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      Views and experiences of the female condom in Australia: An exploratory cross-sectional survey of cisgender women

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          Abstract

          Background

          The female condom is the only female-initiated form of protection against unintended pregnancy and sexually transmissible infections (STIs). However, use of this method in Australia is low. To better understand women’s views and experiences of the female condom, we conducted an interventional cross-sectional study.

          Methods

          Cisgender women ≥16 years, heterosexually active and living in New South Wales were recruited through social media advertisements and email invitations to clients of a family planning service. Eligible participants were provided with three female condoms and invited to complete a follow-up survey. Survey responses for women who attempted to use at least one female condom were summarised using counts and proportions.

          Results

          We recruited 556 women; few (30/556) had used the female condom before the study. There were 284 women who used, or attempted to use, a female condom during the study and completed the follow-up survey. Fifty-one percent (104/205) reported experiencing some difficulty in insertion, although only 46% (130/284) had seen an instructional demonstration. Approximately half (105/204) of women rated the sensation and comfort of the female condom as the same or better than the male condom, and 66% (137/204) reported that it provided the same or better lubrication. Approximately half of women said they would consider using the female condom again for STI prevention (51% (133/260)) or contraception (40% (103/260)), or would recommend to others (43% (112/260)).

          Conclusion

          Findings highlight the need for increased health promotion and education regarding use of the female condom. To increase access it will be important to address method cost and availability in Australia. Future research should explore other perspectives of this method, including among the LGBTIQ+ community.

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          Most cited references48

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          Videos to influence: a systematic review of effectiveness of video-based education in modifying health behaviors.

          This systematic review examines the effectiveness of videos in modifying health behaviors. We searched PubMed (1975-2012), PsycINFO (1975-2012), EMBASE (1975-2012), and CINAHL (1983-2012) for controlled clinical trials that examined the effectiveness of video interventions in changing health behaviors. Twenty-eight studies comprised of 12,703 subjects were included in the systematic review. Video interventions were variably effective for modifying health behaviors depending on the target behaviors to be influenced. Video interventions appear to be effective in breast self-examination, prostate cancer screening, sunscreen adherence, self-care in patients with heart failure, HIV testing, treatment adherence, and female condom use. However, videos have not shown to be effective in influencing addiction behaviors when they are not tailored. Compared to loss-framing, gain-framed messages may be more effective in promoting certain types of health behavior change. Also, video modeling may facilitate learning of new behaviors and can be an important consideration in future video interventions.
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            Perceptions of the benefits and costs associated with condom use and unprotected sex among late adolescent college students.

            To assess the differential effects of the perceived benefits and costs associated with both condom use and unprotected sex on sexual risk behaviors, data were collected from 704 ethnically diverse male and female sexually experienced late adolescent college students (aged 17-25). Perceived benefits and costs for condom use and perceived benefits and costs for unprotected sex were measured separately through an anonymous self-report survey. In addition, participants completed measures of self-efficacy for practicing safer sex and temptation for unsafe sex in various situations, and three measures of sexual risk-taking (stage of change for condom use, consistency of condom use during the past month, and whether or not a condom was used for the last act of intercourse). Univariate analyses indicated that benefits and costs of condom use, benefits of unprotected sex, self-efficacy and situational temptation were all related to sexual risk-taking. Gender differences were identified, with females reporting more benefits of condom use and costs of unprotected sex, fewer benefits of unprotected sex and costs of condom use, greater self-efficacy for practicing safer sex, and less situational temptation for unsafe sex. Multivariate analyses indicated that sexual risk behaviors were most related to situational temptation, self-efficacy for safer sex, and perceived benefits of unprotected sex. The results suggest that, among late adolescents, perceived benefits of the unhealthy behavior (unprotected sex) were better determinants of sexual risk-taking than were perceived benefits (or costs) associated with the healthy behavior (condom use). Perceived costs associated with unprotected sex were unrelated to sexual behaviors. These findings support previous work identifying adolescents as more driven by their perceptions of the positive benefits associated with risky behaviors, rather than knowledge of the costs or dangers involved in risk-taking. Copyright 2000 The Association for Professionals in Services for Adolescents.
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              Pleasure and prevention: when good sex is safer sex.

              Most sexual health education programmes use fear and risk of disease to try to motivate people to practise safer sex. This gives the impression that safer sex and pleasurable sex are mutually exclusive. Yet there is growing evidence that promoting pleasure alongside safer sex messaging can increase the consistent use of condoms and other forms of safer sex. To this end, the Pleasure Project created The Global Mapping of Pleasure, a document that identifies projects and organisations worldwide that put pleasure first in HIV prevention and sexual health promotion, and sexually provocative media that include safer sex. This article summarises some of the findings of this mapping exercise and what we learned about incorporating pleasure from it. We found that there are a variety of organisations, including religious and youth groups, and HIV/AIDS organisations and NGOs, promoting pleasurable safer sex. The techniques they use include promoting sexual techniques and dialogue about sex, teaching married couples how to have better sex and putting images of desire in sexual education materials. This paper focuses on ways of eroticising female and male condoms as examples of effective ways of using pleasure in HIV prevention and sexual health promotion.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 February 2021
                2021
                : 16
                : 2
                : e0246664
                Affiliations
                [1 ] Family Planning NSW, Ashfield, New South Wales, Australia
                [2 ] Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
                University of New South Wales, AUSTRALIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-6157-9739
                Article
                PONE-D-20-31472
                10.1371/journal.pone.0246664
                7894813
                33606704
                d68c55b9-cfbe-4991-9431-03b8d6b9f913
                © 2021 Fenwick et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 October 2020
                : 24 January 2021
                Page count
                Figures: 0, Tables: 6, Pages: 12
                Funding
                Funded by: Female Health Company
                Award Recipient :
                Funded by: GLYDE Health
                This is an investigator-initiated study, partially funded by the Female Health Company, and with FC2 female condoms provided by GLYDE Health. Neither organization was involved in the conduct of the research or preparation of this article, apart from approving the final manuscript for submission for publication. No additional external funding was received for this study.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Female Contraception
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Contraception
                Male Contraception
                People and Places
                Geographical Locations
                Oceania
                Australia
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Physical Sciences
                Materials Science
                Tribology
                Lubrication
                Engineering and Technology
                Mechanical Engineering
                Tribology
                Lubrication
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Perception
                Sensory Perception
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Social Sciences
                Psychology
                Cognitive Psychology
                Perception
                Sensory Perception
                Biology and Life Sciences
                Neuroscience
                Sensory Perception
                Medicine and Health Sciences
                Public and Occupational Health
                Health Promotion
                Biology and Life Sciences
                Anatomy
                Reproductive System
                Genital Anatomy
                Vagina
                Medicine and Health Sciences
                Anatomy
                Reproductive System
                Genital Anatomy
                Vagina
                Custom metadata
                The Family Planning NSW Human Research Ethics Committee approved the collection and analysis of data presented in this paper, however approval was not sought at the time for release of a deidentified unit-level dataset as it contains potentially sensitive information. Researchers wishing to access such data can contact the Ethics Executive Officer of the Family Planning NSW Human Research Ethics Committee ( ethics@ 123456fpnsw.org.au ) citing ethics approval number #R2018-08.

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