy and STIs. (See Chapter 14 – Male Condoms, "Difficulty persuading partner to use condoms or not able to use a condom every time".)

Mild irritation in or around the vagina or penis (itching, redness, or rash)

• Usually goes away on its own without treatment.
• Suggest adding lubricant to the inside of the condom or onto the penis to reduce rubbing that may cause irritation.
• If symptoms persist, assess and treat for possible vaginal infection or STI, as appropriate.
  
  • If there is no infection, help the client choose another method unless the client is at risk for STIs, including HIV.
  • For clients at risk of STIs, including HIV, suggest using male condoms. If using male condoms is not possible, urge continued use of female condoms despite discomfort.
  • If neither partner has an infection, a mutually faithful sexual relationship provides STI protection without requiring condom use but does not protect against pregnancy.

Suspected pregnancy

• Assess for pregnancy.
• A woman can safely use female condoms during pregnancy for continued STI protection.

New Problems That May Require Switching Methods

Severe allergic reaction to condom (hives or rash over much of body, dizziness, difficulty breathing, or loss of consciousness during or after condom use). See Appendix B – Signs and Symptoms of Serious Health Conditions.

• Tell the client to stop using latex condoms. Non-latex female condoms may be available.
• Refer for care, if necessary. Severe allergic reaction to latex could lead to life-threatening anaphylactic shock. Help the client choose another method.
• If the client or partner cannot avoid risk of STIs, suggest they use non-latex female condoms or plastic male condoms, if available. If neither partner has an infection, a mutually faithful sexual relationship provides STI protection without requiring condom use but does not protect against pregnancy.