Female condoms for anal sex

While female condoms (internal condoms) were originally designed for use in vaginal intercourse, some gay and heterosexual couples have used them for anal sex. There are no research studies on their efficacy in preventing the transmission of HIV and sexually transmitted infections during anal sex, but they form a barrier which should prevent semen and other bodily fluids from passing from one sexual partner to the other. Laboratory studies have demonstrated that the device is impermeable to HIV and other viruses. It is therefore reasonable to assume that using a female condom for anal intercourse will provide protection.

Whereas most male condoms are made from latex, female (internal) condoms are made from a synthetic rubber called nitrile. This means they are less likely to cause allergic reactions and can be used with oil-based lubricants.

In 2018, American regulatory authorities (the Food and Drug Administration) changed the female condom's name to “single-use internal condom” in order to reduce the perception that it is only intended and appropriate for use by women. The regulators now approve the device for both vaginal and anal sex. They define the internal condom as a “sheath-like device that lines the vaginal or anal wall and is inserted into the vagina or anus prior to the initiation of coitus”.

UK guidelines for safer sex advice, issued by the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA) state that female condoms can be used for anal sex.

Research published in 2003 assessed the safety and user experience of the female condom for anal sex among gay men. Participants reported on their experiences with both female and male condoms. When using female condoms, participants were more likely to report condom slippage during use or withdrawal. Rates of condom breakage were similar for female and male condoms. After using both sets of condoms, participants were generally more likely to use male than female condoms in future. Of those who would be willing to use the female condom with future partners, the stated reasons were that the female condom was more comfortable, easier to use, and perceived to be stronger and safer.

"UK guidelines for safer sex advice state that female condoms can be used for anal sex."

The researchers suggested that gay men who are considering using the female condom might require training so as to avoid slippage and semen spillage. They added that "further work is warranted on design modifications, safety and acceptability of the female condom in HIV-negative gay men". This remains the case today.

How to use internal condoms for anal sex

For the rest of this article, we will refer to the devices as ‘internal’ rather than ‘female’ condoms.

• The easiest way to use the internal condom for anal sex is to wear it like a 'male' condom. Put lubricant in the internal condom and then place it over the penis (or a dildo). Use plenty of lubricant on the outside of the internal condom or around the anus before having intercourse.
• However, an alternative method is to insert the internal condom in the rectum first, as for vaginal sex. If trying this, use plenty of lubricant around the anus, and loosen it with a finger in readiness for the internal condom. Make sure your fingernails are cut short.
• After removing the internal condom from its wrapper, hold the inner ring between your thumb, index and forefinger, and squeeze it so that it forms an oval. While some people remove the inner ring, this may be more likely to lead to breakage.
• Unless putting the internal condom on the penis, push it up into the rectum as far as you can. Use the inner ring as a guide, whilst spreading your anus with your other hand. Then put your index finger inside the internal condom, until you feel the bottom of the inner ring. Push up as far as you can, but do not insert the outer ring.
• You will find that the outer ring, and perhaps a small part of the internal condom, is on the outside of your anus. That's meant to happen and should stop the internal condom from slipping inside.
• Use more lubricant inside the internal condom, to keep it moist, and add it whenever you need it during sex.
• Check every now and again during intercourse that the outer ring of the internal condom hasn't slipped inside the anus, or that the penis hasn't slipped between the internal condom and the anus. If it has, stop, remove the internal condom, and use a new one before starting again.
• Don't re-use the internal condom. It is designed for single use – using it multiple times or with multiple partners is likely to put excess strain on the device.
• Finally, remove the internal condom. Because it lines the inside of the rectum, your partner doesn't have to withdraw immediately after coming. You can remove the sheath when it suits you, making sure that no semen is spilt. Twist the outer ring three times to keep the semen inside, then pull gently until is withdrawn. Throw it away after use rather than flushing down the toilet.