Anastacia Tomson has an irrepressible drive for justice, to make the world of healthcare a more accessible and kinder place. She’s one of the advocates pushing for inner condoms to be mainstream in education, healthcare, and society at large.
This article is part of an African Alliance series celebrating 25 years of the inner condom in South Africa and the people who helped to establish the world’s biggest state-funded inner condom project.
Anyone seen Community, the TV show? In season 1, episode 11, Annie runs an STD fair with the tagline “Catch Knowledge”. But someone stapled her promotional message directly onto the condoms, making them ineffectual. One of her friends then runs to the speaker system and urges his fellow students: “: “If you’re having sex, don’t use the condoms”.
A version of this happened in real life, in South Africa.
Dr Anastacia Tomsom, a primary care doctor based in Seapoint, Cape Town, recalls the time when somebody handed her an inner condom with instructions stapled onto them, rendering them useless.
The intentions were good, because not everyone knows how to use an inner condom, but the result was disastrous.
Besides being a primary care doctor, she’s an author and activist. Her focus is on LGBTQIA+ health care and gender affirming health care. In 2021, she led the team producing the first South African guideline for gender affirming hormone therapy.
“We do need to be mindful of the language. Once you start calling it an internal condom, it allows access for assigned female at birth trans people, it allows access when people are having anal intercourse,” she explains.
There is a power dynamic in society between female and male, and renaming the condom serves to help dismantle this power dynamic, she adds.
Because of the work done as a doctor, activist, educator, teaching medical students at the University of Cape Town, partnering with organisations like the South African Judicial Education Institute, the Centre for Human Rights at the University of Pretoria – the ongoing partnerships mean she does a lot of public engagement. Specifically, with the Sexual and Reproductive Justice Coalition, inner condoms have come into focus with the STIs and HIV prevention and management.
“I think it’s very important to understand when we speak about intercourse and how to engage in it safely – a lot of that is geared towards straight relationships, and a lot of it is geared to disempower people who are already marginalised.”
That’s where she’s come in, to educate people on the use of an inner condom, to campaign for better language that is more inclusive, and to advocate for it being widely available. If the external condom is available in public restrooms and clinics, Dr Tomsom believes the inner condom should be too.
Not ovary acting – inner condoms are important
“It’s not just about epidemiology and sexually transmitted infections and pregnancy and HIV, she says. “People should be allowed to exert autonomy and control over their own bodies, over their own reproductive and sexual health.”
Dr Tomson explains that there’s a negotiation between two people using condoms. Sometimes, people might not be in a position to negotiate. Inner condoms allow people to make their own decisions about sexual health.
It puts the agency back in their hands, she adds.
“It feels weird to say it’s empowering, because I think the default should be that people are empowered. And I think what we have been doing by limiting availability is we’ve been actively disempowering people.”
Through education and greater accessibility of inner condoms, health providers and activists have been able to undo some of that disempowerment.
“We have to take responsibility for this. Public health institutions, the Department of Health, us as clinicians, we have actively disempowered people, and we need to own that and take responsibility for it. It’s our problem.”
There’s a political aspect to it, she goes on to say, and everyone needs to have control over their own reproductive and sexual destiny.
“It’s our responsibility to give you the tools to do so.”
Sex education shouldn’t be a ‘Bad Education’ / Don’t be neutral about the gender neutral applications of the inner condom
Dr Tomson says the inner condom should become absolutely mainstream.
“We’re still at a point where I can say to someone, inner condom, and their eyes will glaze over. Because we don’t see it. Everyone’s seen a video of a banana and a condom. How many people know where to get an inner condom? Or how to use it?”
Although we’ve had 25 years of the inner condom, looking towards the next 25, Dr Tomson starts speaking about how she hopes it will become a default accessible option for people, regardless of gender identity, sexual orientation, and social circumstance.
“I don’t think you should need to be rich and very well connected in order to get access to this kind of thing. I would hope to see them everywhere. And I would hope that it becomes completely demystified, completely mainstream, that it forms part of comprehensive sexuality education, from the level of basic and secondary education onwards.”
Beyond education, she hopes clinicians will become better educated on the inner condoms. While she was at med school she’d only heard of them as a footnote, so she hopes that is already changing.
Let’s talk about double-bagging
Double-bagging is the practice of wearing two external condoms over one penis, or two people having sex where one wears an external condom and the other wears an internal condom.
“People do tend to get a little anxious over sexual health. Those who are inclined to want to have protected intercourse want as much protection as possible,” Dr Tomson explains. “And I think maybe just addressing the misconception of ‘more is better’. It’s one condom at a time. Don’t use an internal and an external condom.”
In fact, using two condoms at once increases the chance of breakage.
Motivations to mainstream the inner condom
Dr Tomson brings up how when you walk through a pharmacy in South Africa well-known brands of external condoms like Durex hang from the shelves. But you don’t see inner condoms.
“When it comes to private sector and retail chains, I think there’s a financial motivation to make this more accessible,” she says.
The take home message is that inner condoms are not something that only applies to the fields of health, activism, feminism or intersectional politics, she says.
“I think this is something that can be used by everyone, by every couple that’s having any kind of penetrative intercourse. I think this is something that is appropriate, usable, and potentially has a huge benefit.”
Everyone stands to benefit if the inner condom goes mainstream, she adds.
Dr Tomson’s lived experience as a queer, trans, autistic doctor drives her passion for making healthcare safer, more accessible, and kinder. She has an irrepressible drive for justice, and a profound capacity for compassion.
When she’s not working, you might find her running, building LEGO, cooking up a delicious vegan storm, or gazing at her collection of fountain pens and exquisite inks whilst feeling guilty that she’s not using them to write or draw.
Do you need more information about why ‘double bagging’ is riskier than using just one condom? Get in touch with us on X and Instagram. We’re at @Afri_Alliance on both platforms.