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Wireko S, Ofosu M, Agyemang F, Dankluvi HE, Cobbina AE. Vaginal douching and health risks among young women. Health Sci Rep 2024; 7:e1882. [PMID: 38357485 PMCID: PMC10865275 DOI: 10.1002/hsr2.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
Objective Vaginal douching is practiced by women for various reasons. Studies have shown that this practice can upset the normal vaginal flora, increasing susceptibility to certain sexually transmitted diseases (STIs). This study aimed to assess the health risks associated with this practice among women aged 15-54 years in a densely populated community in Kumasi, the second capital city of Ghana. Methods A cross-sectional survey was conducted to gather data on the prevalence of vaginal douching among young women and their beliefs, motivations, and knowledge about the practice. A structured questionnaire was used in recruiting participants. One-hundred and fifteen structured questionnaires were administered to women aged between 15 and 54 after their consent was sought. Results The study established that more than half of the participants (69.6%) engaged in douching with a midpoint of 19.5. The study indicated no significant difference between the age of participants and douching (p < 0.93). However, there was an indication of a significant association between educational status, marital status, and perception in relation to douching (p < 0.003, 0.0015, and 0.00, respectively), which also influenced the frequency of douching and contraction of STIs. Conclusion Most women in the study community recruited, regardless of their educational and marital status, believed that douching is necessary and considered part of feminine hygiene practices. Practicing douching may lead to most health complications including pelvic inflammatory disease and infertility which must be given serious attention by researchers, health personnel, and various women's groups.
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Affiliation(s)
- Solomon Wireko
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Mina Ofosu
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Florence Agyemang
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Herbert Ekoe Dankluvi
- Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
- Department of Medical DiagnosticsKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Andrews Evans Cobbina
- Department of Clinical MicrobiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
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2
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Schuster A, Randrianasolo BS, Rabozakandraina OO, Ramarokoto CE, Brønnum D, Feldmeier H. Knowledge, experiences, and practices of women affected by female genital schistosomiasis in rural Madagascar: A qualitative study on disease perception, health impairment and social impact. PLoS Negl Trop Dis 2022; 16:e0010901. [PMID: 36342912 PMCID: PMC9639808 DOI: 10.1371/journal.pntd.0010901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Background Female genital schistosomiasis (FGS) is a neglected manifestation of urogenital schistosomiasis caused by S. haematobium. The disease presents with symptoms such as pelvic pain, vaginal discharge and bleeding and menstruation disorders, and might lead to infertility and pregnancy complications. The perspectives of women with FGS have not been studied systematically. The aim of the study was to understand knowledge, experiences, and practices of women with FGS. Methods We performed a qualitative study with seventy-six women diagnosed of having FGS, in the Ambanja district in Northwest Madagascar. Data collection was either through focus group discussion (N = 60) or in an individual semi-structured interview (N = 16). FGS was diagnosed by colposcopy. The data was analysed using Mayring´s qualitative content analysis. Results Knowledge on how the disease is acquired varied and ideas on prevention remained vague. Patients suffered from vaginal discharge and pelvic complaints. Some women expressed unbearable pain during sexual intercourse and compared their pain to an open wound being touched. FGS considerably impaired women´s daily activities and their quality of life. Infertility led to resignation and despair, conflicts with the partner and to social exclusion from the community. Women fearing to sexually transmit FGS refrained from partnership and sexual relations. Many women with FGS reported stigmatisation. A coping strategy was to share strain with other women having similar complaints. However, concealing FGS was a common behaviour which led to social isolation and delayed health care seeking. Conclusions Our study underlines that FGS has an important impact on the sexual health of women and on their social life in the community. Our results highlight the importance of providing adequate health education and structural interventions, such as the supply of water and the provision of sanitation measures. Further, correct diagnosis and treatment of FGS in adolescent girls and women should be available in all S. haematobium-endemic areas. Trial registration The qualitative study was embedded in a randomised controlled trial (RCT) in which two doses of praziquantel were compared (https://clinicaltrials.gov/ct2/show/NCT04115072). Female genital schistosomiasis is a parasitic disease, acquired by humans when exposed to infested water. Patients can develop severe gynaecologic symptoms and face psychological and social problems. Although urogenital schistosomiasis is very common in many communities in Sub-Sahara Africa, knowledge on FGS among community members and health care workers is poor. Knowledge and experiences of women affected by FGS have never been explored but need to be understood to provide effective health care and to promote adequate interventions. In this study, waterborne and sexual transmission were the most recurrently mentioned pathways for FGS acquisition. Most women perceived the risk for FGS as immutable and related to the precarious living conditions. The women were able to differentiate between urinary and female genital schistosomiasis. FGS caused partnership conflicts and affected women’s position in the community. Stigma within the community and mistrust in health care resulted in delayed seeking health care. In view of these results, we propose including health education and structural interventions to improve living conditions, in order to reduce the burden of FGS. Further, improved access to correct diagnosis and treatment should be provided.
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Affiliation(s)
- Angela Schuster
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of General Practice, Berlin, Germany
- * E-mail:
| | | | | | | | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Hermann Feldmeier
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of Microbiology, Infectious Diseases and Immunology, Berlin, Germany
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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Brody C, Berkowitz RL, Chhoun P, Kaplan KC, Tuot S, Yi S. "Feeling clean": stigma and intravaginal practices among female entertainment workers in Cambodia. BMC WOMENS HEALTH 2021; 21:127. [PMID: 33765990 PMCID: PMC7993474 DOI: 10.1186/s12905-021-01271-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
Background Intravaginal practices (IVPs), methods used by women most often to manage vaginal hygiene and address perceived disruptions to vaginal health, may increase the risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This qualitative study explores the social, professional, and peer context surrounding IVPs, the experiences of self-cleaning or getting cleaned from a health professional, and the perceived impacts of IVPs among female entertainment workers (FEWs) in Cambodia. Methods In 2017, we conducted 27 focus group discussions from four provinces, and 16 follow-up semi-structured in-depth interviews with purposively selected participants in two provinces. Data collection occurred over three weeks, with concurrent data transcription and translation. The data from the transcripts were analyzed using Dedoose, an online, open-access qualitative analysis software. Two researchers independently labeled sections of transcripts associated with broader categories and subcategories based on the initial content analysis matrix and created codes. This process continued iteratively until a final coding schema and conceptual model was created. Results We found that IVPs are widely practiced among FEWs in Cambodia and are associated with internalized and enacted stigma. Stigma was an overarching theme that impacted the sub-themes of (1) messages about cleaning, (2) the cleaning process, and (3) the impact of cleaning. Experiences of enacted stigma and internalized stigma permeated conversations about IVP, including feeling pressured by peers to keep themselves clean, practicing internal cleaning after transactional sex, and being called dirty by health providers. Conclusions FEWs who practice IVP talk about it in the context of their lived experiences stigma and discrimination. Highly stigmatized practices such as IVP among FEWs may benefit from a harm reduction approach that emphasizes positive changes without judgment, coercion, or discrimination.
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Affiliation(s)
- Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, 94592, USA.
| | | | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Kathryn C Kaplan
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Alcaide ML, Rodriguez VJ, Brown MR, Pallikkuth S, Arheart K, Martinez O, Roach M, Fichorova RN, Jones DL, Pahwa S, Fischl MA. High Levels of Inflammatory Cytokines in the Reproductive Tract of Women with BV and Engaging in Intravaginal Douching: A Cross-Sectional Study of Participants in the Women Interagency HIV Study. AIDS Res Hum Retroviruses 2017; 33:309-317. [PMID: 27897054 DOI: 10.1089/aid.2016.0187] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
High levels of inflammatory cytokines in the genital tract suggest mucosal vulnerability and increased risk of HIV and sexually transmitted infection (STI) acquisition. Intravaginal douching is associated with bacterial vaginosis (BV) in women in the United States, and both douching and BV are linked to HIV and STI acquisition. This study evaluates inflammatory cytokines in the genital tract to increase understanding of the effects of both BV and intravaginal douching to the vaginal mucosa. A cross-sectional study of participants in the Miami WIHS investigated 72 reproductive age women (45 HIV+ and 27 high-risk HIV-) who completed intravaginal douching questionnaires and underwent collection of vaginal swabs and cervicovaginal lavages (CVLs). BV was assessed using the Nugent score. Inflammatory cytokines in the CVLs (interleukin [IL]-6, IL-8, IL-1α, IL-1β, soluble intracellular adhesion molecule-1 [sICAM-1], interferon [IFN]α2, chemokine C ligand 5 (CCL5), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP1), tumor necrosis factor alpha (TNFα), and secretory leukocyte protease inhibitor [SLPI]) were measured. Fourteen (19%) women reported intravaginal douching; 24 (33%) had BV. BV, intravaginal douching, and HIV were associated with higher levels of inflammatory cytokines. After controlling for demographic and risk factors and HIV status, women who had BV and douched had higher levels of inflammatory cytokines than those without BV and who did not douche, or who only had BV or only douched. These findings suggest that BV and douching are associated with greater mucosal inflammation and may facilitate HIV acquisition and transmission. Although longitudinal studies are needed to determine temporal associations and causality, interventions to decrease rates of intravaginal douching and BV could significantly decrease women's risks of acquiring STIs and HIV and limit the spread of HIV.
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Affiliation(s)
- Maria L. Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Violeta J. Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Megan R. Brown
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Suresh Pallikkuth
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kristopher Arheart
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, Florida
| | - Octavio Martinez
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret Roach
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida
| | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Deborah L. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Savita Pahwa
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida
| | - Margaret A. Fischl
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Hickey RJ, Zhou X, Settles ML, Erb J, Malone K, Hansmann MA, Shew ML, Van Der Pol B, Fortenberry JD, Forney LJ. Vaginal microbiota of adolescent girls prior to the onset of menarche resemble those of reproductive-age women. mBio 2015; 6:e00097-15. [PMID: 25805726 PMCID: PMC4453513 DOI: 10.1128/mbio.00097-15] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/18/2015] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. IMPORTANCE This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls.
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Affiliation(s)
| | - Xia Zhou
- Department of Biological Sciences, University of Idaho, Moscow, Idaho, USA
| | | | - Julie Erb
- FemCare Division, Procter & Gamble, Cincinnati, Ohio, USA
| | - Kristin Malone
- FemCare Division, Procter & Gamble, Cincinnati, Ohio, USA
| | | | - Marcia L Shew
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, USA
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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7
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Bui TC, Tran LTH, Ross MW, Markham CM. Douching practices among female sex workers in Phnom Penh, Cambodia. Int J STD AIDS 2014; 26:238-42. [PMID: 24810219 DOI: 10.1177/0956462414533098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several studies indicate that douching has few benefits but numerous adverse health outcomes, including increased risk for sexually transmitted infections and HIV. No published study explores douching practices among Cambodian female sex workers. This report provides preliminary data about the prevalence and frequency of douching among female sex workers in Phnom Penh, Cambodia. Survey data were obtained from 81 female sex workers who were taken into custody due to engagement in commercial sex from March to June 2011. Results showed that 91% of participants douched. The mean numbers of times douched before sex and after sex per 10 sex episodes were 4.43 (SD = 3.87) and 4.63 (SD = 3.94), respectively. Half of the participants thought that douching could help to prevent sexually transmitted infections including HIV; 24% were unsure about this. Usually, douching after sex was associated with ever obtaining an HIV test (p = .012) and was marginally associated (although not statistically significant) with a higher average number of clients per week (p =. 063) and consistent condom use with clients (p = .053). This suggests that these practices may be related to individual perceptions of sexually transmitted infections/HIV risk or susceptibility. Given the commonness of douching and related misperceptions among Cambodian female sex workers, future studies and interventions are needed to prevent adverse health problems.
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Affiliation(s)
- Thanh Cong Bui
- Division of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Ly T H Tran
- Division of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Michael W Ross
- Division of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas - Health Science Center at Houston, Houston, TX, USA
| | - Christine M Markham
- Division of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas - Health Science Center at Houston, Houston, TX, USA
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Bayer LL, Jensen JT. ACIDFORM: a review of the evidence. Contraception 2014; 90:11-8. [PMID: 24565736 DOI: 10.1016/j.contraception.2014.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/19/2014] [Accepted: 01/20/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE ACIDFORM is a candidate microbicide with spermicidal properties. A large Phase 3 trial is underway, and it is anticipated that this product will be approved for contraceptive use and marketed soon in the United States. The goal of this article is to critically review the evidence supporting the properties, safety profile and different uses of ACIDFORM gel. STUDY DESIGN We searched PubMed and Medline for any published literature on ACIDFORM. RESULTS ACIDFORM is an acidifying agent that works by lowering the vaginal pH to enhance the normal vaginal defenses. In addition to strong acid-buffering properties, ACIDFORM has high bioadhesive and viscosity-retaining properties. Several Phase 1 clinical trials have demonstrated the vaginal safety of ACIDFORM used alone or in combination with a diaphragm, although dose-dependent side effects appear to be present. Studies investigating the efficacy of ACIDFORM against sexually transmitted infections (STIs) are promising, but further trials are needed. CONCLUSIONS The properties of ACIDFORM offer many advantages for use, either alone or in combination with another active ingredient, such as Tenofovir. Potential applications for ACIDFORM include use as a personal lubricant, a vaginal contraceptive (alone or with a barrier method) and a microbicidal product or as a formulation vehicle for an active ingredient. IMPLICATIONS ACIDFORM is a candidate female-controlled vaginal preparation with microbicidal and spermicidal properties. A dual protection method could prevent unwanted pregnancies and reduce the risk of STI acquisition.
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Affiliation(s)
- Lisa L Bayer
- Oregon Health & Science University, Portland, OR 97239, USA.
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9
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Ahn S. Feminine Hygiene and Vaginal Douche Practices in Middle-aged Women. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2013; 19:285-294. [PMID: 37684773 DOI: 10.4069/kjwhn.2013.19.4.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The study was done to survey feminine hygiene and vaginal douche practices in middle-aged women to obtain basic information for public health education. METHODS With a descriptive survey design, 134 middle-aged women who have menstrual period were recruited via convenience sampling. Survey contents were from the study by Czerwinski (2000) regarding feminine hygiene and vaginal douching practices. After obtaining IRB approval, a self-administered structured questionnaire was distributed to study participants. RESULTS Mean age of middle-aged women was 46.88 years old. Fifty-six percent of the women practiced vaginal douching. Women performed douching with water (68%), commercial products (13%), soap (12%), and vinegar-mixed water (6%) for clean and fresh feeling, removal of unpleasant odor, and removal of vaginal discharge. Vaginal douche practice was significantly related to a history of vaginitis. CONCLUSION The study results indicate that most of the women practiced inadequate feminine hygiene especially in douching, suggesting that is important to develop education programs on feminine hygiene practices for women of all ages, especially regarding douching and hand washing before and after changing pads or tampons.
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Affiliation(s)
- Sukhee Ahn
- College of Nursing, Chungnam National University, Daejeon, Korea
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10
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Ekpenyong CE, Etukumana EA. Ethnicity, family socioeconomic inequalities, and prevalence of vaginal douching among college students: the implication for health. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2013; 61:222-230. [PMID: 23663126 DOI: 10.1080/07448481.2013.787620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study assessed the association between ethnicity and family socioeconomic status (SES) as it relates to the prevalence of vaginal douching among female undergraduates in a university community. PARTICIPANTS AND METHODS This was a cross-sectional survey conducted between September 2011 and February 2012 among 1,535 female undergraduates using a semistructured behavioral questionnaire adapted by the authors from previous research related to vaginal douching practice. RESULTS The overall prevalence of vaginal douching was 79.35% and the practice was significantly associated with the mother's age, ethnicity, low SES (educational level, occupation, and monthly income), and area of residence. The father's age and SES were statistically nonsignificant. CONCLUSION Ethnicity and low SES of mothers were significantly associated with a higher prevalence of douching in daughters. These factors should be considered among others in any intervention to discourage vaginal douching among college women.
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Affiliation(s)
- Christopher E Ekpenyong
- Department of Physiology, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria.
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11
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Diclemente RJ, Young AM, Painter JL, Wingood GM, Rose E, Sales JM. Prevalence and correlates of recent vaginal douching among African American adolescent females. J Pediatr Adolesc Gynecol 2012; 25:48-53. [PMID: 22051790 PMCID: PMC3252400 DOI: 10.1016/j.jpag.2011.07.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 07/28/2011] [Accepted: 07/28/2011] [Indexed: 10/15/2022]
Abstract
STUDY OBJECTIVE To describe the prevalence and correlates of vaginal douching among urban African American adolescents and to examine the association between douching and sexually transmitted infection (STI) status. DESIGN Demographic, psychosocial, and behavioral data were collected through cross-sectional, self-administered surveys. Self-collected vaginal swabs were assayed using nucleic acid amplification tests for trichomoniasis, chlamydia, and gonorrhea. SETTING Sexual health clinic in a large metropolitan area of the southeastern United States. PARTICIPANTS African American females (N = 701), ages 14-20, participating in a human immunodeficiency virus prevention intervention. MAIN OUTCOME MEASURE The outcome of interest was the association between vaginal douching (lifetime, past 90 days, and past 7 days) with demographic characteristics (eg, age, education, and socioeconomic status), physical and mental health status, STI status, sexual behavior (eg, number of vaginal sexual partners, age of sex partners, consistent condom use in the past 90 days, sex while self/partner was high on drugs or alcohol), and psychosocial characteristics (eg, sexual adventurism, social support, peer norms, sexual satisfaction, self-efficacy for sex refusal, self-esteem, relationship power, risk avoidance). RESULTS Forty-three percent reported ever douching, and 29% reported douching in the past 90 days. In bivariate analyses, recent douching was associated with demographic, behavioral, and psychosocial variables, but not current STI status. In multivariate analyses, recent douching was associated with age (odds ratio [AOR] = 1.13, confidence interval [CI] = 1.02-1.25), lower socioeconomic status (AOR = 1.25, CI = 1.05-1.47), and having sex with much older partners (AOR = 1.87, CI = 1.22-2.86). CONCLUSION Increased age, lower socioeconomic status, and older partners may be salient risk factors for douching behavior among African American young women.
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Affiliation(s)
- R J Diclemente
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA.
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12
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Terrell LR, Tanner AE, Hensel DJ, Blythe MJ, Fortenberry JD. Acceptability of the vaginal contraceptive ring among adolescent women. J Pediatr Adolesc Gynecol 2011; 24:204-10. [PMID: 21454109 DOI: 10.1016/j.jpag.2011.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 02/01/2011] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Although underutilized, the vaginal contraceptive ring has several advantages over other contraceptive methods that could benefit adolescents. We examined factors that may influence willingness to try the vaginal ring including: sexual and contraceptive history, genital comfort, and vaginal ring characteristics. DESIGN Cross sectional SETTING Midwestern adolescent health clinics PARTICIPANTS Adolescent women (N = 200; 14-18 years; 89% African-American) INTERVENTIONS/MAIN OUTCOME MEASURES: All participants received education about the vaginal ring and viewed pictures demonstrating insertion; they then completed a visual/audio computer-assisted self interview. The primary outcome variable, willingness to try the vaginal ring, was a single Likert-scale item. RESULTS Over half the participants reported knowledge of the vaginal ring with healthcare providers identified as the most important source of contraceptive information. Comfort with one's genitals, insertion and removal, using alternative methods of insertion, and knowing positive method characteristics were significantly associated with willingness to try the vaginal ring. A decreased willingness to try the vaginal ring was related to concerns of the ring getting lost inside or falling out of the vagina. CONCLUSIONS Willingness to try the ring was associated with positive feelings about genitals (e.g., comfort with appearance, hygiene, function). Thus, to increase willingness to try the vaginal ring among adolescents, providers should make it common practice to discuss basic female reproductive anatomy, raise awareness about female genital health and address concerns about their genitals. Providers can offer alternative insertion techniques (e.g., gloves) to make use more accessible. These strategies may increase vaginal ring use among adolescents.
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Affiliation(s)
- Lekeisha R Terrell
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Mark H, Sherman SG, Nanda J, Chambers-Thomas T, Barnes M, Rompalo A. What has changed about vaginal douching among African American mothers and daughters? Public Health Nurs 2011; 27:418-24. [PMID: 20840711 DOI: 10.1111/j.1525-1446.2010.00874.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore African American mothers' and daughters' practices and influences related to vaginal douching. DESIGN AND SAMPLE Our overall study used a sequential mixed-method design with 3 phases. Phase 1, the focus of this report, used grounded theory methods and in-depth, semistructured individual interviews. Two generations of African American girls and women: 24 girls ("daughters") aged 14-18 and 17 women ("mothers" or "mother figures") aged 22-43, recruited from 1 adolescent health clinic in Baltimore, MD. MEASURES In-depth interviews were taped and transcribed and data analysis used the constant comparison method. RESULTS Daughters were much less likely to douche or to have been exposed to douching information than mothers. Many mothers and daughters were influenced by health care providers and/or family members to not initiate, to decrease, or to stop douching. Women who currently douche often do so because of the perception of improved smell and cleanliness around menstruation and sexual intercourse. CONCLUSIONS These data indicate that although some women continue to believe that vaginal douching has therapeutic value, others have been influenced to stop or not start douching by family and health care providers. Health care providers should continue efforts to educate patients on the risks of vaginal douching.
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Affiliation(s)
- Hayley Mark
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland 21205-2110, USA.
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Penman-Aguilar A, Legardy-Williams J, Turner AN, Rabozakandriana TOO, Williams D, Razafindravoavy S, Behets F, Van Damme K, Jamieson DJ. Effect of treatment assignment on intravaginal cleansing in a randomized study of the diaphragm with candidate microbicide. J Womens Health (Larchmt) 2011; 20:187-95. [PMID: 21314445 DOI: 10.1089/jwh.2010.2143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intravaginal cleansing may predispose women to adverse health outcomes and may interfere with the effectiveness and safety of female-initiated methods for preventing sexually transmitted infections (STIs). In a 4-week randomized study of 192 Malagasy sex workers, we evaluated associations between self-reported intravaginal cleansing and randomization assignment: diaphragm with viscous candidate microbicide gel (Acidform™, TOPCAD, Chicago, IL, licensed to Instead, Coppell, TX), diaphragm with placebo hydroxyethylcellulose gel (HEC, ReProtect LLC, Baltimore, MD), Acidform alone, or HEC alone. METHODS Women were counseled to avoid intravaginal cleansing and were blinded to gel assignment. We evaluated changes in self-reported intravaginal cleansing across the study and assessed the effects of treatment assignment and covariates on frequent (more than once daily) intravaginal cleansing. Significant predictors in domain-specific models were evaluated in an all-domain multiple regression model. RESULTS The proportion of women reporting intravaginal cleansing decreased from baseline (97%) to week 1 (82%) (p < 0.001). Self-reported frequent intravaginal cleansing decreased from baseline (87% to 56%) during the same time period (p < 0.001). In adjusted analyses, the Acidform-diaphragm group had 60% lower odds of frequent intravaginal cleansing during the study (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.8) compared to the control group (HEC only). HEC-diaphragm and Acidform only users did not differ from controls. Living on the coast of Madagascar, not cohabiting, frequent intravaginal cleansing at enrollment, and high coital frequency predicted frequent intravaginal cleansing during follow-up. CONCLUSIONS Gel characteristics and the diaphragm's presence likely influenced women's cleansing. Viscous gel delivered by a cervical barrier (such as a diaphragm) may minimize the likelihood of frequent intravaginal cleansing.
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Affiliation(s)
- Ana Penman-Aguilar
- Women's Health and Fertility Branch, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Hull T, Hilber AM, Chersich MF, Bagnol B, Prohmmo A, Smit JA, Widyantoro N, Utomo ID, François I, Tumwesigye NM, Temmerman M. Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: findings from a multicountry household survey. J Womens Health (Larchmt) 2011; 20:1097-109. [PMID: 21668355 DOI: 10.1089/jwh.2010.2281] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women worldwide use various vaginal practices to clean or modify their vulva and vagina. Additional population-level information is needed on prevalence and motivations for these practices, characteristics of users, and their adverse effects. METHODS This was a household survey using multistage cluster sampling in Tete, Mozambique; KwaZulu-Natal, South Africa; Yogyakarta, Indonesia; and Chonburi, Thailand. In 2006-2007, vaginal practices and their motivations were examined using structured interviews with women 18-60 years of age (n=3610). RESULTS Prevalence, frequency, and motivations varied markedly. Two thirds of women in Yogyakarta and Chonburi reported one or more practices. In Yogyakarta, nearly half ingest substances with vaginal effects, and in Chonburi, external washing and application predominate. In Tete, half reported three or four current practices, and a quarter reported five or more practices. Labial elongation was near universal, and 92% of those surveyed cleanse internally. Two third's in KwaZulu-Natal practiced internal cleansing. Insertion of traditional solid products was rare in Chonburi and Yogyakarta, but one tenth of women in KwaZulu-Natal and nearly two thirds of women in Tete do so. Multivariate analysis of the most common practice in each site showed these were more common among less educated women in Africa and young urban women in Asia. Explicit sexual motivations were frequent in KwaZulu-Natal and Tete, intended for pleasure and maintaining partner commitment. Practices in Chonburi and Yogyakarta were largely motivated by femininity and health. Genital irritation was common at African sites. CONCLUSIONS Vaginal practices are not as rare, exotic, or benign as sometimes assumed. Limited evidence of their biomedical consequences remains a concern; further investigation of their safety and sexual health implications is warranted.
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Affiliation(s)
- Terence Hull
- Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia
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Liu S, Han J, Xiao D, Ma C, Chen B. A report on the reproductive health of women after the massive 2008 Wenchuan earthquake. Int J Gynaecol Obstet 2009; 108:161-4. [DOI: 10.1016/j.ijgo.2009.08.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Revised: 08/12/2009] [Accepted: 09/22/2009] [Indexed: 01/23/2023]
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Hacialioğlu N, Nazik E, Kiliç M. A descriptive study of douching practices in Turkish women. Int J Nurs Pract 2009; 15:57-64. [PMID: 19335521 DOI: 10.1111/j.1440-172x.2009.01735.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vaginal douching is a common hygiene practice for many women all over the world. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the aim of this study is to evaluate the status of vaginal douching practices of women in the Erzurum province of Turkey. The present study was a descriptive and cross-sectional quality. All participants were 15-49 years of age and all were married. Data analysis included descriptive statistics and chi(2) test. The present study revealed that the frequency of douching was 51.4% among women and that the most common reason for their habit was feminine hygiene and the most popular material used was water. A statistically significant relationship was found between the habit of doing the vaginal douching and the educational level, age of marriage, number of births, case of genital infections within the last year and presence of complaints indicating vaginal infections for the last month. This study provides preliminary information about women's douching practices and attitudes. It might also provide information to health-care practitioners in their efforts to educate women on the adverse effects of vaginal douching.
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Affiliation(s)
- Nazli Hacialioğlu
- Department of Nursing, Erzurum Health School, Atatürk University, Erzurum, Turkey
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Ott MA, Ofner S, Fortenberry JD. Beyond douching: use of feminine hygiene products and STI risk among young women. J Sex Med 2009; 6:1335-40. [PMID: 19170863 DOI: 10.1111/j.1743-6109.2008.01152.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Use of feminine hygiene products (feminine wipes, sprays, douches, and yeast creams) by adolescent women is common, yet understudied. AIM We examine the association among these genital hygiene behaviors, condom use, and sexually transmitted infection (STI). MAIN OUTCOME MEASURES Using the interview as our unit of analysis, we examined associations between genital hygiene behaviors (use of feminine wipes, feminine sprays, douches, or yeast creams), STI risk factors, and infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. METHODS We recruited 295 adolescent women from primary care clinics as part of a larger longitudinal study of STI among high-risk adolescents. Participants completed face-to-face interviews every 3 months, and provided vaginal swabs for STI testing. Data were analyzed with repeated measures logistic models to control for multiple observations contributed by each participant. RESULTS Participants reported douching in 25% of interviews, feminine sprays in 29%, feminine wipes in 27%, and yeast creams in 19% of interviews. We observed a co-occurrence of douching, spraying, and wiping. A past STI (6 months or more prior) was associated with increased likelihood of yeast cream use, and a recent STI (3 months prior) was associated with increased likelihood of feminine wipe use. Condom use was modestly associated with increased likelihood of douching. CONCLUSIONS Young women frequently use feminine hygiene products, and it is important for clinicians to inquire about use as these products may mimic or mask STI. We found no associations between douching and STI, but instead modest associations between hygiene and STI prevention, suggesting motivation for self-care.
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Affiliation(s)
- Mary A Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine 410 West 10th Street, HS 1001, Indianapolis, Indiana 46202, USA.
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Redding KS, Funkhouser E, Garcés-Palacio IC, Person SD, Kempf MC, Scarinci IC. Vaginal douching among Latina immigrants. Matern Child Health J 2008; 14:274-82. [PMID: 19067134 DOI: 10.1007/s10995-008-0438-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2008] [Accepted: 11/17/2008] [Indexed: 11/26/2022]
Abstract
Little is known about vaginal douching among Latina immigrants in the U.S. Understanding factors associated with douching is important due to the negative reproductive outcomes associated with this practice. This study examined demographic and behavioral factors associated with vaginal douching among Latina immigrants. A cross-sectional anonymous survey was administered among a convenience sample of 206 Latina immigrants aged 19-44 years (mean = 28 years) living in the U.S. at least 6 months (mean = 4 years). Demographic and behavioral characteristics, history of regular douching (at least once a month for 6 months), and current regular douching (at least once a month for the last 6 months) were assessed. Adjusted odds ratios (adj. OR) were estimated using multiple logistic regression. Overall, 25% (n = 50) of women reported ever douching regularly and 15% (n = 31) reported current regular douching. Ever douching regularly was significantly associated with a woman's number of lifetime sex partners (adj. OR = 1.6 per additional partner over one, 95% CI: 1.1-2.5), hormonal contraceptive use (adj. OR = 0.3, 95% CI: 0.1-0.9), and healthcare seeking behavior (adj. OR = 2.3, 95% CI: 1.1-5.2). Regular vaginal douching is a common practice among Latina immigrants. Factors associated with douching in this population vary from those in other U.S. populations and, therefore, it needs to be addressed in a culturally appropriate manner.
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Affiliation(s)
- Katherine S Redding
- Division of Preventive Medicine, University of Alabama, Birmingham, AL 35294-4410, USA
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Vulnerability of women in southern Africa to infection with HIV: biological determinants and priority health sector interventions. AIDS 2008; 22 Suppl 4:S27-40. [PMID: 19033753 DOI: 10.1097/01.aids.0000341775.94123.75] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review biomedical determinants of women's vulnerability to infection with HIV and interventions to counter this, within the southern African context. RESULTS Apart from number of exposures, if any, several factors influence the efficiency of HIV transmission during sex. Acute HIV infection, with extraordinarily high semen viral load, in conjunction with concurrent partnerships maximizes this efficiency. Delaying sexual debut and avoiding HIV exposure among biologically and socially vulnerable youth is critical. Reducing unintended pregnancies keeps girls in school and prevents vertical (also possibly horizontal) transmission. Female condoms, especially newer versions, are an under-exploited prevention technology. Control of sexually transmitted infections (STI), which facilitate HIV acquisition and transmission, remains important, especially among the most at-risk populations. Pathogens, such as herpes simplex virus type 2, which contribute most to HIV transmission in southern Africa must be targeted, although the importance of bacterial vaginosis and Trichomonas vaginalis is under-recognized. Also, heavy episodic alcohol use affects sexual decision-making and condom skills. Moreover, prevailing social contexts, partly a consequence of poor leadership, constrain the behavioural 'choices' available for girls and women. CONCLUSIONS Priority health sector interventions for preventing HIV are: male and female condom programming; prevention and control of STI; outreach to most vulnerable populations; HIV testing in all patient-provider encounters; male circumcision; and the integration of HIV prevention within sexual and reproductive health services. Future interventions during acute HIV infection and microbicides will reduce women's biological vulnerability. Far-reaching measures, such as sexual equity and alcohol control, create conditions necessary for achieving sustained prevention results. These are, however, contingent on stronger, more informed cultural and political leadership.
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Hilber AM, Chersich MF, van de Wijgert JHHM, Rees H, Temmerman M. Vaginal practices, microbicides and HIV: what do we need to know? Sex Transm Infect 2008; 83:505-8. [PMID: 18024709 DOI: 10.1136/sti.2007.028597] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Weisman CS, Grimley DM, Annang L, Hillemeier MM, Chase GA, Dyer AM. Vaginal douching and intimate partner violence: is there an association? Womens Health Issues 2007; 17:310-5. [PMID: 17659883 DOI: 10.1016/j.whi.2007.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 05/14/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study tests the hypothesis that vaginal douching among women of reproductive age is associated with exposure to intimate partner violence (IPV). METHODS The data source is a cross-sectional population-based sample of 2,002 women ages 18-45 in the Central Pennsylvania Women's Health Study. The survey included measures of IPV, douching behavior, and relevant sociodemographic and health-related covariates. FINDINGS Six percent of the sample reported experiencing any type of IPV in the past year, and 23% reported douching in the past year. IPV is significantly associated with douching after controlling for sociodemographic and health-related covariates. This finding holds for women with and without current reproductive capacity. CONCLUSIONS This is the first study to identify an association between vaginal douching and IPV. Because vaginal douching is a risk factor for sexually transmitted infections, bacterial vaginosis, and adverse pregnancy outcomes, the findings could have important implications for prevention. Further research is needed to identify the reasons why women who have been exposed to IPV are more likely to douche.
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Affiliation(s)
- Carol S Weisman
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, Pennsylvania 17033, USA.
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Bramante M. Genital Hygiene. THE VULVA 2006:183-216. [DOI: 10.1201/9781420005318-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Caliskan D, Subasi N, Sarisen O. Vaginal douching and associated factors among married women attending a family planning clinic or a gynecology clinic. Eur J Obstet Gynecol Reprod Biol 2006; 127:244-51. [PMID: 16377067 DOI: 10.1016/j.ejogrb.2005.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 10/25/2005] [Accepted: 11/03/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to determine the vaginal douching habits and associated factors of women attending two different healthcare clinics. STUDY DESIGN This cross-sectional study was conducted between 1 and 31 May 2004. All participants were women (n=635) who attended either a university hospital gynecology clinic or a primary health care center family planning unit. One-way ANOVA, chi-squared test, and binary and multiple logistic regression analyses were used for the statistical evaluation of data. RESULTS The mean age of the participants was 36.90+/-10.72 years (range: 18-75). Half of the participants believed vaginal douching had a positive effect on health. They believed vaginal douching demonstrates cleanliness, prevents infections and pregnancy, removes sperm following intercourse, a necessity of Islamic doctrine, and reduces symptoms like discharge, unpleasant odor, etc. Of the women, 50.2% performed vaginal douching. Vaginal douching was associated with age, education level, type of dwelling, working outside of the home, age at marriage, age at birth of first child, parity, spontaneous abortion, history of pelvic inflammatory disease, use of contraceptives, and attending a healthcare clinic. CONCLUSION Douching is a common habit among Turkish women. Many women are not aware of the harmful effects of douching. Public health and health professionals should monitor more closely this traditional habit in Turkey.
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Affiliation(s)
- Deniz Caliskan
- Public Health Department, Ankara University School of Medicine, Münzeviler Sokak No: 1, 06590 Akdere-Ankara, Turkey.
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Abstract
The aim of this study was to identify women's motivations for vaginal douching, vaginal douching practices, and women's reactions to situations that discourage vaginal douching. Research took place in the outskirts of Antalya, a city located on the Mediterranean coast of Turkey. A total of 776 women participated in the study. Age, religious affiliation, place of residence, and poverty were found to influence women's attitudes to douching. Motivating factors included mothers' attitudes as well as women's own individual motivations. Women who douched believed that it was a normal and routine behaviour. Women who were members of the Shafii sect were much less likely to practice vaginal douching. Healthcare providers should be aware of women's beliefs and concerns about feminine hygiene and tailor their strategies accordingly.
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Affiliation(s)
- Kamile Kukulu
- Akdeniz University Antalya Health School Campus 07058, Antalya, Turkey.
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Kelly-Weeder S, O'Connor A. Modifiable risk factors for impaired fertility in women: What nurse practitioners need to know. ACTA ACUST UNITED AC 2006; 18:268-76. [PMID: 16719845 DOI: 10.1111/j.1745-7599.2006.00130.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide an overview of impaired fertility in childbearing-aged women, to review the current research on modifiable lifestyle risk factors implicated in its development, and to suggest strategies for nurse practitioners (NPs) to assist women in behavioral changes that will allow them to protect their fertility. DATA SOURCES Original research articles and comprehensive review articles identified through Medline, CINAHL, and OVID databases. CONCLUSIONS Research has shown that advancing age, a history of a sexually transmitted infection and/or pelvic inflammatory disease, extremes of body weight, and tobacco and caffeine use are potentially modifiable risk factors in the development of impaired fertility. IMPLICATIONS FOR PRACTICE NPs must be aware of the link between these behaviors and the development of impaired fertility in order to assist women in preserving their fertility. Individual counseling, education, and community-wide education strategies are discussed.
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Affiliation(s)
- Susan Kelly-Weeder
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts 02467, USA.
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Grimley DM, Annang L, Foushee HR, Bruce FC, Kendrick JS. Vaginal douches and other feminine hygiene products: women's practices and perceptions of product safety. Matern Child Health J 2006; 10:303-10. [PMID: 16555141 DOI: 10.1007/s10995-005-0054-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 11/16/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Use of vaginal douche products has been linked with a variety of reproductive health problems; nonetheless, the practice of douching persists. The goals of this study were to 1) determine the use of vaginal douches and other feminine hygiene products, 2) ascertain how safe women think vaginal douche products are, and 3) evaluate women's readiness to stop douching. METHODS A random-digit-dial computer-assisted telephone survey was conducted among US women between the ages of 18 and 44. RESULTS Of the 2,602 women interviewed, 11.8% (n = 307) engaged in regular douching (White: 9.1%; African American: 27.7%; Hispanic: 15.0%). Women who douched, compared to women who did not douche, used other feminine hygiene products significantly more often (vaginal sprays [ p < .0001], wipes/towelettes [ p < 0.01], vaginal powder [ p < 0.0001] and bubble bath for feminine cleansing [ p < 0.001]). Women who douched also were more likely than nondouchers to agree with the statement, "Douche products are safe to use; otherwise they wouldn't be on the market" (70.3% vs. 33.4%, respectively; p < 0.0001). Nearly all women (90.0%) who douched had no intention to discontinue the practice. CONCLUSION Compared with women who do not douche, women who douche use other feminine hygiene products at a much higher rate and also believe that douche products are safe. Women who douche will remain resistant to stopping the practice without innovative interventions. Given that most women start douching in adolescence, teens should be targeted for prevention efforts.
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Affiliation(s)
- Diane M Grimley
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, Alabama 35294, USA.
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Grimley DM, Oh MK, Desmond RA, Hook EW, Vermund SH. An intervention to reduce vaginal douching among adolescent and young adult women: a randomized, controlled trial. Sex Transm Dis 2006; 32:752-8. [PMID: 16314772 DOI: 10.1097/01.olq.0000190018.58079.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate an intervention to reduce vaginal douching among adolescent and young women who report douching. STUDY This study consisted of a randomized, controlled trial of 275 primarily black adolescent and young adults aged 14 to 23 years. All women participated in 3 15-minute individualized counseling sessions. The experimental group received interventions based on their stage of readiness for ceasing vaginal douching. The comparison condition emphasized healthy eating and nutrition. The primary outcome measure was douching cessation (i.e., no douching in the preceding 3 months) at the 6-and 12-month assessment; a secondary outcome was progression through the stages of change toward douching cessation. RESULTS Based on an intention-to-treat model, participants assigned to the douching intervention group were significantly more likely to report having stopped douching at 6 months (relative risk [RR], 1.34; 95% confidence interval [CI], 1.03-1.73) and at 12 months (RR, 1.60; 95% CI, 1.28-2.00). At baseline, 89.9% of all women reported no intention to stop douching. Also based on an intention-to-treat model, there were no differences in stage across the 2 groups at 6 months (P = 0.29); however, at 12 months, the difference between the intervention and comparison group was statistically significant (P = 0.008). CONCLUSION Stage-matched interventions can reduce douching among adolescent and young adult women.
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Affiliation(s)
- Diane M Grimley
- School of Public Health, Department of Health Behavior, RPHB 227, 1530 3rd Ave. South, University of Alabama at Birmingham, 35294-0022, USA.
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Abstract
PURPOSE OF REVIEW Bacterial vaginosis, a common disorder among young women, is associated with adverse reproductive health outcomes. This review summarizes our current understanding of bacterial vaginosis and where future research should be focused. Recommendations for prevention, diagnosis, and treatment in both nonpregnant and pregnant populations are discussed. RECENT FINDINGS Little progress has been made in understanding the causal factors. The results of several large prospective studies have shown that racial differences persist for rates of bacterial vaginosis even when other known risk factors are controlled for. Studies of the gene-environment interaction that examine the genetic aspects of immune response may explain racial differences and why some but not all women with bacterial vaginosis experience complications. Trials to prevent preterm birth by the treatment of bacterial vaginosis in pregnancy are disappointing. Resistance to clindamycin by bacterial vaginosis-associated anaerobic organisms has also been documented. New technology to provide rapid point-of-care diagnostic testing for bacterial vaginosis has emerged. SUMMARY To understand the vaginal ecosystem and its role in reproductive health and disease, we will need to study not only the microflora but also the host-immune response. Currently recommended treatment options for bacterial vaginosis are associated with high rates of recurrence. A new concern is the development of macrolide resistance to vaginal anaerobic flora when clindamycin is used as treatment. Further studies are still needed to determine whether prevention or control of bacterial vaginosis, particularly approaches that rely not on antibiotic treatment but on the maintenance of a healthy vaginal ecosystem, can reduce adverse health outcomes.
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Affiliation(s)
- Rebecca Flynn O'Brien
- Division of General Pediatrics and Adolescent Medicine, The Floating Hospital for Children at Tufts-New England Medical Center, and Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
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