The female condom flopped when it was launched some 20 years ago, but it never disappeared entirely and now a number of companies are entering the fray with new products. Could its time have come?
Its formal name was the FC1, though many of us knew it as the Femidom, or Reality, and jokers called it all sorts of names - plastic bag, windsock, hot air balloon...
Two decades on, Mary Ann Leeper has yet to see the funny side of such quips. "I so believed in that product," she says. "I so believed that women would want to be able to take care of themselves. We were naive, or I certainly was naive."
Leeper was the president of Chartex, the company that made the FC1. Before the launch, there was an atmosphere of curiosity and anticipation, but those involved underestimated just how unfamiliar the large, slippery device would look and feel to customers in Europe and the US.
Leeper traces the backlash to a single negative article in an influential US women's glossy magazine.
"That story was the pivotal story that became like a domino effect," she says. "It was a shock to me, to tell you the truth. Why would you make fun of a product that was going to help young women stay healthy, that was going to protect them from sexually transmitted infections as well as unintended pregnancy?"
To be fair, the FC1 had something of a design flaw. Made of polyurethane, it was a bit noisy during sex, and it was inevitable that comic stories of rustling under the bedclothes would be told and re-told.
In the early years, Chartex's successor, the Female Health Company, considered folding, but instead it set about developing an education programme. Then one day in 1995, Leeper received a telephone call from a woman called Daisy, responsible for Zimbabwe's HIV and Aids programme.
"She said, 'I have a petition here on my desk signed by 30,000 women demanding that we bring in the female condom,'" recalls Leeper.
It was the start of a set of partnerships that took the female condom to women in large parts of the developing world.
The FC1's successor, the FC2 - made of non-rustling synthetic latex - is far more successful than many in the West realise. It is available in 138 countries, sales have more than doubled since 2007, and the Female Health Company has been turning a profit for eight years.
The vast majority of sales are to four customers - the US aid agency (USAID), the UN and the ministries of health in Brazil and South Africa. Donors and public health officials are keen on anything that gives women the upper hand in what they call "condom negotiation" with men.
Female condoms have other advantages too. They can be inserted hours before sex, meaning that there is no distraction at the crucial moment, and they don't need to be removed immediately afterwards. For women, there is better protection from sexually transmitted infections, since the vulva is partially covered by an outer ring that keeps the device in place.
User feedback is also pretty good.
A 2011 survey found that 86% of women were interested in using the method again and 95% would recommend trying them to friends.
"Many people report that female condoms heighten sexual pleasure," says Saskia Husken from the Universal Access to Female Condom Joint Program (UAFC). For men, they are less tight than male condoms. For women, the large ring of the condom - which remains outside the vagina - can also be stimulating.
In Africa, the free availability of female condoms at clinics has led to an unexpected fashion trend. Women have taken to removing the flexible ring from the device and using it as a bangle. "If you are [romantically] available you have a new bangle on," says Marion Stevens from the female health campaigning body Wish Associates. "If you are in a long-term relationship your bangle is old and faded."
Meyiwa Ede, from the Society of Family Health in Nigeria, says that while men are often excited by the prospect of sex without having to wear a regular condom, women are taken aback by their first glimpse of the device.
"They look at it and say 'OK - are you saying I have to put that in myself?'" she says.
Ede's team of demonstrators use a mannequin to show the condom is inserted and compare the task to using a new phone - bewildering at first, but second nature after a while.
In most developed countries there is still that 20-year-old image problem to overcome.
"I think the issue is when you open the package they're already open - they're not like male condoms that are in these neat little packages and then they're unrolled," says Mags Beksinska from the University of the Witwatersrand in South Africa. "In fact, they're the same length as a male condom so if you hold the two together open, they're not that different."
Beksinska is the lead author of a clinical trial recently published in the journal Lancet Global Health of three new models of female condom:
- The Woman's Condom, already available in China and soon to be distributed in South Africa, is the fruit of a 17-year project by Path - an NGO that specialises in health innovation - which has tested more than 50 versions. Out of the packet, it's smaller than the FC2. It looks like a tampon, with most of the condom gathered into a rounded polyvinyl capsule, which dissolves inside the vagina. Once it has expanded, dots of foam help keep it in place.
- The Cupid is available in India, South Africa and Brazil. It is vanilla scented and comes in pink or natural colours. It is currently the only model besides the FC2 to have been qualified by the World Health Organization (WHO) for public-sector purchase. A smaller version aimed at the Asian market is in trial.
- The VA Wow, like the Cupid, contains a sponge which helps users to insert the condom and prevents it slipping.
The Lancet study, which showed that all were no less reliable than the FC2, improves their chances of gaining wide acceptance internationally.
Other radically redesigned female condoms are either available now, or will be soon.
The Air Condom, on sale in Colombia, features a little pocket of air to aid insertion.
The Panty Condom, made by the same Colombian manufacturer, Innova Quality, is packaged with a special pair of knickers, which keep the condom in place, though this product currently lacks a distributor.
Meanwhile, a female condom known as the Origami is about a year away from market launch in the US.
Its designer, Danny Resnic, who started to work in this area after contracting HIV because of a broken condom in 1993, paid close attention to the jokes about the FC1.
"There's a reason it looks like a plastic bag - it is a plastic bag," he says. "It's putting a round peg into a different-shaped hole."
His female condom is oval-shaped, which mirrors the female anatomy he says. It is packaged as a teat-shaped capsule (see image at the top of this story), and once inserted it expands like the bellows of a concertina. The outer ring of the condom is designed to sit flat against the labia, rather than dangling as some others do.
"It's an intimate product and a shared experience, for two people," he says. "So our female condom is intended to be attractive for both men and women."
Since the Origami condom is made from silicone, it has the added benefit of being reusable - it can be washed in a dishwasher.
Saskia Husken of UAFC says it's important for couples to have a choice of products if the female condom is to achieve its potential.
"There is a need for variety," says Husken. "Some women prefer one product and some prefer another, and men as well. We are not all the same."
A 2010 study bears this out. Researchers asked 170 South African women to try out three different female condoms five times. After nine weeks, they could choose to stop the research or continue, using the female condom of their choice. Eighty-seven percent chose to continue, and by this time almost all of them had a definite preference (44% opted for the women's condom, while 37% went for the FC2 and 19% for the VA Wow).
The fact that 20 years have passed and the female condom has not matched the success of the male condom - it still accounts for only 0.19% of global condom procurement, and costs about 10 times as much - does not dent the confidence of these entrepreneurs.
Mary Ann Leeper explains how she came to realise that it could be a very long game.
Several years after the disastrous launch of the FC1, a man from Tampax came to talk to her. He said it had taken not years but decades before doctors put their faith in tampons, and women stopped seeing them as weird and gross.
"He showed me the learning curve," Leeper recalls.
"I said 'Oh God, don't tell me! Have I got to wait all this time? I don't know if I can last that long!'"
But the female condom evangelists may yet have the last laugh.