Vaginal douching: personal practices and public policies

Pelvic inflammatory disease in the adolescent and young adult: An update

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).

"Feeling clean": stigma and intravaginal practices among female entertainment workers in Cambodia

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.

Prevalence and Factors Associated With Vaginal Douching Among Secondary School Girls in a Metropolitan City in Ogun State, Nigeria

STUDY OBJECTIVE

This study was designed to determine the prevalence and factors associated with vaginal douching among secondary school girls in a metropolitan city in Ogun State, Nigeria.

DESIGN

A descriptive cross-sectional study was carried out using a semi-structured interviewer-assisted questionnaire adapted from previous studies.

SETTING

Eight secondary schools in a metropolitan city of Ogun State.

PARTICIPANTS

A total of 818 secondary school girls aged 10-19 years.

MAIN OUTCOME MEASURE

The outcome of interest was the association between vaginal douching (lifetime) with demographic characteristics, socioeconomic characteristics of respondents' parents, source of information on douching (eg, family members, teachers), and perception about douching and its health consequences.

RESULTS

Mean age of the respondents was 13.9 ± 1.9 years. Most (72.7%) respondents were from co-educational schools; 62.5% were from public schools; 53.2% were day students; and majority (82.0%) were from nuclear families. Prevalence of vaginal douching was 63.8% and the predictors of the practice were respondents' age (OR, 0.2; 95% CI = 0.063-0.603), family setting (OR = 0.4; 95% CI = 0.221-0.819), fathers' occupation (OR = 0.6; 95% CI = 0.312-0.953), main source of douching information (OR = 2.4; 95% CI = 1.370-4.192), and perception about douching and its health consequences (OR = 2.2; 95% CI = 1.403-3.523 and OR = 2.0; 95% CI = 1.236-3.187 respectively).

CONCLUSION

Vaginal douching was prevalent among secondary school adolescent girls in the study area. Factors associated with the practice include age, family setting, fathers' occupation, source of information on douching, perception about douching practice, and perceived health consequences of the practice.

Using Film to Disseminate Information on Cervical Cancer Prevention in Lusaka: Results from a Small Intervention Study

In order to prevent the spread of cervical cancer, people must be aware and knowledgeable about the available preventive practices such as screening and vaccination. The purpose of this study was to determine the extent that film is effective in disseminating information on cervical cancer and its prevention to women and men in Lusaka. A pilot intervention study was carried out at churches in Lusaka city from August to September 2017. A sample size of 38 women and 43 men filled in both baseline and follow-up questionnaires. A knowledge grade (range, 1-10 points) which linked causes to risk factors for cervical cancer was used to assess the knowledge of a respondent. Significant results (p < 0.01) were obtained at follow-up for watching the film and having awareness and knowledge. The main finding is that a short informational film can be an effective means of disseminating information on cervical cancer and its prevention to women and men.

Knowledge, attitudes and practices of cervical cancer prevention among Zambian women and men

BACKGROUND

In Zambia, cervical cancer screening was started in 2006 and the human papillomavirus vaccine was piloted in 2013. Nevertheless, cervical cancer remains the leading cancer. It is assumed that knowledge, social interaction, health behaviors and religion are factors that can influence screening and vaccination practices. This study addresses the question, what is the relationship between knowledge about cervical cancer, attitudes, self-reported behavior, and immediate support system, towards screening and vaccination of cervical cancer of Zambian women and men. The results of this study serve as a basis for future research, an input for improvement and adjustment of the existing prevention program and build on documented health behavior frameworks.

METHODS

A cross-sectional mixed methods study was conducted from February to May 2016. Two separate questionnaires were used to collect data from women (N = 300) and men (N = 300) residing in Chilenje and Kanyama (two townships in the capital city Lusaka). Respondent's knowledge of cervical cancer was operationalized by grading their ability to correctly identify causes and protective factors if they were aware of cervical cancer. Besides providing descriptive statistics of all study variables, we tested four research hypotheses concerning the link between knowledge, attitudes and practices suggested by the literature, by applying appropriate statistical tests (chi square test, analysis of variance, logistic regression).

RESULTS

Less than half of the respondents (36.8%) had heard of cervical cancer, 20.7% of women had attended screening and 6.7% of the total sample had vaccinated their daughter. Knowledge of causes and prevention was very low. There was a strong association between having awareness of cervical cancer and practicing screening (odds ratio = 20.5, 95% confidence interval = [9.214, 45.516]) and vaccination (odds ratio = 5.1, 95% confidence interval = [2.473, 10.423]). Social interactions were also found to greatly influence screening and vaccination behaviors.

CONCLUSIONS

The low level of knowledge of causes and prevention of cervical cancer suggests a need to increase knowledge and awareness among both women and men. Interpersonal interactions have great impact on practicing prevention behaviors, for instance, vaccination of daughters.

Douching practices among women in the Bolgatanga municipality of the upper east region of Ghana

BACKGROUND

Vaginal douching is a common practice among women all over the world. Women douche for various reasons, despite evidence indicating the harmful health effects of the practice. There is lack of data on the practice in Ghana but health behaviors like vaginal douching may be influenced by differences in culture and geography. Therefore, this study sought to assess prevalence and predictors of vaginal douching practices among women of the Bolgatanga Municipality of Ghana.

METHODS

This cross-sectional study was conducted among 200 women from January to March 2016.

RESULTS

Sixty-seven percent of the women practiced vaginal douching, from which a similar proportion did it daily. Over two-thirds (67.7%) of the women used water for douching. The reasons for douching were cleansing the vagina (67.7%), therapeutic effects (12.8%) and tightening of the vaginal muscles (19.5%). The majority (87.2%) of women who douched were unaware of the harmful health effects associated with the practice. The educational level of the women (p = 0.025) and having knowledge of the dangers associated with douching (p <  0.001) were then significantly associated with douching practices.

CONCLUSION

Vaginal douching is commonly practiced by women in the Bolgatanga Municipality. Most of these women douche because they did not know that there are health problems associated with the practice. Health education on the issues of women health is very vital for the improvement of women's health.

Indigenous HIV Prevention Beliefs and Practices Among Low-Earning Chinese Sex Workers as Context for Introducing Female Condoms and Other Novel Prevention Options

New interventions to reduce HIV and sexually transmitted infections (STI) among female sex workers are introduced into the context of women's existing prevention beliefs and practices. These indigenous practices affected implementation of our program to introduce female condoms to women in sex-work establishments in southern China. We used ethnographic field observations and in-depth interviews to document common prevention methods women reported using to protect themselves before and during intervention implementation. Individual, sex-work establishment, and other contextual factors, including sources of information and social and economic pressures to use or reject prevention options, shaped their perceptions and selection of these methods and affected adoption of female condoms as an additional tool. Efforts to improve uptake of effective prevention methods among low-income sex workers require attention to the context and spectrum of women's HIV/STI prevention practices when introducing innovations such as female condoms, microbicides, pre-exposure prophylaxis pills, and others, as they become available.

'Basically, it's sorcery for your vagina': unpacking Western representations of vaginal steaming

Vaginal steaming made global headlines in 2015 after its promotion by celebrity Gwyneth Paltrow. One of many female genital modification practices currently on offer in Anglo-Western nations - practices both heavily promoted and critiqued - vaginal steaming is claimed to offer benefits for fertility and overall reproductive, sexual or even general health and wellbeing. We analysed a selection of online accounts of vaginal steaming to determine the sociocultural assumptions and logics within such discourse, including ideas about women, women's bodies and women's engagement with such 'modificatory' practices. Ninety items were carefully selected from the main types of website discussing vaginal steaming: news/magazines; health/lifestyle; spa/service providers; and personal blogs. Data were analysed using thematic analysis, within a constructionist framework that saw us focus on the constructions and rationalities that underpin the explicit content of the texts. Within an overarching theme of 'the self-improving woman' we identified four themes: (1) the naturally deteriorating, dirty female body; (2) contemporary life as harmful; (3) physical optimisation and the enhancement of health; and (4) vaginal steaming for life optimisation. Online accounts of vaginal steaming appear both to fit within historico-contemporary constructions of women's bodies as deficient and disgusting, and contemporary neoliberal and healthist discourse around the constantly improving subject.

Intravaginal practices among HIV-negative female sex workers along the US-Mexico border and their implications for emerging HIV prevention interventions

OBJECTIVE

To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico.

METHODS

Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs.

RESULTS

Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6months (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.1-3.1; P=0.03), three or more pregnancies (aOR 1.9, 95% CI 1.1-3.2; P=0.02), and having clients who became violent when proposing condom use (aOR 5.8, 95% CI 1.0-34.3; P=0.05), which are all factors related to inconsistent condom use.

CONCLUSION

Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

Vaginal douching and association with sexually transmitted infections among female sex workers in a prefecture of Yunnan Province, China

Vaginal douching is a common practice and has been hypothesised to increase a woman's risk for human of contracting HIV and sexually transmitted infections (STIs). Our objective was to assess the prevalence of douching and its association with STIs, genital symptoms and HIV/STI knowledge among female sex workers (FSWs). We conducted a cross-sectional study of 837 FSWs with interviews and laboratory tests for HIV/STIs in a prefecture of Yunnan Province in southern China. Vaginal douching was reported by 84% of the women. We found a higher prevalence of vaginal douching practice among FSWs of Han ethnicity, and who were single or cohabitating. Douching was also significantly more common among more educated FSWs and those with greater knowledge of HIV/STIs, and as well as in FSWs who had experienced clinical symptoms in the previous 12 months. Douching was linked to higher risks of HIV (adjusted odds ratio = 2.29; 95% confidence interval 1.01-5.23) and herpes simplex virus type 2 infections (adjusted odds ratio = 2.18; 95% confidence interval 1.46-3.24) after adjusting for confounding factors. Medical professionals and public health workers should correct women's misconception about the effectiveness of douching and discourage women from douching through educational activities. More prospective studies among FSWs are urgently required to identify the relationship between vaginal douching and HIV/STIs.

Recurrent vulvovaginal candidosis among young women in south eastern Nigeria: the role of lifestyle and health-care practices

This work was carried out to study the association between lifestyle, health-care practices and incidence of recurrent vulvovaginal candidosis (RVVC) among young women in south eastern Nigeria. It was a multicentre case-control study of 176 women aged between 20 and 35 years recruited from the designated health facilities. Lifestyle and health-care practice structured questionnaires were used to survey the participants. Clinical examination was performed and vaginal swabs were taken from participants for microscopy, culture and sensitivity. The germ tube test was performed for identification of Candida albicans. The results of this study showed that frequent douching with water or other fluids (odds ratio [OR](adjusted) = 2.41, 95% confidence interval [CI] = 1.25-4.66, P = 0.000), wearing tight nylon/synthetic underwear (OR(adjusted) = 4.76, 95% CI = 2.28-9.95, P = 0.000), alternative medical treatment for repeated or recalcitrant cases (OR(adjusted) = 4.84, 95% CI = 2.94-15.91, P = 0.000), were significantly associated with higher odds for RVVC and self-diagnosis and use of over-the-counter antifungal medications (OR(adjusted) = 4.61, 95% CI = 2.29-9.32, P = 0.000) were associated with RVVC. Results of the fungal cultures showed that C. albicans and non-C. albicans were isolated from 83.7% and 16.3% of participants, respectively. Our results supported the association between some of the hypothesized risk factors and the occurrence of RVVC.

Vaginal douching by women with vulvovaginitis and relation to reproductive health hazards

Background

Vaginal douching (VD) is a common practice among married women all over the world specially those in the Middle East. It is used for personal hygiene or for other aesthetic reasons in many countries. The current study investigates the prevalence of VD among patients with vulvovaginitis in Egypt. It also compares the reproductive health hazards among women performing routine VD with those using external hygiene. It also investigates why, and how women practice this douching.

Methods

A cross sectional observational study was conducted in a tertiary university affiliated hospital in Assiut, Egypt. An interview administered questionnaire was administered to 620 women by two trained clinic nurses. Women presented to the outpatient clinic and diagnosed to have any type of vaginal infections were approached for participation. The principle outcome was the history of preterm labor in women who routinely performed VD versus those who did not (upon which sample size was estimated). Other outcome measures were the types of vaginal infections, and reproductive implications comprising, ectopic pregnancy, abortion and pelvic inflammatory disease (PID).

Results

The participants were predominantly multiparas from semi-urban background and middle socioeconomic level. Considering VD as a religious duty and a kind of personal cleanliness were the most common reasons for performing VD in 88.9% and 80.6% of the studied population, respectively. History of preterm labor was reported in 19.2% versus 11.9% (p=0.048), while history of PID in 13.2% versus 6.0% (p=0.008) in women performing VD compared to those not performing this habit, respectively. There were no significant differences between the two groups as regard the history of ectopic pregnancy or the number of previous abortions.

Conclusion

Vaginal douching is a prevalent practice in Egypt and has traditional and religious roots within the community. There are many misbeliefs around this habit in Egypt. Vaginal douching increases certain reproductive health hazards especially preterm labor and PID. Much effort and awareness campaigns are needed to increase women awareness about health hazards of this incorrect practice and to limit its use.

Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006-2010

BACKGROUND

Few studies have examined recent temporal trends in self-reported receipt of pelvic inflammatory disease (PID) treatment. We assessed trends in receipt of PID treatment and associated correlates using national survey data.

METHODS

We used data from the National Survey of Family Growth, a multistage national probability survey of 15- to 44-year-old women. We examined trends in self-reported receipt of PID treatment from 1995, 2002, to 2006-2010. In addition, we examined correlates of PID treatment in 1995 and 2006-2010 in bivariate and adjusted analyses.

RESULTS

From 1995 to 2002, receipt of PID treatment significantly declined from 8.6% to 5.7% (P < 0.0001); however, there was no difference from 2002 to 2006-2010 (5.0%, P = 0.16). In bivariate analyses, racial differences in PID treatment declined across time; in 2006-2010, there was no significant difference between racial/ethnic groups (P = 0.22). Also in bivariate analyses, similar to 1995, in 2006 to 2010, some of the highest reports of receipt of PID treatment were women who were 35 to 44 years old (5.6%), had an income less than 150% of poverty level (7.5%), had less than high school education (6.7%), douched (7.7%), had intercourse before age 15 years (10.3%), and had 10 or more lifetime partners (8.0%). In adjusted analyses, differing from 1995, women at less than 150% of the poverty level were more likely (adjusted odds ratio [AOR], 2.60; 95% confidence interval [CI], 1.79-3.76) than women at 300% or more of the poverty level to have received PID treatment in 2006-2010.

CONCLUSIONS

Receipt of PID treatment declined from 1995 to 2006-2010, with the burden affecting women of lower socioeconomic status.

Ethnicity, family socioeconomic inequalities, and prevalence of vaginal douching among college students: the implication for health

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.

Effects of vaginal douching education on Turkish women's vaginal douching practice

BACKGROUND

Vaginal douching (VD) is a very common practice in Turkish culture. This practice is affected by individual and cultural characteristics.

PURPOSE

The aim of the research was to determine how the education based on Pender's health promotion model (HPM) affects women's decision to quit vaginal douche and the factors that cause women to continue VD practices.

METHODS

The HPM guided the 2-hr education process. The sample has 58 women.

RESULTS

As a result, the model education-based HPM helped 69% of women to quit VD practice. It was also determined that education affected women who performed VD to feel clean and to comply with the religion but was less effective in women who had lower education or performed VD to comply with the husband's demand.

CONCLUSIONS

Finally, the study showed that the education based on HPM affected the women to change their attitude toward VD and quit it.

Genital Appearance Dissatisfaction: Implications for Women's Genital Image Self-Consciousness, Sexual Esteem, Sexual Satisfaction, and Sexual Risk

Findings regarding the link between body image and sexuality have been equivocal, possibly because of the insensitivity of many of body image measures to potential variability across sensory aspects of the body (e.g., appearance versus odor), individual body parts (e.g., genitalia versus thighs), and social settings (e.g., public versus intimate). The current study refined existing methods of evaluating women's body image in the context of sexuality by focusing upon two highly specified dimensions: satisfaction with the visual appearance of the genitalia and self-consciousness about the genitalia during a sexual encounter. Genital appearance dissatisfaction, genital image self-consciousness, and multiple facets of sexuality were examined with a sample of 217 undergraduate women using an online survey. Path analysis revealed that greater dissatisfaction with genital appearance was associated with higher genital image self-consciousness during physical intimacy, which, in turn, was associated with lower sexual esteem, sexual satisfaction, and motivation to avoid risky sexual behavior. These findings underscore the detrimental impact of negative genital perceptions on young women's sexual wellbeing, which is of particular concern given their vulnerability at this stage of sexual development as well as the high rates of sexually transmitted infections within this age group. Interventions that enhance satisfaction with the natural appearance of their genitalia could facilitate the development of a healthy sexual self-concept and provide long-term benefits in terms of sexual safety and satisfaction.

Evidence of African-American women's frustrations with chronic recurrent bacterial vaginosis

PURPOSE

The purpose of this study was to explore the impact of recurrent bacterial vaginosis (BV) and its treatment on quality of life (QOL), acceptance of current treatment options, and psychosocial issues related to lifestyle practices associated with BV.

DATA SOURCES

Qualitative and quantitative data were obtained from 23 African American women with recurrent BV. Participants completed a short survey, developed by the researchers based on a prior study which examined factors associated with recurrent BV, and a one-on-one interview assessing the impact of BV, current treatment modalities, and lifestyle practices related to recurrent BV.

CONCLUSIONS

Emerging themes suggest that recurrent BV is associated with psychosocial issues that are currently not addressed in a typical office visit. Reported feelings of shame and embarrassment often cause women to engage in hypervigilant routines of hygiene that negatively impact their professional, personal, and intimate relationships, significantly affecting their QOL.

IMPLICATIONS FOR PRACTICE

Without proper education, advice, and support, BV is perpetuated by lifestyle practices leading to recurrent infection and associated symptoms. With proper guidance, it is expected that women with recurrent BV will see an improvement in their QOL, with fewer complications from BV infection, and healthy relationships with intimate partners, family, and friends.

Douching patterns in women related to socioeconomic and racial/ethnic characteristics

OBJECTIVE

To examine whether socioeconomic and racial/ethnic characteristics contribute independently and in combination to influence douching behavior.

DESIGN

A cross-sectional design.

SETTING

United States.

PARTICIPANTS

Women between 14 and 49 years of age who were both interviewed and examined as part of the National Health and Nutrition Examination Survey data collection process.

MAIN OUTCOME MEASURES

Douching rates in women categorized on socioeconomic and racial and ethnic characteristics.

RESULTS

Based on data from 3,522 women, 21% reported recent douching. Separated by race, Black women douche at much higher percentage (47%) than non-Hispanic White (17%), Mexico-born Mexican American women (12.5%), or U.S.-born Mexican American women (19%). Although increasing age and low socioeconomic status are both associated with increased douching, the effects of socioeconomic status on douching vary by race/ethnicity.

CONCLUSIONS

Low income and minority racial status contribute both independently and together to influence douching behavior in women. These findings suggest cultural contributions to douching may be especially prevalent in the Black population while Mexican American women born in Mexico may be relatively immune to U.S. cultural influences.

Vaginal douching in Cambodian women: its prevalence and association with vaginal candidiasis

BACKGROUND

We determined the prevalence of vaginal douching (cleansing of the vagina with liquid) in a sample of Cambodian women, and examined the associations of douching with genitourinary symptoms and infections, after controlling for potential confounding factors, including genitourinary symptoms and sociodemographic factors.

METHODS

A total of 451 adolescent and adult females aged 15 to 49 years who attended 17 maternal and child health (MCH) clinics in 7 provinces of Cambodia in 2001 were consecutively enrolled as a part of the Sexually Transmitted Infection Sentinel Survey. Sociodemographic factors, genitourinary symptoms, and frequency of douching were assessed by face-to-face interviews using a structured questionnaire. Vaginal infections were examined by using standard diagnostic procedures specific to each pathogen.

RESULTS

The proportion of participants who douched at least once a week was 76.7% (n = 346). Douching was significantly more prevalent in urban than in rural women (85.7%, n = 198 vs 67.3%, n = 148; P < 0.001). Frequency of douching was significantly associated with genitourinary symptoms, which were most prevalent in participants who douched from several times a week to once a day; genitourinary symptoms were less prevalent in those who douched more than once a day. Douching was significantly associated with vaginal candidiasis, but not with trichomoniasis or bacterial vaginosis, and this association persisted even after controlling for sociodemographic factors and genitourinary symptoms.

CONCLUSIONS

Vaginal douching was very common among Cambodian women visiting MCH clinics. Further investigations are warranted to elucidate the reasons for douching. In addition, women should be informed that douching may endanger their reproductive health.

Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents

OBJECTIVE

The objective of the study was to examine the association between douching and 4 sexually transmitted infections (STIs).

STUDY DESIGN

We followed up 411 high-risk human immunodeficiency virus-infected and uninfected female adolescents aged 12-19 years over a median 3-year period, both by time from study entry/first STI-free visit until an incident STI for participants who never, intermittently, and always douched and also by reported douching at a given STI-free visit and incidence of STI at the next visit, using adjusted Cox proportional hazards models to calculate hazard ratios (HR).

RESULTS

The time to STI was shorter for adolescents who always (HR, 2.1; 95% confidence interval [CI], 1.2-3.4) and intermittently (HR, 1.5; 95% CI, 1.0-2.2) douched, compared with never-douchers. An adjusted hazard for STI was 1.8 times larger for always-douchers (95% CI, 1.1-3.1) and 1.4 times larger for intermittent douchers (95% CI, 0.9-2.0), compared with never-douchers. When classifying by follow-up after an STI-free visit, always-douchers had a shorter STI-free time than never-douchers (HR(adj), 2.1; 95% CI, 1.5-3.1).

CONCLUSION

Counseling to discourage douching may reduce STI risk in adolescents.

Health practices and vaginal microbicide acceptability among urban black women

BACKGROUND

Intravaginal topical microbicides are being investigated for prevention of HIV transmission. Use of vaginal microbicides will constitute a new type of practice, occurring in the context of other vaginal practices related to contraception, hygiene, and self-care, which are affected by cultural norms and personal beliefs. Given the high rate of HIV infection among black women, research on practices and decision making relevant to microbicide acceptability is needed in this population.

METHODS

Twenty-three black women in New York City, aged 25-64, completed in-person semistructured interviews and self-administered questionnaires. Quantitative analyses examined vaginal practices and willingness to use microbicides. Qualitative analyses explored underlying decision-making processes involved in choices regarding vaginal practices and general healthcare.

RESULTS

Willingness to use vaginal products for HIV prevention was high, especially among more educated women. Safety was a major concern, and women were cautious about using vaginal products. Whereas some viewed synthetic products as having potentially harmful side effects, others perceived natural products as risky because of insufficient testing. Choices about vaginal practices were affected by assessments of risk and efficacy, prior experience, cultural background, and general approach to healthcare.

CONCLUSIONS

The majority of women in the sample expressed willingness to use a vaginal product for HIV prevention. Decision-making processes regarding vaginal practices were complex and were affected by social, cultural, and personal factors. Although specific preferences may vary, attitudes toward using a vaginal product are likely to be positive when side effects are minimal and the product is considered safe.

National trends in iodine nutrition: is everyone getting enough?

Iodine deficiency is an important public health problem worldwide. Until the 1920s, endemic iodine deficiency disorders were prevalent in the Great Lakes, Appalachian, and Northwestern regions of the United States. Iodized salt was responsible for eliminating endemic goiter in the United States and remains the mainstay of iodine deficiency disorder eradication efforts worldwide. Although urinary iodine values have decreased by 50% since the early 1970s, the United States remains iodine sufficient. However, U.S. iodine nutrition, particularly among women of childbearing age, may remain an area worthy of public health concern. There is a wide amount of variation in the iodine content of some common foods, and the iodine content of foods is not well reflected by package labeling. There needs to be increased awareness of the importance of adequate iodine nutrition, particularly during pregnancy and lactation, among the U.S. public.

Variation and predictors of vaginal douching behavior

INTRODUCTION

Vaginal douching is a widespread practice among American women. Little research has been done examining variation in the practice or identifying risk factors.

METHODS

We collected data on douching, as well as hypothesized predictors of vaginal douching, as part of a cohort study on preterm birth. African-American women residing in Baltimore City, Maryland, were enrolled if they received prenatal care or delivered at The Johns Hopkins Medical Institution. Interview data were collected on 872 women between March 2001 and July 2004, with a response rate of 68%. Logistic regression analysis was selected to identify factors associated with douching in the 6 months prior to pregnancy.

RESULTS

Almost two thirds of women reported ever douching and more than two thirds of those women reported douching in the 6 months prior to pregnancy. Variation was seen in the practice of douching with regard to frequency as well as technique. After adjusting for several confounders, prenatal enrollment (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.29, 2.53), more unmet needs for time for "non-essentials" (OR, 1.83; 95% CI, 1.27, 2.63), smoking in the year prior to the birth (OR, 1.78; 95% CI, 1.22, 2.60), and age >19 years (OR, 2.60; 95% CI, 1.36, 4.97) were significant predictors of douching in the 6 months prior to pregnancy.

DISCUSSION

We identified considerable heterogeneity in the practice of vaginal douching in a cohort of low income African-American women.

CONCLUSIONS

Future studies should incorporate measures of the predictors of douching and detailed exposure information to determine the independent contribution of vaginal douching to health outcomes.

Modifiable risk factors for impaired fertility in women: What nurse practitioners need to know

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.

Intergenerational transfer of douching information

STUDY OBJECTIVE

To characterize the discussions on douching that female parents/guardians have with daughters.

DESIGN

A questionnaire assessing personal douching history, beliefs on the practice of douching, and what they had discussed or intended to discuss about douching with their daughters was administered to women who were parenting females 11-21 years of age.

PARTICIPANTS

Fifty-seven women who had douched or currently douche completed the questionnaire.

RESULTS

Fifty-six of the women had discussed or planned to discuss the subject with their daughters. The girls with whom they had had a discussion were significantly older (16.2 years) than those with whom they planned to have a discussion (14.1 years). Most (73%) of the women had encouraged or planned to encourage douching, while only 18% had or planned to discourage it. Mothers had or planned to have the conversation in the context of menses (76%), sexual activity (40%), or when their daughter instigated the conversation (44%). Over 40% of the mothers had not or did not intend to discuss any negatives about douching. Only ten of the women stated that a health care provider had spoken to them or their daughter about the subject.

CONCLUSION

Female parents/guardians are an important source of information about douching for their daughters. Health care providers need to educate girls as well as the women who parent them on the health risks associated with douching. Public campaigns aimed at decreasing douching should target this intergenerational transfer of information.

Vaginal douches and other feminine hygiene products: women's practices and perceptions of product safety

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.