Search

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.

The article below summarizes a roundtable discussion of a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009;200:38.e1-38.e8.

Purpose: Although vaginal douching is associated with several adverse outcomes, the reasons why women douche have not been studied prospectively., Methods: Non-pregnant (N = 3620) women aged 15 to 44 years presenting for routine care at 12 clinics in Birmingham, Alabama, participated in a longitudinal study of vaginal flora (1999-2003). Participants were assessed quarterly for 1 year. The authors applied conditional logistic regression in a case-crossover analysis to determine the individual-level factors that vary between a woman's douching and non-douching intervals. Findings were compared to a population-level analysis utilizing generalized estimating equations., Results: Thirty percent of participants douched in every interval; 28% douched in some but not all intervals. The case-crossover analysis indicated a woman was more likely to douche when reporting "fishy" vaginal odor (odds ratio [OR]:2.74; 95% confidence interval [CI]: 1.55, 1.84), vaginal irritation (OR: 1.52; 95% CI: 1.10, 2.11), summer month (OR: 1.37, 95% CI: 1.13, 1.67), or increase in number of sex partners (> or = 3, OR: 2.42, 95% CI: 1.11, 5.26). Bacterial vaginosis/trichomoniasis treatment (OR: 0.72, 95% CL: 0.59, 0.89) and absent menses (OR: 0.37, 95% CI: 0.28, 0.50) were negatively associated with douching. These ORs were farther from the null than comparable population-level estimates., Conclusions: Programs targeting these predictors may decrease the untoward sequelae associated with douching. Furthermore, a case-crossover analysis applied to prospective studies can provide insights into time-varying factors.

The aim of this study was to examine factors related to frequent douching among a predominantly black and Hispanic alternative school population. It was observed that although Hispanic females were more likely to douche weekly compared with black females (30% vs. 13%), monthly douching was associated with black ethnicity, beliefs related to the therapeutic value of douching, perceived partner expectations, having female relatives who douched, and pregnancy history.

Objective: The purpose of this study was to examine how vaginal douching may influence risk of preterm birth., Study Design: We conducted a hybrid cohort study on risk factors for preterm birth. African American women who resided in Baltimore City, Maryland, were enrolled prenatally if they received prenatal care at 1 of 4 Johns Hopkins Medical Institution prenatal clinics or were enrolled after delivery if they delivered at the Johns Hopkins Medical Institution with late, none, or intermittent prenatal care. Interview data were collected on 832 women delivering singleton infants between March 2001 and July 2004., Results: The preterm birth rate was 16.4%. After adjustment for several potential confounders, those covariates that were associated with either vaginal douching or preterm birth in our sample or that were identified as confounders in the literature, vaginal douching 6 months before pregnancy, and < 3 times per month (prevalence ratio, 0.63; 95% CI, 0.42-0.95) were associated with a reduced risk of preterm delivery. Douching during pregnancy was associated with a trend toward increased risk of preterm birth (prevalence ratio, 1.64; 95% CI, 0.97-2.76)., Conclusion: Vaginal douching effects on the risk of preterm birth depend on the timing of the exposure. Douching in the 6 months before pregnancy, but not during pregnancy, appears to protect against preterm birth.

Objective: To document knowledge, beliefs, douching practices, prevalence of bacterial vaginosis, and preterm births in women who douche., Design: Descriptive, cross-sectional nonexperimental design., Setting: Six private midwifery/nurse practitioner offices and eight county health departments in the Florida panhandle., Participants: Four hundred eighty-three English- or Spanish-speaking women aged 14 to 45 years., Methods: Self-administered questionnaire about douching; medical record review., Main Outcome Measures: Prevalence of douching, history of preterm labor, preterm births, and prevalence of bacterial vaginosis., Results: Of 483 women, 76% had douched, 43% douched at least once per month, and 36% were unaware they should not douche. As determined by odds ratio, women who douched monthly were 2.5 times more likely to have a history of bacterial vaginosis than women who did not douche (p < .001), and women who douched weekly were 2.75 times more likely to have bacterial vaginosis (p = .004). Of 409 clients with medical records available, 32 had preterm births of which 69% had a history of bacterial vaginosis (x2 = 4.5, df = 1, p = .034). Among women with preterm births who douched regularly prior to pregnancy (n = 14), 87% had a history of bacterial vaginosis (x2 = 7.14, df = 1, p = .008)., Conclusions: Associations of douching with bacterial vaginosis and bacterial vaginosis with preterm labor were significant. Health care professionals should initiate discussions to discourage douching.

Objective: The purpose of this study is to characterize African-American women attending a community clinic who report frequent douching (douching > or = 2 times per week)., Methods: A consecutive sample of 115 black women attending a community clinic were interviewed face-to-face about their douching practices. Logistic regression was used to control for age and compute odds ratios and 95% confidence intervals., Results: Of the 115 women interviewed, 93% (107) had douched sometime during their lifetime; 16% (18) reported douching > or = 2 times per week. Frequent douchers compared with women who douche < 2 times per month were more likely to report douching after sex [89% (n=16) vs. 49% (n=32), odds ratio (OR): 5.35, 95% confidence interval (CI): 1.09, 26.2] or after discharge [89% (n=1 6) vs. 58% (n=38), OR: 8.11, 95% CI: 1.64, 40.1], and self-report a history of gonorrhea [28% (n=5) vs. 8% (n=5), OR: 4.87, 95% CI: 1.07, 22.2]., Conclusion: Further research should be done to understand the use of douching as an STD/HIV prevention method and the association between sexual risk behaviors and douching practices.