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Referral and warning signs
When to refer
Refer for severe hypersensitivity reaction.
Red flags
- Signs of severe allergic reaction (anaphylaxis) - very rare.
Signs and symptoms
- Side Effects/Disadvantages: Requires practice for correct insertion, May cause noise during intercourse, Inner ring may cause discomfort for some, Occasional hypersensitivity (rare), Can be dislodged during intercourse if not used correctly.
Risk factors
- Hypersensitivity to polyurethane/nitrile (rare).
Diagnosis
Clinical assessment
Method choice based on client preference, need for STI/HIV protection, desire for female-controlled barrier method, or male partner latex allergy/refusal.
Diagnostic criteria
Suitable for women seeking female-controlled dual protection method.
Management
Non-pharmacological management
- Counseling and training on correct insertion, use during intercourse, removal, storage, and disposal.
- Supply adequate quantities (e.g., 40 per month per UCG).
- Address potential concerns (noise, comfort).
Monitoring
Assess correct and consistent use at follow-up. Address any difficulties or concerns.
Complications
- Unintended pregnancy if used incorrectly/inconsistently or breakage/displacement occurs.
- Hypersensitivity reaction (rare).
Prevention
- Using a new condom for every act of intercourse.
- Ensuring correct insertion and position of rings.
- Using additional lubricant if needed.
Patient education
- Dual protection benefit.
- Woman-controlled method.
- Correct insertion technique (inner ring placement past pubic bone).
- Removal technique.
- Need for use with every act of sex.
- Can be inserted hours before intercourse.
- Does not require immediate withdrawal after ejaculation.
- Disposal.
Uganda-specific notes
Less commonly available and used compared to male condoms. Requires specific training for providers and users. May be an option where male condom use is inconsistent or refused.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 15, Section 15.2.2