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A longitudinal study of vaginal douching and bacterial vaginosis--a marginal structural modeling analysis.
- Source :
-
American journal of epidemiology [Am J Epidemiol] 2008 Jul 15; Vol. 168 (2), pp. 188-96. Date of Electronic Publication: 2008 May 23. - Publication Year :
- 2008
-
Abstract
- The etiology of bacterial vaginosis is unknown, and there are no long-term therapies for preventing this frequently recurring condition. Vaginal douching has been reported to be associated with bacterial vaginosis in observational studies. However, this association may be due to confounding by indication--that is, confounding by women douching in response to vaginal symptoms associated with bacterial vaginosis. The authors used marginal structural modeling to estimate the causal effect of douching on bacterial vaginosis risk while controlling for this confounding effect. In 1999-2002, nonpregnant women (n = 3,620) were recruited into a prospective study when they visited one of 12 public health clinics in Birmingham, Alabama, for routine care. Participants were assessed quarterly for 1 year. Bacterial vaginosis was based on a Nugent's Gram stain score of 7 or higher. Thirty-two percent of participants douched in every study interval, and 43.0% never douched. Of the 12,349 study visits, 40.2% were classified as involving bacterial vaginosis. The relative risk for regular douching as compared with no douching was 1.21 (95% confidence interval: 1.08, 1.38). These findings indicate that douching confers increased risk of disruption of vaginal flora. In the absence of a large randomized trial, these findings provide the best evidence to date for a risk of bacterial vaginosis associated with douching.
- Subjects :
- Adult
Confidence Intervals
Confounding Factors, Epidemiologic
Female
Genital Diseases, Female diagnosis
Genital Diseases, Female epidemiology
Humans
Logistic Models
Longitudinal Studies
Multivariate Analysis
Risk Factors
Vaginal Douching statistics & numerical data
Vaginosis, Bacterial diagnosis
Vaginosis, Bacterial epidemiology
Vaginal Douching adverse effects
Vaginosis, Bacterial etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1476-6256
- Volume :
- 168
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- American journal of epidemiology
- Publication Type :
- Academic Journal
- Accession number :
- 18503038
- Full Text :
- https://doi.org/10.1093/aje/kwn103