Which types of condoms are best for preventing pregnancy?
Condoms are public health's first line of defence when it comes to protecting us from STIs - so much so that putting a condom on a banana is the defining image of many people's sex education. But there are more options than you might realise.
Internal condoms never really took off after their introduction in 1992. They instead became a bit of a divisive product - most people who've tried them either love or hate them. Lots of people don't even know that they exist. So we're taking a dive into the benefits and drawbacks to help you decide if an internal condom is right for you.
What is an internal condom?
What we typically recognise as a condom - when rolled up resembling a small rubber hat - is actually the 'male' or 'external' condom, worn on the penis. The 'female' condom, or 'Femidom', now known as the internal condom, is a barrier method which is inserted into the vagina or anus, to protect against pregnancy and STIs. It is a soft, pouch with a ring on each end: one to keep the condom in place internally, and one which hangs outside of the body.
The internal condom is the only barrier method for penetrative sex which is controlled by the person receiving. Unlike the traditional condom, the internal condom doesn't rely on the person with a penis or sex toy putting it on and knowing how to do so correctly.
Internal condoms can be used vaginally or anally, although there is limited research on their effectiveness for anal sex. "Some men who have sex with men (MSM) use internal condoms in their rectum - they usually take the top ring out - which is why they are now called internal condoms rather than Femidoms," says Jackie Redding, Head of Operations at young people's sexual health charity, Brook.
"They will protect both the insertive and receptive partner but if the receptive partner has more than one partner without changing the condom, they will only protect the receptive partner," she explains.
Once an internal condom has been used, it doesn't have to be taken out immediately, unlike an external condom. When it's removed from the vagina or anus, the end should be twisted to contain any ejaculate, and the condom should be disposed of.
Internal condoms can be inserted up to eight hours before sex, so putting one in isn't going to kill the mood or disrupt an erection - no worries about fumbling around for a condom in the heat of the moment!
This is also one of its drawbacks. Some users recommend that the internal condom should be inserted at least twenty minutes before sex to be effective and comfortable as it helps the condom to adhere to the walls of the vagina or anus. This means you have to be able to somewhat anticipate that you will be having sex. Unlike the male condom, the internal condom doesn't require an erection to be used.
Internal condoms are made from a different material to external condoms, says Dr Eleanor Draeger, a specialist in Genitourinary Medicine and spokesperson for BASHH. "Internal condoms are normally made of polyurethane or nitrile, rather than latex, which is what most external condoms are made from, so they are suitable for people with a latex allergy. This also means that they can be used with all types of lubricant."
Some people find that the internal condom can actually increase sexual pleasure, explains Draeger. "The external ring sits near the clitoris, so that some people find it adds extra stimulation during sex and can enhance the experience."
Other users of the internal condom enjoy being able to take their sexual health into their own hands and feel more at ease knowing that they are protecting themselves from pregnancy and STIs. For people with penises who don't like traditional condoms because they feel tight, the internal condom may be the solution as they fit more loosely.
Whilst some people really love internal condoms, others really don't. They can take a bit of getting used to and often require practice to be able to insert quickly and correctly. Some people don't like the process of putting them in, or the sensation during sex. Additionally, as the outer ring hangs out of the vagina or anus during sex, some people find the appearance of an internal condom off-putting.
Some people who use internal condoms complain about a noisy 'rustling' sound during sex. This was far worse in earlier versions of the internal condom. Inserting the condom twenty minutes before sex and using extra lubricant can help to reduce noise.
Whilst they are a reliable form of contraception and protection against STIs, internal condoms are slightly less effective than external condoms, says Draeger. "If used correctly, 5 out of 100 women who use female condoms will get pregnant in one year, as opposed to 2 out of 100 women who use male condoms. If they are not used correctly, however, 21 out of 100 women will get pregnant in one year."
It's worth considering using another form of contraception as well as using a condom if you are concerned about pregnancy. You and your partner can't use both an internal and external condom at the same time as this increases the likelihood that the condom will break or be damaged.
Where can you get internal condoms?
Chances are, you might not have seen an internal condom in real life because they are nowhere near as accessible as external condoms. This can make them less convenient because you probably can't just pop to the shops to buy a pack. They can also be more expensive because there is less demand.
"Because we don't get asked for them very often, some places may have stopped stocking them as they have a 'use by' date and often they go out of date before they are given out. People can still buy them or get them free from sexual health providers and some GPs," says Redding.
Many sexual health centres, including Brook, have internal condoms available, although they might not always be included in free condom distribution schemes. Internal condoms can be more difficult to find in shops and pharmacies than traditional condoms but there are lots of online retailers and sexual health services which can offer them cheaply or in bulk if you decide that you want to give them a go.