Advocating for Safer Anal Sex: Finding Empowerment and Equality in the Female Condom

By Emily Snoek, NCSD 

Before I started working in the sexual health field, I was your average 20-something “young professional.” With the recently graduated glow of having finished what had been the most grueling and enjoyable four years of my life (up until that point), I moved to Washington, D.C. and stepped right into the field of STD prevention.

I thought I knew a lot then. I considered myself a well-educated sex-positive individual. Discussing female orgasm and personal contraceptive choices with strangers did not faze me, and I was the person that friends sought out with supposedly awkward questions about sexuality, gender, and sexual health. This is not, however, how most people in this field are welcomed into sexual health and STD prevention.

When I came on board at the National Coalition of STD Directors (NCSD), I saw these issues from an advocacy viewpoint, not a public health one. But NCSD has introduced me to sexuality as a matter of public health, and I now see this issue through both these lenses. My interest in sexuality from an advocate’s standpoint and NCSD’s mission of advancing sexual health through STD prevention combine in the use of public health for the empowerment of women and the advancement of LGBT equality—something I find embodied in the concept of using female condoms during anal sex. Confused? Let me explain…

1. Female condoms (FCs) are a symbol of empowerment for receptive partners across the globe.

The female condom is an effective method of reducing risk for STDs, HIV, and unplanned pregnancy. Not only that, the female condom represents a way for women and men to take control of their sexual health. As a barrier method that is inserted into the vagina or anus, FCs can be controlled by receptive partners and not worn by an insertive partner like the male latex condom. This is unlike any other method. There is a lot of power in being able to control your sexual health and female condoms represent that empowerment. FCs increase the sexual confidence and autonomy receptive partners feel, in addition to helping them negotiate protection and promote healthy behaviors. FCs are the only receptive partner-controlled contraceptive method that also  offers protection against STDs, including HIV. Female condoms thus advance a feminist agenda, and offer more options for men and women engaging in anal sex, a practice commonly associated with the gay community—quite fulfilling for the advocate in me.

2. Female condoms make anal sex safer.

Anal sex is taking place regularly in both heterosexual and homosexual relationships, yet it somehow remains a taboo associated with the HIV epidemic and the danger of “gay sex.” Over one third of men and women have engaged in anal sex with a member of the opposite sex, and there are studies to suggest that these are not just one time experimental encounters. What does this mean in public health? In heterosexual relationships where unplanned pregnancy may be the greatest fear during sexual encounters, anal sex may feel like an escape from all risk. For men who have sex with men (MSM) where HIV has always loomed overhead, the growing acceptance and use of PrEP may mitigate some of the fear associated with these sexual relationships. The truth is however, that anal sex transmits STDs and HIV more easily than either vaginal or oral sex. I don’t want to make anal sex out to be a villain of course, but in terms of public health there needs to be more protected anal intercourse happening. Aside from increasing male latex condom use, female condom uptake is another important and complimentary tact.

Neither male nor female condoms are FDA-approved for anal sex. The public health community has treated male condoms as effective for anal intercourse for years. Some attribute this to the fact that the penis, covered by the male condom, is the same sexual anatomy during anal and vaginal intercourse, so more efficacy testing is considered unnecessary. Female condoms are not treated in the same manner but there is no reason to believe the female condom does not reduce risk for those using them for anal intercourse.

Female condoms fill a much-needed void of prevention tools for use during anal sex—what a win for public health and receptive partners everywhere! We can improve health outcomes by ensuring more individuals know what female condoms are, know how to use them for vaginal and/or anal sex, and know where to obtain them. This not only improves health outcomes for sexually active individuals, a key indicator of success for public health work, but also connects back to my first point—that having knowledge and ownership over protection from STDs, HIV, and unplanned pregnancy is incredibly empowering.

3. The current lack of research, data, and excitement around female condoms for anal intercourse is indicative of institutionalized homophobia.

While many heterosexual couples have anal sex, anal intercourse is still stigmatized, poorly researched, and associated with the HIV epidemic and gay men. Laws criminalizing sodomy have deterred researchers from pursuing this topic and while these laws are no longer on the books, the pleasure, practice, and safety of anal sex are still incredibly under-researched and misunderstood. This is just one indicator of the lack of prioritization around LGBT health issues.

Working toward marriage equality, ending employment discrimination, and making adoption policies friendly toward same-sex families are some examples of what makes up the current backbone of the LGBT rights movement. As LGBT individuals are granted these rights, and this community celebrates successes, the movement will further diversify their work. We can already see this in the celebration of the defeat of DOMA, the Windsor case, and the repeal of DADT. But right now, in public health, we have the opportunity to advance both equality and sexual health. Promoting the use of female condoms for safer anal sex, encouraging research on prevention methods for anal use (like female condoms for STD and HIV prevention or rectal microbicides for HIV prevention), and prioritizing the needs of MSM in a culturally-competent and sex-positive way are three ways I think the sexual health community can do this.

So there you have it! Empowerment, safer sex, and working toward LGBT equality—these are the three ways I see female condoms and anal sex representing the combination of my own interest in the promotion of sexual health in a sex-positive, pro-women, and pro-LGBT way and my interest in sexuality from a public health perspective. Wherever your interests lie within these issues, we should all be working toward the normalization of female condoms as a risk reduction method for anal sex, and increasing the number of sexually active individuals who are able to use them, and use them correctly.

And to learn more about the best practices of a handful of health departments in establishing female condom campaigns and brainstorm ideas for your own project area, please see NCSD’s factsheet “Female Condoms: Health Department Success Stories.”

Happy STD Awareness Month! Visit @NCSDdc and www.nationalfccoalition.org for more information.