Professional nurse Maya Gokul doesn’t go anywhere without a few female condoms in her handbag.

She’s taught health workers and community members about female condoms since 1998 when the Female Health Company first brought them to South Africa. 

Twenty-five years later South Africa’s programme is one of the biggest state-funded projects in the world. 

The multipurpose, non-latex sheaths, which have sparked a sexual pleasure revolution, have become an extension of Gokul’s personality. She says it doesn’t take much for her to launch into a quick tutorial, speaking on the phone from her home in Durban.

A reluctant customs official at Zambia’s international airport in Lusaka was one such surprise student. 

When Gokul explained that she was in Zambia to conduct a workshop about the female condom, the man asked: “What’s that?” That was all she needed. 

Whether it’s the hotel receptionist or the housekeeping staff in the corridor on the way to her room, no one is left uninformed when Maya is on the move. 

She gave him a handful of condoms, a brochure and an instruction to provide some of the condoms and booklets to his female immigration colleagues. “They should also know what this is all about,” she remembers telling him. 

A seatmate on an international flight once got a full demonstration. Gokul would have retrieved the “O-Cube” from her leather handbag. It’s a transparent box with a round opening on one side that’s a stand-in for the vaginal opening. 

This leads into a soft sheath that perfectly fits the vaginal canal. 

Whether it’s the hotel receptionist or the housekeeping staff in the corridor on the way to her room, no one is left uninformed when Maya is on the move. 

She explains: “It’s a calling. One of my life’s purposes.”

How a condom can spark intimacy

The female condom was designed as a way to give receptive partners more control over their sexual and reproductive health. 

It can be difficult for women to negotiate condom use with a male partner, especially if they depend on him for money.

But, women have told researchers that their partners are more likely to agree to a female condom than its male equivalent since they see it as “hers to use”. This is, of course, only true of relationships where the woman has the power to say no to sex in the first place. 

The sheath can be inserted a few minutes to a couple of hours before sex to eliminate the need for a conversation about STI protection and unplanned pregnancies. It works 95% of the time if used perfectly, but usually it’s 79% effective. 

The Female Health Company’s first iteration of the female condom, the FC1, were made of plastic, so they could be noisy during sex. 

The company’s improved condom, the FC2, which was launched in South Africa in 2008, is made from a thin type of rubber called “nitrile” that warms to body temperature and doesn’t contain natural latex (to which some people are allergic). It’s also cheaper than the original design and the same length as the male condom.

People love it. The strawberry-scented ones are always chosen first.

In the same year the FC2 was launched, a national HIV household survey showed that only 7% of people said they’d used a female condom. This is despite the fact that most of the people surveyed (more than 77%) said they’d heard of the device.

A handful of smaller studies published between 2013 and 2017 put female condom use between 2% and 38%. 

It’s not that people aren’t interested in using female condoms, according to 2020 research published in PLOS One. Other system-wide problems have to be smoothed out too, including poor planning by facilities (leading to stockouts) and overstretched staff (who don’t have time to explain to people how to use the female condom). 

Projects to increase demand for the condoms through advocacy, education drives and social media campaigns are also in desperate need of funding. 

Still, Gokul says people she comes across are far more open to it than they used to be. 

In smaller towns where clinics might not have condoms in stock, people often ask her for extras that they can take home. 

“People love it. The strawberry-scented ones are always chosen first.” 

The pleasure principle 

The FC2 internal condom’s true power is that it provides a wider area of protection in both partners and may boost their pleasure as well, Gokul says. 

When a man’s penis goes underneath the inner ring during sex, the ring brushes over the nerve endings at the tip of the penis. “The guys love it.”

There’s extra pleasure in the deal for women as well. The outer ring of the condom lies over the vulva and clitoris, and the slight movement over that area can be pleasurable too.

The best way to convince people to reach for a condom is to help them understand that it’s an expression of their love for themselves.

All in all, Gokul says, it’s far more inclusive than the traditional male condom (the idea for which, she’s quick to point out, has existed for more than 5,000 years).

Someone with erectile dysfunction or a latex allergy won’t be able to put on a male condom, but the FC2 gives them another option. 

“With the female condom, you can truly share responsibility, or be in total control of protecting oneself from pregnancy and STIs, including HIV.

How to change people’s minds 

When you spend a quarter of a century speaking to people about sex and pleasure, you learn to spot the signs of discomfort and embarrassment. 

Gokul says she’s careful to watch people’s body language to ensure everybody feels included in her longer training sessions, regardless of their faith or cultural background. 

She does this by using a strategy called “values clarification”. This helps people build a picture of what’s important to them when it comes to their sexual and reproductive health. 

It’s proven to make it easier for people to adopt positive behaviours and attitudes towards tricky things like safe sex, even if it takes them out of their comfort zones. 

Negotiating for female condom use is one example. 

She’ll start by asking the room whether they enjoyed sex the last time they had it. They’ll usually say yes among a few giggles. Then she asks: “And was the sex that you had free from worry.” 

This is usually met with grumbles.

“The best way to convince people to reach for a condom is to help them understand that it’s an expression of their love for themselves,” she explains. 

When the African Alliance spoke with Gokul, she was preparing to preach the FC2 gospel in Harare for the International Conference on Aids and STIs in Africa. 

She says her garage is stocked with enough books, female condoms and O-Cubes for a year’s worth of demonstrations across the continent. 

Her work for the Female Health Company has taken her to more than 30 countries on nearly every continent. “We haven’t missed any HIV conferences yet.” 

Such gatherings of researchers, health workers and activists are crucial, Gokul says, because it’s a way to keep conversations about the female condom going. 

Female condoms are a critical part of any HIV prevention programme, she says. 

Yes, there are now highly effective HIV prevention medicines that eliminate the risk of infection. And taking antivirals every day can cut the level of the virus in someone’s blood to the extent that they can no longer transmit it during sex (this phenomenon is called undetectable = untransmittable). 

But, Gokul says with her trademark passion and tenacious tone, the HIV world can’t afford to work with such prevention tools in isolation.

“We can have it all.” DM

The African Alliance is a client of the Female Health Company. The Alliance runs their booths at HIV conferences. There are now two other brands of female condoms available in South Africa too.

Additional reporting by Joan van Dyk 

Tian Johnson is the director of the advocacy non-profit African Alliance. Click here to sign up for their newsletter.