As GuyTopeka said, many guys take the ring out and use the Reality female condom as a big condom. Personally, I like to keep the ring in because you can pinch it (as shown in the package directions) to make it easy to insert in your ass. Also, once the ring is inside the ass, it expands out and makes it harder for the female condom to slip out of the ass. Sometimes the top's dick will hit the ring on the way in, but the ring will slip aside and not be felt by either party.
I accessed the "medical safety studies" on the Reality at my local medical school library. The only data available is based on very small sample sizes (because the company has no money to conduct bigger studies) and therefore you can not draw any conclusions, other than the fact that their small studies showed a statistical possibility that it has a higher rate of failure than regular condoms. However, there is no logical reason for this other than normal statistical variation because the Reality is made out of polyurethane, which is actually a better and stronger material than the latex rubber used in most condoms. You can use oil based lubes with polyurethane, which is another advantage of female condoms.
The only real hazzard I have experienced with Reality female condoms is that it is fun to simulate barebacking because the top can pull out and thrust back in while fucking your ass. If you are not careful, the outside ring can slip aside and the dick can slip in beside the female condom instead of into the center of it, thereby exposing your ass to the real hazards of bareback ass fucking. With an inexperienced top, I will hold onto the outside ring and make sure this doesn't happen.
An interesting side note is that they actually published instructions for anal sex and ran tests, but they never formally filed for government approval because sodomy was still illegal when they sought FDA approval and they had no money to fight being rejected. There is a book that printed a photo of these instructions and explained the politics. This was back in the worst days of AIDS (early 1990s) and they had hoped to get an exception because "gay anal sex" was known to be the primary way HIV was being spread in the USA.
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