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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., (© The Author(s) 2015.)

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., (Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

Background: We assessed the effects of preventive practices on sexually transmitted infections (STIs) and reproductive tract infections (RTIs) among female sex workers (FSWs) in Lanzhou, China., Methods: A cross-sectional survey was conducted among 350 FSWs from November 2008 to January 2009. Demographic information and behavioural factors associated with STIs were collected from all the participants. Blood samples and cervical swabs were obtained, and genital and cervical examinations were done at the collection site. A multivariate logistic regression model was used to analyze the relationships between preventive measures and the incidences of STIs and RTIs., Results: The utilization rates of vaginal douching (VD), regular intravenous infusion (RII), and prophylactic oral antibiotics (POA) among FSWs were 72.9%, 35.7%, and 36.3%, respectively. The preventive measures had no impact on diagnosed STIs. On the contrary, the use of VD + POA could increase the risk of vaginal infection by 2-fold (odds ratio (OR) 2.9, 95% credible interval (95% CI) 1.3-6.7). Moreover, the risk for cervical infection increased with the use of POA alone (OR 4.0, 95% CI 1.1-15.4), VD + POA (OR 4.2, 95% CI 1.7-10.3), and VD + RII (OR 2.5, 95% CI 1.1-5.7)., Conclusions: VD, RII, and POA, which were used widely by FSWs to prevent STIs after sex with their clients, were assumed to prevent STIs. Instead, our study indicates that they could increase the risk of vaginal or cervical infections. Therefore, FSWs should be informed of proper preventive strategies to reduce the incidence.

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., (Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

The objective of this study was to assess the sexually transmitted infection (STI) prevalence and sexual risk behavior among female sex workers (FSWs) in Indonesia. This cross-sectional 2005 study involved 2500 FSWs in nine provinces in Indonesia. Informed consent was obtained; behavioral and clinical data were collected. Specimens were collected for STI testing, endocervical swabs were tested for Chlamydia trachomatis and Neisseria gonorrhoeae (PCR), vaginal smears were cultured to detect Trichomonas vaginalis and sera were tested for syphilis (RPR and TPHA). The prevalence of chlamydial infection was 43.5%, gonorrhea 28.6%, trichomoniasis 15.1%, and syphilis 8.7%; the prevalence of any STI was 64.0%. Inconsistent condom use, younger age, and higher number of clients were independent risk factors for the presence of gonorrhea/chlamydia. Inconsistent condom use was common (73.2%); starting sex work at younger age, and higher number of clients were independent risk factors. Vaginal douching was reported by 89.6% of FSWs; no association with gonorrhea/chlamydial infection was found. This study identified a high STI prevalence and low consistent condom use among FSWs in Indonesia. This will need to be addressed to prevent further spread of infections, including HIV.

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.

Objective: To determine the prevalence of douching among a cohort of HIV-infected women and to examine clinical outcomes associated with frequent douching-namely bacterial vaginosis, presence of a sexually-transmitted infections, and genital tract HIV-1 RNA shedding., Study Design: Participants included a concurrent cohort of 187 women attending an HIV outpatient clinic in New Orleans, LA. Subjects underwent clinical examinations and answered questions in a computer-assisted survey at each visit., Results: At baseline, 1-, and 3-month follow-ups, 64.2%, 56.5%, and 54.7% of women, respectively, indicated that they douched. In multivariable analyses, douching >1 time a month was independently associated with the outcomes of bacterial vaginosis and presence of a selected sexually transmitted infection (Trichomonas vaginalis, Neisseria gonorrhea, or Chlamydia trachomatis). Although not significant, women who douched >1 time a month were also twice as likely to have genital tract HIV-1 RNA shedding as nondouchers., Conclusions: This is the first study performed in women infected with HIV to link a significant dose-response relationship between douching and the clinical outcomes of bacterial vaginosis and presence of a sexually transmitted infection, and to examine the association between douching and genital tract HIV-1 RNA shedding.

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.

Objective: The objective of this study was to identify douching patterns and their relation to sexually transmitted disease (STD) among black women seeking an STD evaluation., Study Design: This study was a cross-sectional survey with biologic testing for chlamydia and gonorrhea infection., Results: Of 891 participants, 46.1% were current douchers. Commonly identified reasons for douching were to cleanse after menses (65.4%) and to feel fresh (42.2%). Frequent douching was associated with douching after sex (P<0.001), to alleviate an itch (P<0.001), and to feel fresh (P<0.001). Women who douched during menses (adjusted odds ratio [AOR]=4.78; 95% confidence interval [CI]=1.13-20.13) and to alleviate an itch (AOR=3.66; 95% CI=1.00-13.41) were more likely to have a current chlamydial infection., Conclusions: Douching was common among this high-risk population of black women. Prospective studies are needed to determine the consequences of douching and any mediating effects of women's motivation for the behavior on reproductive health.

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.