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Cannovo N, Bianchini E, Gironacci L, Garbati E, Di Prospero F, Cingolani M, Scendoni R, Fedeli P. Sexually Transmitted Infections in Adolescents and Young Adults: A Cross Section of Public Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:501. [PMID: 38673412 PMCID: PMC11050350 DOI: 10.3390/ijerph21040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Sexually transmitted infections (STIs) can be caused by a number of microorganisms that vary greatly in size, life cycle, clinical manifestations, and sensitivity to available treatments. Transmission of STIs can occur during unprotected (or condomless) sexual contact and through the exchange of body fluids during any type of activity. The prevalence of sexually transmitted diseases remains high in the world, despite diagnostic and therapeutic improvements for these infectious diseases that rapidly eliminate the contagiousness of patients. Our study determines the prevalence of STI pathogens in adolescents and young adults in the population of the Province of Macerata (Italy). We will analyze data in correspondence to age and gender, and we will compare our results to international studies. MATERIALS AND METHOD We analyzed STI test results from the entire database of a Provincial Health Authority for the period 2021-2022. The samples came from the following age groups: 0-12, 13-18, 19-25, and 26-35 from 2021 to 2022. The results came from vaginal and cervical swabs (for females); urethral, rectal, and pharyngeal swabs (for males and females); and seminal fluid (for males) for the following infections: HPV, Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasmas, Gardnerella, Trichomonas vaginalis, Neisseria gonorrhoeae, and Treponema pallidum. The results also came from blood tests for HIV, hepatitis C, hepatitis B, and Treponema pallidum (TPHA, VDRL). In addition, we examined results from urine tests for chlamydia, Neisseria gonorrhoeae, trichomonas, and Treponema pallidum. CONCLUSIONS The literature for other countries reports the need for comprehensive, culturally and developmentally sensitive care to address sexuality-related issues in adolescents and young adults, a need that also applies to Italy. These data will be of great importance in adopting evidence-based STI control programs in Marche Region. This study could, indeed, represent a landmark for public health officials and professionals, with the aim of promoting adolescents' access to sexual health services to receive useful information, strengthening preventive measures in younger age groups, and designing sexual education programs.
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Affiliation(s)
- Nunzia Cannovo
- Legal Medicine Unit, Local Health Authority (AST) 3, 62032 Camerino, Italy;
| | - Elena Bianchini
- Clinical Governance and Risk Unit, Macerata Hospital, Local Health Authority (AST) 3, 62100 Macerata, Italy;
| | - Luciana Gironacci
- Analysis Laboratory Unit, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy;
| | - Elisabetta Garbati
- Gynecology and Obstetrics Unit, Civitanova Marche Hospital, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy; (E.G.); (F.D.P.)
| | - Filiberto Di Prospero
- Gynecology and Obstetrics Unit, Civitanova Marche Hospital, Local Health Authority (AST) 3, 62012 Civitanova Marche, Italy; (E.G.); (F.D.P.)
| | - Mariano Cingolani
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy;
| | - Roberto Scendoni
- Department of Law, Institute of Legal Medicine, University of Macerata, 62100 Macerata, Italy;
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
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Yazdy GM, Mitchell C, Sobel JD, Tuddenham S. Recurrent Infectious Vaginitis: A Practical Approach for the Primary Care Clinician. Med Clin North Am 2024; 108:373-392. [PMID: 38331486 DOI: 10.1016/j.mcna.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Recurrent infectious vaginitis can lead to significant morbidity, patient frustration, and health care costs. The most common causes are bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC); however, other infectious and noninfectious etiologies should be considered in patients with recurrent symptoms. A detailed history and physical examination with appropriate testing at the time of symptoms is critical to establishing a correct diagnosis. Management options for recurrent BV and VVC are limited. Complex cases including those with atypical symptoms, negative testing for common causes, refractory symptoms despite appropriate therapy or recurrences during suppressive therapy will require referral to specialist care.
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Affiliation(s)
- Golsa M Yazdy
- Department of Gynecology & Obstetrics, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Caroline Mitchell
- Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Jack D Sobel
- Department of Medicine, Division of Infectious Diseases, Wayne State University, 3901 Chrysler Drive Suite 4A, Detroit, MI 48201, USA
| | - Susan Tuddenham
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, 5200 Eastern Avenue, MFL Center Tower, Suite 381, Baltimore, MD 21224, USA.
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Ziogou A, Ziogos E, Giannakodimos I, Giannakodimos A, Sifakis S, Ioannou P, Tsiodras S. Bacterial Vaginosis and Post-Operative Pelvic Infections. Healthcare (Basel) 2023; 11:healthcare11091218. [PMID: 37174760 PMCID: PMC10178576 DOI: 10.3390/healthcare11091218] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/18/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Bacterial vaginosis (BV) represents a condition in which the normal protective Lactobacilli, especially those that produce H2O2, are replaced by high quantities of facultative anaerobes, leading to gynecologic and obstetric post-operative complications. BV is an important cause of obstetric and gynecological adverse sequelae and it could lead to an increased risk of contracting sexually transmitted infections such as gonorrhea, genital herpes, Chlamydia, Trichomonas, and human immunodeficiency virus. Herein, we reviewed bacterial vaginosis and its association with post-operative pelvic infections. In Obstetrics, BV has been associated with increased risk of preterm delivery, first-trimester miscarriage in women undergoing in vitro fertilization, preterm premature rupture of membranes, chorioamnionitis, amniotic fluid infections, postpartum and postabortal endomyometritis as well as postabortal pelvic inflammatory disease (PID). In gynecology, BV increases the risk of post-hysterectomy infections such as vaginal cuff cellulitis, pelvic cellulitis, pelvic abscess, and PID. BV is often asymptomatic, can resolve spontaneously, and often relapses with or without treatment. The American College of Obstetricians and Gynecologists recommends testing for BV in women having an increased risk for preterm delivery. Women with symptoms should be evaluated and treated. Women with BV undergoing gynecological surgeries must be treated to reduce the frequency of post-operative pelvic infections. Metronidazole and clindamycin are the mainstays of therapy. Currently, there is no consensus on pre-surgery screening for BV; decisions are made on a case-by-case basis.
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Affiliation(s)
- Afroditi Ziogou
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleftherios Ziogos
- Department of Gynecology and Obstetrics, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Ilias Giannakodimos
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alexios Giannakodimos
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Sotirios Tsiodras
- School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Fourth Department of Internal Medicine, Attikon General Hospital, 12462 Athens, Greece
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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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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 719] [Impact Index Per Article: 239.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Dabee S, Passmore JAS, Heffron R, Jaspan HB. The Complex Link between the Female Genital Microbiota, Genital Infections, and Inflammation. Infect Immun 2021; 89:e00487-20. [PMID: 33558324 PMCID: PMC8091093 DOI: 10.1128/iai.00487-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The female genital tract microbiota is part of a complex ecosystem influenced by several physiological, genetic, and behavioral factors. It is uniquely linked to a woman's mucosal immunity and plays a critical role in the regulation of genital inflammation. A vaginal microbiota characterized by a high abundance of lactobacilli and low overall bacterial diversity is associated with lower inflammation. On the other hand, a more diverse microbiota is linked to high mucosal inflammation levels, a compromised genital epithelial barrier, and an increased risk of sexually transmitted infections and other conditions. Several bacterial taxa such as Gardnerella spp., Prevotella spp., Sneathia spp., and Atopobium spp. are well known to have adverse effects; however, the definitive cause of this microbial dysbiosis is yet to be fully elucidated. The aim of this review is to discuss the multiple ways in which the microbiota influences the overall genital inflammatory milieu and to explore the causes and consequences of this inflammatory response. While there is abundant evidence linking a diverse genital microbiota to elevated inflammation, understanding the risk factors and mechanisms through which it affects genital health is essential. A robust appreciation of these factors is important for identifying effective prevention and treatment strategies.
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Affiliation(s)
- Smritee Dabee
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | | | - Heather B Jaspan
- Seattle Children's Research Institute, Seattle, Washington, USA
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- University of Washington, Seattle, Washington, USA
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Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women. Nurs Res 2021; 70:405-411. [PMID: 34262008 PMCID: PMC8462522 DOI: 10.1097/nnr.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence suggests that intravaginal practices (IVPs) women use to cleanse their vagina or enhance sexual pleasure may be associated with unhealthy changes in the vaginal microbiome (VM). However, the effects of these practices in postmenopausal women are unknown. OBJECTIVES The objective of this pilot study was to characterize the VM communities of postmenopausal women, identify types and frequency of IVPs, and explore associations between the VM and IVPs in postmenopausal women. METHODS We analyzed the VM data of 21 postmenopausal women in Atlanta, Georgia, from vaginal swabs collected at a routine gynecological visit. 16S rRNA gene sequencing in the V3-V4 region was used to characterize the VM. In addition, we described the IVPs of these women, identified by using our newly developed instrument: the Vaginal Cleansing Practices Questionnaire. The associations between the VM and IVPs were explored by comparing the alpha diversities, beta diversities, and the relative abundances at both the community level and individual genus level. RESULTS The most abundant known bacterial genus found in the VM samples was Lactobacillus (35.7%), followed by Prevotella (21.4%). Eleven women (52%) reported using at least one type of IVP since menopause. The most common type of IVP was soap and water to clean inside the vagina. The use of IVPs was not associated with any alpha diversity metric, including Shannon index, inverse Simpson index, and Chao1 index; beta diversity metric, including Bray-Curtis and Jaccard distances; nor relative abundances at the community and individual genus level. Sociodemographic factors were also not associated with any alpha diversity metric. DISCUSSION Clinicians must assess IVPs and other vaginal and sexual hygiene practices of women of all ages to educate and promote healthy behaviors. More than half of the postmenopausal women in this pilot study use IVPs. Understanding the reasoning behind participants' use of IVPs and their perceptions of the possible effects of these practices will require further research. Although the small sample did not show associations with the VM, more extensive studies are warranted.
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Gondwe T, Ness R, Totten PA, Astete S, Tang G, Gold MA, Martin D, Haggerty CL. Novel bacterial vaginosis-associated organisms mediate the relationship between vaginal douching and pelvic inflammatory disease. Sex Transm Infect 2019; 96:439-444. [PMID: 31810995 PMCID: PMC7476288 DOI: 10.1136/sextrans-2019-054191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives We sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among Atopobium vaginae, the BV-associated bacterium 1 (BVAB1), neathia (Leptotrichia) amnionii and Sneathia sanguinegens. Methods We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models. Results Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95% CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95% CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95% CI: 0.53 to 1.70) as intermediate variables. Conclusions Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.
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Affiliation(s)
- Tamala Gondwe
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Roberta Ness
- Department of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA
| | - Patricia A Totten
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sabina Astete
- Department of Medicine, Division of Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Gong Tang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Melanie A Gold
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center and Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - David Martin
- Department of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - Catherine L Haggerty
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA .,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA
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Chapa HO, Dawson D, Brading K, Hodnett M, Zimmermann R, Teke M. Non-Sexual Pelvic Inflammatory Disease in a Virginal Patient Resulting in Catatonic Conversion Reaction. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bui TC, Tran LTH, Hor LB, Scheurer ME, Vidrine DJ, Markham CM. Intravaginal Practices in Female Sex Workers in Cambodia: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:935-943. [PMID: 26742508 PMCID: PMC4821710 DOI: 10.1007/s10508-015-0675-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/12/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phnom Penh, Cambodia. We conducted in-depth interviews using open-ended questions with 30 FSWs in July-August 2014. We analyzed data using thematic content analysis, with thematic codes based on the constructs of the theory of planned behavior. The results showed that the most common IVP was a combination of intravaginal washing and wiping, to which we refer as intravaginal cleansing. There was a clear and close connection between IVP and sex work. Perceived benefits of intravaginal cleansing were numerous, while the perceived risks were few. As a result, the attitude toward intravaginal cleansing was favorable. A common misperception of benefit was that intravaginal cleansing could prevent sexually transmitted infections. Local physicians considerably influenced the subjective norm related to IVP. Intention to quit IVPs was suboptimal. In conclusion, the psychological factors associated with IVPs in FSWs were somewhat different from those in the general population of Cambodian women and women in other countries. Behavioral beliefs, attitude, and subjective norms appeared salient and important factors in IVPs. Interventions aimed at reducing IVPs should target these constructs as well as the sex-work-associated economic motives. Local physicians may be an agent to change IVP and an effective channel to deliver interventions.
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Affiliation(s)
- Thanh Cong Bui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA.
| | - Ly Thi-Hai Tran
- Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Michael E Scheurer
- Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine and Texas Children's Cancer Center, Houston, TX, USA
| | - Damon J Vidrine
- Stephenson Cancer Center and Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christine M Markham
- Department 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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Kovachev SM. Obstetric and gynecological diseases and complications resulting from vaginal dysbacteriosis. MICROBIAL ECOLOGY 2014; 68:173-184. [PMID: 24711012 DOI: 10.1007/s00248-014-0414-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/24/2014] [Indexed: 06/03/2023]
Abstract
Accurate knowledge of the composition and ecology of vaginal microbial environment of a healthy woman is necessary for the understanding of normal flora and how to reduce the risk for diseases. Vagina and its microflora form a balanced ecosystem in which dominated bacteria are vaginal lactobacilli. There are dynamic changes in this ecosystem having structure and composition depending on many factors. The term dysbacteriosis defines any movement outside the normal range for the given biotope of obligate and/or facultative microflora. Such a change in the quantity and quality of the respective microbial balance is fraught with danger and requires correction and recovery. The purpose of this overview is to examine obstetric and gynecological diseases that can cause vaginal impaired microbial balance. Vaginal dysbacteriosis is a cause, predecessor, and often also consequence of vaginal infections. In essence, any vaginal infection can be seen as dysbacteriosis, developed to the most severe extent. Here, there is a dominant microorganism other than lactic acid bacteria in the vagina (clinically manifested or not, respectively), depletion of defense mechanisms of the vagina associated with the shift of lactobacilli from their dominant role in the vaginal balance, decrease in their number and species diversity, and a resulting change in the healthy status of the vagina. Vaginal dysbacteriosis can be found in pathogenetic mechanism, whereby many obstetric and gynecological diseases develop. Most of these diseases lead directly to increased maternal and infant morbidity and mortality, so it is important to understand the reasons for them and the arrangements for their prevention.
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Affiliation(s)
- Stefan Miladinov Kovachev
- Department of Gynecology, Military Medical Academy, "P.U.Todorov" bul. bl. No. 5, entr. B, fl. No. 25, 1404, Sofia, Bulgaria,
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Nicole W. A question for women's health: chemicals in feminine hygiene products and personal lubricants. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:A70-5. [PMID: 24583634 PMCID: PMC3948026 DOI: 10.1289/ehp.122-a70] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Farage MA, Miller KW, Davis A. Cultural aspects of menstruation and menstrual hygiene in adolescents. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.11.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment. Infect Dis Clin North Am 2013; 27:793-809. [PMID: 24275271 DOI: 10.1016/j.idc.2013.08.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pelvic inflammatory disease (PID) is characterized by infection and inflammation of the upper genital tract in women and can cause significant reproductive health sequelae for women. Although a definitive diagnosis of PID is made by laparoscopic visualization of inflamed, purulent fallopian tubes, PID is generally a clinical diagnosis and thus represents a diagnostic challenge. Therefore, diagnosis and treatment algorithms advise a high index of suspicion for PID in any woman of reproductive age with pelvic or abdominal pain. Antibiotic therapy should be started early, and given for an adequate period of time to reduce the risk of complications. Coverage for anaerobic organisms should be considered in most cases.
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Marrazzo JM, Hillier SL. Bacterial Vaginosis. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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Donders GGG, Andabati G, Donders F, Michiels T, Eggermont N, Bellen G, Lulé J. Acceptance of self-testing for increased vaginal pH in different subsets of Ugandan women. Int J STD AIDS 2012; 23:30-5. [DOI: 10.1258/ijsa.2011.011190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the acceptance of self-testing for vaginal pH in 344 Ugandan women in different clinical settings. Women tested themselves by insertion of a gloved finger into the vagina to test vaginal pH and provide a smear on a glass slide. None of the tested women found the test very difficult: 8% found it somewhat difficult, 16% rather easy and 76% very easy to do. Of the 20% who found it difficult to read the test result, more women were attending a family planning clinic or had a higher diploma ( P = 0.001). Pregnant women were least likely to understand of the meaning of the test, while those visiting family planning clinics had the opposite experience. HIV-infected women were most motivated to accept: 95% would be happy to use the test more often if requested, and another 3.5% felt they might be better motivated to do repeat testing after extra explanation. Self-sampling of vaginal pH is well accepted by Ugandan women. Our new method also allows diagnostic work-up by formal microscopy. Before commencing large-scale population screening, unexpected reactions of different subpopulations should be taken into account.
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Affiliation(s)
- G G G Donders
- Department of Ob/Gyn, University Hospital, Gasthuisberg, Leuven
- H Hart Hospital, Tienen
- Femicare Clinical Research for Women, Tienen, Belgium
| | - G Andabati
- Department of Ob/Gyn, Mulago Hospital, Kampala, Uganda
| | - F Donders
- Femicare Clinical Research for Women, Tienen, Belgium
| | - T Michiels
- Femicare Clinical Research for Women, Tienen, Belgium
| | - N Eggermont
- Femicare Clinical Research for Women, Tienen, Belgium
| | - G Bellen
- Femicare Clinical Research for Women, Tienen, Belgium
| | - J Lulé
- Department of Ob/Gyn, Mulago Hospital, Kampala, Uganda
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Erbil N, Alışarlı A, Terzi HÇ, Ozdemir K, Kuş Y. Vaginal douching practices among Turkish married women. Gynecol Obstet Invest 2011; 73:152-7. [PMID: 22122972 DOI: 10.1159/000332372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 08/17/2011] [Indexed: 11/19/2022]
Abstract
AIM This study was conducted to investigate the prevalence of the practice of vaginal douching among Turkish married women and associations between their douching status, predisposing factors, and effects on their health. METHODS This cross-sectional survey of women between 17 and 61 years of age was conducted between February 1, 2007, and May 18, 2007, in the Maternity-Gynecology and Children's Hospital in Ordu, Turkey. The sample of this study included 427 women. A confidential and anonymous self-reported questionnaire was collected in a convenient sample of the women. RESULTS Of the 427 women in the study, 165 women (38.6%) had douched at some time. Housewives [odds ratio (OR) 2.660, 95% confidence interval (CI) 1.162-6.090], women who had experienced a spontaneous abortion (OR 4.676, 95% CI 1.606-13.618), or had beliefs about positive health effects of vaginal douching (OR 29.603, 95% CI 14.090-62.192) also had risk factors associated with vaginal douching practices. CONCLUSION In conclusion, this study found that vaginal douching is a common practice among women. Many of the women who practiced vaginal douching believed in its health benefits. The results may enhance healthcare practitioners' knowledge and efforts to educate their patients.
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Affiliation(s)
- Nülüfer Erbil
- Department of Nursing, School of Health, Ordu University, Ordu, Turkey
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19
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Burnett AM, Anderson CP, Zwank MD. Laboratory-confirmed gonorrhea and/or chlamydia rates in clinically diagnosed pelvic inflammatory disease and cervicitis. Am J Emerg Med 2011; 30:1114-7. [PMID: 22030186 DOI: 10.1016/j.ajem.2011.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/13/2011] [Accepted: 07/15/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the rates of laboratory confirmed gonorrhea (GC) and chlamydia (CT) in emergency department (ED) patients with pelvic inflammatory disease (PID) and cervicitis who were diagnosed clinically and treated empirically. A secondary goal examines which clinical criteria were present in patients with PID testing positive for GC/CT. METHODS We conducted a retrospective chart review of all ED patents diagnosed with PID or cervicitis during a 40-month period (January 2007-March 2010). Charts were reviewed for laboratory-confirmed GC or CT. For patients with positive GC or CT studies, the presence of key clinical criteria used in the diagnosis of PID was tallied. RESULTS A total of 1469 patients were diagnosed with cervicitis and 343 with PID. Of these patients, 27 (1.8%) of 1469 and 15 (4.4%) of 343 were GC positive, and 136 (9.3%) of 1469 and 34 (10%) of 343 were CT positive. Twenty-six cervicitis (1.8%) and 9 PID (2.6%) patients were positive for both infections. One hundred eighty-nine cervicitis (13%) and 58 PID (17%) patients were positive for at least 1 sexually transmitted infection. Of the 58 patients with PID with laboratory-confirmed GC/CT, the following clinical criteria were present: abdominal pain, 58 of 58; abdominal tenderness, 50 of 58; cervical discharge, 47 of 58; cervical motion tenderness, 46 of 58; adnexal tenderness, 32 of 58; vaginal bleeding, 8 of 58; and fever, 2 of 58. Ultrasound was preformed in 27 (47%) of 58 GC/CT-positive patients with PID, with findings suggestive of PID in 12 (44%) of 27 ultrasounds. One hundred percent of abnormal ultrasounds were associated with positive GC and/or CT results. CONCLUSION There is a generally low prevalence of GC and CT in this patient population diagnosed with cervicitis or PID. There is a very low prevalence of coinfection.
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Affiliation(s)
- Aaron M Burnett
- Department of Emergency Medicine, Regions Hospital, St Paul, MN 55101, USA.
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20
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Short MB, Black WR, Flynn K. Discussions of vaginal douching with family members. J Pediatr Adolesc Gynecol 2010; 23:39-44. [PMID: 19643647 DOI: 10.1016/j.jpag.2009.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 05/06/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE This study examined women's personal douching history and the information they were given by others. METHODS Participants in the study (N=199; mean age=28.92) completed a 48-question survey on douching practices and attitudes. RESULTS Fifty-seven percent of participants had douched and 39% currently douche. The majority of women reported douching after menstruation, before or after sex, or as needed. Reasons for douching included maintaining cleanliness, feeling good and fresh, eliminating vaginal odor, and removing menstrual blood. Most women (69%) had at least one discussion about douching, with 49% having a discussion with their mother and 22% with a health care provider (HCP). Of the women who currently do not douche, 47% stopped after a HCP instructed them to quit; whereas, 100% of women whose HCP encouraged douching went on to douche. Furthermore, 66% of women planned to discuss douching with a younger girl, with 57% encouraging or being neutral and 43% discouraging it. Women who have previously douched were more likely to discuss and encourage douching than women who had never douched. Also, women who have received a discussion about douching or were encouraged to douche were more likely to douche than women who had not received a discussion or were discouraged. CONCLUSIONS Results from this study suggest that younger generations may be taught about or encouraged to douche by their mothers. By giving women accurate information and discouraging douching, women may be less likely to douche or encourage douching in their daughters.
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Affiliation(s)
- Mary B Short
- Department of Psychology, University of Houston-Clear Lake, Houston, Texas 77058, USA.
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21
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Arbour M, Corwin EJ, Salsberry P. Douching patterns in women related to socioeconomic and racial/ethnic characteristics. J Obstet Gynecol Neonatal Nurs 2010; 38:577-85. [PMID: 19883479 DOI: 10.1111/j.1552-6909.2009.01053.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Megan Arbour
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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22
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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.e1-8. [PMID: 18667177 DOI: 10.1016/j.ajog.2008.06.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/30/2008] [Accepted: 06/05/2008] [Indexed: 11/26/2022]
Abstract
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.
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23
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McKee MD, Baquero M, Anderson MR, Alvarez A, Karasz A. Vaginal douching among Latinas: practices and meaning. Matern Child Health J 2008; 13:98-106. [PMID: 18297379 DOI: 10.1007/s10995-008-0327-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Vaginal douching is widely practiced by American women, particularly among minority groups, and is associated with increased risk of pelvic and vaginal infections. This research sought to investigate vaginal hygiene practices and meaning associated with them among Latina women and adolescents. Study results would guide development of an intervention to decrease douching among Latinas. METHODS In depth qualitative interviews conducted with English- and Spanish-speaking women aged 16-40, seeking care for any reason who reported douching within the last year (n = 34). Interviews were audiotaped, transcribed and analyzed using qualitative methods. One-third of interviews were conducted in Spanish. RESULTS Two explanatory models for douching motives emerged: one stressed cosmetic benefits; the other, infection prevention and control. Most women reported douching to eliminate menstrual residue; a small number reported douching in context of sexual intercourse or vaginal symptoms. Many were unaware of associated health risks. Respondents typically learned about douching from female family members and friends. Male partners were described as having little to no involvement in the decision to douche. Women varied in their willingness to stop douching. Two-thirds reported receiving harm reduction messages about "overdouching". About half indicated previous discussion about douching with health care providers; some had reduced frequency in response to counseling. A number of previously unreported vaginal hygiene practices and products were described, including use of a range of traditional hygiene practices, and products imported from outside the US. CONCLUSIONS Respondents expressed a range of commitment to douching. Counseling messages acknowledging benefits women perceive as well as health risks should be developed and delivered tailored to individual beliefs. Further research is needed to assess prevalence and safety of previously unreported practices.
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Affiliation(s)
- M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461, USA.
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24
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Smith KJ, Cook RL, Roberts MS. Time from sexually transmitted infection acquisition to pelvic inflammatory disease development: influence on the cost-effectiveness of different screening intervals. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2007; 10:358-66. [PMID: 17888100 DOI: 10.1111/j.1524-4733.2007.00189.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To prevent pelvic inflammatory disease (PID), some experts recommend screening for sexually transmitted infection (STI) every 12 months, with more frequent screening suggested in higher-risk women. Nevertheless, the time from STI acquisition to PID development, possibly an important factor to consider in screening interval choice, is unknown and its influence on the effectiveness and cost-effectiveness of screening is unclear. METHODS Using a Markov model, we estimated PID cases averted and the incremental cost-effectiveness resulting from 6- or 12-month screening strategies for high-risk young women (6%/year infection risk, 2.8%/year PID risk with 12-month screening) while varying PID development time from 1 to 12 months after initial infection. Lower-risk women and alternative parameter values were examined in sensitivity analyses. RESULTS Relative to 12-month screening, 6-month screening decreases PID cases from 6.0% (1 month development time)to 19.4% (12 months); the incremental cost per quality-adjusted life-year (QALY) gained compared with the other strategies varies from $16,600 (12 months development time) to $31,800 (1 month) for high-risk women. In lower-risk women, every 6-month screening is more economically unfavorable, with greater costs per QALY gained at shorter PID development time. CONCLUSION From a cost-effectiveness standpoint, uncertainty about PID development time is not a significant factor in choosing a screening interval in high-risk women, but could be important in lower-risk groups. Significant increases in PID cases averted occur with more frequent screening when PID development time is lengthened, which may allow estimation of this interval through the use of more sophisticated modeling techniques.
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Affiliation(s)
- Kenneth J Smith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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25
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Ege E, Timur S, Zincir H, Egri M, Sunar Reeder B. Women's douching practices and related attitudes in eastern Turkey. J Obstet Gynaecol Res 2007; 33:353-9. [PMID: 17578366 DOI: 10.1111/j.1447-0756.2007.00535.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Vaginal douching is a common hygiene practice for many women all over the world, but it is associated with several health risks. Little is known about the beliefs and attitudes that promote and maintain douching practices. Therefore, the objective of the present study was to evaluate the status of vaginal douching practices of women in the Malatya province of eastern Turkey. METHODS This was a cross-sectional study. A sample of 465 Muslim women was interviewed to ascertain the status of vaginal douching practices. All participants were between 15 and 49 years of age and all were married. Data were collected by using a questionnaire in the process of conducting face-to-face interviews in June 2004. Data analysis included descriptive statistics and logistic regression modeling. RESULTS The present study revealed that the frequency of douching was 61.5% among women. The participants were frequently douching for feminine hygiene (47.6%). Vaginal douching practices were associated with several factors including education level (odds ratio [OR] = 1.991, 95% confidence interval [CI] = 1.154-3.434), family income (OR = 0.996, 95% CI = 0.994-0.998), marital age (OR = 0.402, 95% CI = 0.223-0.715), frequency of sexual intercourse (OR = 2.335, 95% CI = 1.532-3.554), and presence of genital syndromes/infections (OR = 1.813, 95% CI = 1.215-2.739). CONCLUSION This study provides preliminary information about women's douching practices and attitudes in the Malatya region of Turkey. It may 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)
- Emel Ege
- Department of Nursing, Konya School of Health, Selcuk University, Turkey.
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26
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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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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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Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. THE LANCET. INFECTIOUS DISEASES 2005; 5:786-94. [PMID: 16310150 DOI: 10.1016/s1473-3099(05)70298-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Intravaginal practices such as "dry sex" and douching have been suggested as a risk factor that may increase women's susceptibility to HIV infection. These behaviours appear common in different populations across sub-Saharan Africa, where practices include the use of antiseptic preparations, traditional medicines, or the insertion of fingers or cloths into the vagina. We systematically review the evidence for the association between women's intravaginal practices and HIV infection. Although a number of cross-sectional studies have shown that prevalent HIV infection is more common among women reporting intravaginal practices, the temporal nature of this association is unclear. Current evidence suggests that bacterial vaginosis, which is a likely risk factor for HIV infection, may be a mediator of the association between intravaginal practices and HIV. Although biologically plausible mechanisms exist, there is currently little epidemiological evidence suggesting that intravaginal practices increase women's susceptibility to HIV infection. Further research into factors that increase women's susceptibility to HIV will help to inform the design of vaginal microbicides and other HIV prevention interventions.
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Affiliation(s)
- Landon Myer
- Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Abstract
Pelvic inflammatory disease (PID) is a polymicrobial infection typically occurring in sexually active females. It occurs when microorganisms ascend from the lower genital tract into the upper genital tract. The clinical presentation varies in severity, with most patients presenting with mild disease. Complications include tubo-ovarian abscess, ectopic pregnancy, infertility, and chronic pain. The newly revised criteria issued by the Centers for Disease Control and Prevention now include either cervical motion tenderness or adnexal tenderness with unchanged additional criteria.
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Affiliation(s)
- Chantay Banikarim
- Children's Health Center, St. Joseph's Hospital, Phoenix, Arizona, USA
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Haggerty CL, Peipert JF, Weitzen S, Hendrix SL, Holley RL, Nelson DB, Randall H, Soper DE, Wiesenfeld HC, Ness RB. Predictors of Chronic Pelvic Pain in an Urban Population of Women With Symptoms and Signs of Pelvic Inflammatory Disease. Sex Transm Dis 2005; 32:293-9. [PMID: 15849530 DOI: 10.1097/01.olq.0000162361.69041.a5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [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 assess the risk profile for chronic pelvic pain (CPP) after pelvic inflammatory disease (PID). STUDY Multivariate logistic regression was used to assess risk factors for CPP in a longitudinal study of 780 predominately black, urban women with clinically suspected PID: complaints of acute pain (<30 days); a clinical finding of pelvic tenderness; and leukorrhea, mucopurulent cervicitis, or untreated gonococcal or chlamydial cervicitis. CPP was defined as pain reported at >or=2 consecutive interviews conducted every 3 to 4 months for 2 to 5 years. RESULTS Nonblack race (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.31-3.58), being married (OR, 2.06; 95% CI, 1.02-4.18), a low SF-36 mental health composite score (OR, 2.71; 95% CI, 1.69-4.34), >or=2 prior PID episodes (OR, 2.84; 95% CI, 1.07-7.54), and smoking (OR, 1.65; 95% CI, 1.01-2.71) independently predicted CPP. Histologic endometritis or evidence of endometrial Neisseria gonorrhoeae or Chlamydia trachomatis infection was negatively associated with CPP (OR, 0.69; 95% CI, 0.44-1.10). CONCLUSIONS A range of demographic, clinical, historical, and behavioral factors predict CPP after PID.
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Affiliation(s)
- Catherine L Haggerty
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania 15261, USA
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Martino JL, Youngpairoj S, Vermund SH. Vaginal douching: personal practices and public policies. J Womens Health (Larchmt) 2005; 13:1048-65. [PMID: 15665661 DOI: 10.1089/jwh.2004.13.1048] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaginal douching is associated with adverse reproductive health outcomes, yet both health providers and women are often poorly informed about details of this practice. METHODS We searched the English language articles in the MEDLINE database (1965-March 2004) to describe vaginal douching products, policies of professional organizations, predictors of douching practice, douching methods used, timing of use, and motivation. A key report was obtained from the Food and Drug Administration (FDA) via the Freedom of Information Act. Additional product information was obtained from manufacturers. Primary key terms for the literature search included (vagina OR vaginal) and (douche OR douching). Health effects of douching are reviewed briefly; personal practices and public policies are highlighted. RESULTS From the literature search, we identified 432 papers, of which 150 were reviewed in detail. Contrary to the assumptions of many health professionals, douching products are only loosely regulated by the FDA. Few professional organizations have clearly stated policy statements regarding douching. In the United States, the prevalence of douching varies considerably by race (more common among African Americans) and age cohort (more common in women born earlier). Internationally, vaginal douching is common in some cultures and is rare in others. Opinions of mothers, peers, and health professionals, in addition to marketing of commercial products, affect douching behavior. CONCLUSIONS Regulation of vaginal douching products and public education efforts on douching behavior need to be reassessed. Because of the preponderance of evidence that suggests an association between vaginal douching and adverse reproductive health outcomes, professional and public health associations should consider educational and policy activities to discourage women from douching.
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Affiliation(s)
- Jenny L Martino
- Departments of Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
Vaginal immunity in response to microbial perturbation is still poorly understood and may be crucial for protection from adverse outcomes associated with bacterial vaginosis (BV). BV is the most prevalent vaginal disorder in adult women worldwide. However, its pathogenesis is still elusive. In BV-positive women, inflammatory signs are scant--approximately 50% of women are asymptomatic. The number of vaginal neutrophils in the BV-positive patient is not increased with respect to healthy women. In contrast, vaginal interleukin (IL)-1beta levels are largely increased. Recent findings indicate that microbial hydrolytic enzymes could be responsible for dampening the expected proinflammatory response cascade after IL-1beta increase. In other words, BV causes a large increase of vaginal IL-1beta, which is not paralleled by an increase of IL-8 levels, suggesting that BV-associated factors specifically dampen IL-8. The impairment of IL-8 increase may explain the absence of neutrophil increase in most women exposed to a massive abnormal anaerobic vaginal colonization (BV). Among BV-positive women, vaginal innate immunity is strongly correlated to a specific adaptive immune response: the immunoglobulin A (IgA) against the hemolysin produced by Gardnerella vaginalis (anti-Gvh IgA), which is the main bacterium present in BV. High anti-Gvh IgA levels are protective for adverse pregnancy outcomes. However, an exaggerated inflammatory response, mainly attributed to genetic polymorphisms, is also implicated in BV-associated adverse outcomes.
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Affiliation(s)
- Sabina Cauci
- Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Piazzale Kolbe 4, 33100 Udine, Italy.
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Zhang J, Hatch M, Zhang D, Shulman J, Harville E, Thomas AG. Frequency of Douching and Risk of Bacterial Vaginosis in African-American Women. Obstet Gynecol 2004; 104:756-60. [PMID: 15458898 DOI: 10.1097/01.aog.0000139947.90826.98] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Frequent vaginal douching has been associated with bacterial vaginosis. We investigated whether infrequent douching is also a risk factor for bacterial vaginosis. METHODS In this cross-sectional study, we recruited 411 African-American women of reproductive age who were visiting gynecologic or family planning clinics of 2 hospitals in New York City from 1999 to 2001. Detailed information on demographic characteristics, feminine hygiene practice, contraceptive use, and reproductive and medical history was collected through in-person interview. Pelvic examinations and laboratory tests on vaginal secretions were performed. Bacterial vaginosis was defined as Gram stain score of 7 or greater. RESULTS The overall prevalence of bacterial vaginosis in this population was 27%, similar to the national average. Water-vinegar solution was the most common douche. Although one half of the subjects reported douching regularly, only 2% douched frequently (once per week or more). Frequent douching in the past 3 months had a prevalence ratio of bacterial vaginosis of 2.35 (95% confidence interval 0.98-5.63). However, douching less than once per week was not associated with bacterial vaginosis. CONCLUSION Douching less than once per week, particularly with a water-vinegar douche, is not associated with bacterial vaginosis in this African-American population. LEVEL OF EVIDENCE III
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Affiliation(s)
- Jun Zhang
- Departments of Community and Preventive Medicine, Pathology, and Obstetrics, Gynecology and Reproductive Sciences, Mount Sinai School of Medicine, New York, NY, USA.
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Simpson T, Merchant J, Grimley DM, Oh MK. Vaginal douching among adolescent and young women: more challenges than progress. J Pediatr Adolesc Gynecol 2004; 17:249-55. [PMID: 15288026 DOI: 10.1016/j.jpag.2004.05.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The practice of vaginal douching dates back centuries. Numerous studies have shown that douching is quite prevalent and often begins during adolescence. Motivation for the initiation and maintenance of this practice appears complex, and presents challenges to the intervention efforts. The practice of douching remains controversial. Douching has been implicated in numerous adverse reproductive health outcomes such as increased risk for pelvic inflammatory disease, ectopic pregnancy, reduced fertility, and bacterial vaginosis. However, recent studies in developing countries have suggested that in certain circumstances, douching may actually be beneficial. We summarize key findings from the review of published literature and ongoing research, as well as highlight research challenges to our understanding of the role of vaginal douching in reproductive health.
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Affiliation(s)
- Tina Simpson
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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Oh MK, Funkhouser E, Simpson T, Brown P, Merchant J. Early onset of vaginal douching is associated with false beliefs and high-risk behavior. Sex Transm Dis 2003; 30:689-93. [PMID: 12972791 DOI: 10.1097/01.olq.0000079526.04451.de] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaginal douching in young women has been linked to a variety of adverse reproductive health consequences. OBJECTIVES To explore associations with early onset (< or =15 years old) of douching. STUDY DESIGN A confidential survey was self-administered to convenience samples of women attending seven primary care clinics. RESULTS The mean age of the 726 evaluable participants was 27.9 years (ranges, 14-63 years). Twenty-two percent of participants believed douching "kills germs that cause infections," and 27% agreed that "women believe douching prevents pregnancy." A history of having ever used douching products was reported by 73%. Of those who had douched, 24% began the practice at age < or =15 years. Compared with those who began at a later age, those who began at age < or =15 years were also more likely to have begun sexual intercourse under 16 years of age (AOR 2.63; P<0.001), to believe that douching kills germs that cause STDs (AOR=2.15 P=0.004), and to currently douche more than once per month (AOR=2.08; P=0.009). CONCLUSION This study indicates that early onset of vaginal douching is associated with false beliefs and sexual debut at younger age.
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Affiliation(s)
- M Kim Oh
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233-1711, USA.
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Van Kessel K, Assefi N, Marrazzo J, Eckert L. Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review. Obstet Gynecol Surv 2003; 58:351-8. [PMID: 12719677 DOI: 10.1097/01.ogx.0000068791.04785.8d] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED This article is a systematic review of the literature regarding the most commonly used complementary and alternative medicine (CAM) therapies for yeast vaginitis and bacterial vaginosis. A search was conducted of all published literature on conventional search engines (PubMed, EMBASE, the Cochrane Registry, CINAHL, LILACS) and alternative medicine databases (Natural Medicines Comprehensive Database, Longwood Herbal Taskforce, and Alternative Medicine Alert), for all studies of the five most commonly used CAM treatments of vaginitis. Inconsistencies in definition of vaginitis, type of intervention, control groups, and outcomes prevented performance of a meta-analysis, and paucity of high-quality studies made ranking by evidence-based scales unsuitable. Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Because of associated risks in the absence of well-documented clinical benefits, douching remains a practice that should not be recommended for the treatment of vaginitis. Finally, tea tree oil and garlic show some in vitro potential for the treatment of vaginitis, but the lack of in vivo studies preclude their recommendation to patients for the time-being. The available evidence for CAM treatments of vaginitis is of poor quality despite the prevalent use of these therapies. Well-designed randomized, controlled trials investigating the efficacy and safety of these therapies for vaginitis are needed before any reliable clinical recommendations can be made. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader will be able to list the most common complementary and alternative medicine therapies for vaginitis, summarize the data surrounding the efficacy of each therapy, describe the adverse affects of each therapy, and outline which therapies are recommended and not recommended for vaginitis.
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Affiliation(s)
- Katherine Van Kessel
- Department of Obstetrics & Gynecology, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA.
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Blythe MJ, Fortenberry JD, Orr DP. Douching behaviors reported by adolescent and young adult women at high risk for sexually transmitted infections. J Pediatr Adolesc Gynecol 2003; 16:95-100. [PMID: 12742144 DOI: 10.1016/s1083-3188(03)00027-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To describe frequency of douching and reasons as timing to menses, vaginal symptoms, and coitus and the association of these behaviors to the diagnosis of three sexually acquired infections. DESIGN, SETTING, PARTICIPANTS The study involved 160 females between the ages of 14 and 25 yrs attending a STD clinic and/or community adolescent health clinics. Subjects were eligible to enter the study if they had a positive test(s) for and/or were a contact of chlamydia, gonorrhea, trichomonas, and/or nongonococcal urethritis (NGU). Reevaluation for these infections occurred at the 1-month, 4-month, and 7-month visit with one-dose antibiotic treatment provided for positive tests. Data on douching was collected at the 7-month visit only. MAIN OUTCOME MEASURE Results of tests for STI's using urine-based DNA-amplification techniques for chlamydia and gonorrhea and using self-obtained vaginal swabs for trichomonas culture. RESULTS Nearly two-thirds (106/160) of the subjects ages 14-25 yrs completing the 7-month visit reported douching, with 67.7% (69/102) reporting douching once a month or more. Douching was more common in older, black participants, using injectable progestins for contraception. Douching was more common in those reporting more recent sexual partners. Douching related to menses was not associated with any of the three infections, while douching related to symptoms and coitus was associated with positive tests for infections. CONCLUSIONS Results suggest that for this subset of teens at high risk for sexually acquired infections, douching is a commonly reported behavior. This study suggests that the linkage of douching and sexually acquired infections is associated with contraceptive choices, self-treatment of vaginal symptoms, and sexual risk behaviors but not menstrual hygiene.
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Affiliation(s)
- M J Blythe
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Abstract
PURPOSE OF REVIEW To review the published literature on pelvic inflammatory disease over the past year and put into context the major findings. RECENT FINDINGS remains the commonest identified cause of pelvic inflammatory disease, and yet our understanding of how it causes mucosal damage and the factors explaining why only a subgroup of women develop pelvic inflammatory disease are not known. The increasing evidence for a chlamydial toxin may help to explain how tissue damage occurs and the indolent nature of many chlamydial infections. The evidence for as an important sexually transmitted cause of pelvic inflammatory disease is growing, with implications for treatment regimens and diagnostic testing. Power Doppler ultrasound has been reported to be both sensitive and specific in diagnosing pelvic inflammatory disease, although larger studies are needed to confirm these early results. Outpatient treatment with cefoxitin and doxycycline appears to be as effective when given in an outpatient setting compared with inpatient management with the same agents in a large randomized controlled trial with almost 3 years' follow-up. SUMMARY There remain many gaps in our knowledge of pelvic inflammatory disease, but the reviewed studies increase our understanding of the pathogenesis of infection, and offer the possibility of better diagnosis and reassurance about the long-term success of antibiotic treatment.
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Ness RB, Hillier SL, Richter HE, Soper DE, Stamm C, Bass DC, Sweet RL, Rice P, Downs J, Aral S. Why women douche and why they may or may not stop. Sex Transm Dis 2003; 30:71-4. [PMID: 12514446 DOI: 10.1097/00007435-200301000-00014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although douching is common, it is a potentially harmful habit. GOAL We studied attitudes and knowledge around the behavior of douching. STUDY DESIGN Of 1,200 women enrolled in this multisite study, 532 douched and answered questions on a structured interview regarding douching behaviors. RESULTS Over half had douched for 5 or more years. Douching was most often initiated on the recommendation of female relatives and practiced for reasons of hygiene. Half of women considered douching to be healthy. Those who considered douching to be unhealthy reported that douching may disrupt vaginal flora but did not cite more serious risks. Nonetheless, women who had been advised by a health professional to stop douching were less likely to consider douching healthful and were more likely to have tried to stop. CONCLUSION Women had a limited understanding of potential adverse health consequences associated with douching. Targeted health messages may influence women to initiate douching cessation.
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Affiliation(s)
- Roberta B Ness
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
OBJECTIVE To review current literature on vaginal douching. DATA SOURCES MEDLINE, CINAHL, and Cochrane databases from 1997 to 2001, using keywords douche or douching; 2001 Web sites of the Centers for Disease Control and Prevention; and Internet search engines for information about current retail sales of douches. STUDY SELECTION MEDUNE included 67 records, CINAHL 18, and Cochrane 2. Abstracts of articles in English were reviewed, and those pertaining to vaginal douching practices were included. MEDLINE had 44 pertinent articles, CINAHL 11, and Cochrane 1. References from these articles were reviewed and included when appropriate. DATA EXTRACTION Articles were reviewed and summarized. DATA SYNTHESIS Vaginal douching is a common practice for women in the United States. Douching is associated with adverse reproductive and gynecologic outcomes including bacterial vaginosis, preterm birth, low-birth-weight infants, pelvic inflammatory disease, chlamydial infection, tubal pregnancy, higher rates of HIV transmission, and cervical cancer. Cultural beliefs and educational factors strongly influence douching practices. CONCLUSIONS Nursing assessment of women should include information on vaginal douching practices and beliefs. Nurses should use culturally appropriate educational strategies to discourage women of all ages from using vaginal douches as part of routine feminine hygiene because of the associated risks. Further research is needed on factors that influence women's beliefs and douching practices.
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Douching in Relation to Bacterial Vaginosis, Lactobacilli, and Facultative Bacteria in the Vagina. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200210000-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wiesenfeld HC, Hillier SL, Krohn MA, Amortegui AJ, Heine RP, Landers DV, Sweet RL. Lower Genital Tract Infection and Endometritis. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200209000-00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Koblin BA, Mayer K, Mwatha A, Brown-Peterside P, Holt R, Marmor M, Smith C, Chiasson MA. Douching practices among women at high risk of HIV infection in the United States: implications for microbicide testing and use. Sex Transm Dis 2002; 29:406-10. [PMID: 12170130 DOI: 10.1097/00007435-200207000-00008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Douching may interfere with determination of microbicide safety and effectiveness. This practice has not been adequately studied among women at risk of HIV infection. GOAL This study assessed douching practices among women at risk of HIV infection in the United States. STUDY DESIGN Data were collected on douching practices, sexually transmitted diseases, birth control, use of spermicidal products, and sexual risk behaviors among HIV antibody-negative women. RESULTS Of 623 women, 70.2% had recently douched. Most women had been told that douching was not healthy. No associations were found between recent douching and measures of risk behaviors, except number of male partners. Recent douching was associated with being aged 26 to 30 years, compared with being 18 to 25 years of age (odds ratio [OR] = 2.2), black (OR = 3.0), or sterilized (OR = 2.0); having 5 or more male partners (OR = 4.4); and being told that douching is unhealthy (OR = 0.4). CONCLUSIONS Recent douching was very common. The high prevalence of douching has implications for the design of microbicide trials and prevention interventions.
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Affiliation(s)
- Beryl A Koblin
- Laboratory of Epidemiology, New York Blood Center, New York, New York 10021, USA.
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Fiscella K, Franks P, Kendrick JS, Meldrum S, Kieke BA. Risk of preterm birth that is associated with vaginal douching. Am J Obstet Gynecol 2002; 186:1345-50. [PMID: 12066120 DOI: 10.1067/mob.2002.122406] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between vaginal douching and preterm birth. STUDY DESIGN We enrolled hospitalized women after delivery in a case-control study. Women who were delivered of a live preterm singleton infant were assigned as cases. Women who were delivered at term were randomly selected as control subjects. We surveyed women about their douching habits and risk factors for preterm birth and abstracted data from the records. RESULTS After adjustment, vaginal douching within 6 months of pregnancy was not significantly associated with preterm birth (odds ratio, 1.1; 95% CI, 0.8-1.6). However, in secondary analyses, douching more than once per week (odds ratio, 4.0; 95% CI, 1.0-15.5) or longer than 10 years (odds ratio, 1.9; 95% CI, 1.1-3.2) was associated with preterm birth. CONCLUSION Vaginal douching does not appear to be a strong risk factor for preterm birth. Further study is needed to confirm the risk that is associated with frequent or long-term douching.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY, USA
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Cauci S, Driussi S, De Santo D, Penacchioni P, Iannicelli T, Lanzafame P, De Seta F, Quadrifoglio F, de Aloysio D, Guaschino S. Prevalence of bacterial vaginosis and vaginal flora changes in peri- and postmenopausal women. J Clin Microbiol 2002; 40:2147-52. [PMID: 12037079 PMCID: PMC130764 DOI: 10.1128/jcm.40.6.2147-2152.2002] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Our aim was to evaluate the prevalence of bacterial vaginosis and decrease in lactobacillus colonization in women 40 years old or older in relation to menopausal status by evaluation of Gram-stained smears. A total of 1,486 smears from Italian Caucasian women aged 40 to 79 years were examined. Women were classified as follows: fertile (regular cycles) (n = 328), perimenopausal (irregular cycles) (n = 237), and postmenopausal (n = 921), including 331 women on estroprogestinic hormone replacement therapy (HRT). The prevalences of bacterial vaginosis (assessed as a Nugent score of >or=7) in fertile (9.8%) and perimenopausal (11.0%) women were not statistically different, whereas the prevalence was significantly lower overall in postmenopausal women (6.0%) (P = 0.02). Specifically, 6.3% of postmenopausal women without HRT and 5.4% of postmenopausal women with HRT were positive for bacterial vaginosis. The Nugent score system was not adequate for evaluating the normal and intermediate vaginal flora in women over the age of 40 years. High numbers of peri- and postmenopausal women had no lactobacilli and no bacterial-vaginosis-associated microorganisms. This nonpathological absence of lactobacilli in women with a Nugent score of 4 was scored as 4*, and this group was considered separately from the intermediate flora group. A score of 4* was obtained for 2.1% of fertile women, 11.4% of perimenopausal women, 44.1% of postmenopausal women without HRT, and 6.9% of postmenopausal women with HRT. The physiological reduction in lactobacillus colonization of the vagina in postmenopausal women does not cause an increase in bacterial-vaginosis prevalence. Reversion of lactobacillus flora to premenopausal levels due to HRT does not increase the prevalence of bacterial vaginosis in postmenopausal women.
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Affiliation(s)
- Sabina Cauci
- Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, Italy.
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Oh MK, Merchant JS, Brown P. Douching behavior in high-risk adolescents. What do they use, when and why do they douche? J Pediatr Adolesc Gynecol 2002; 15:83-8. [PMID: 12057529 DOI: 10.1016/s1083-3188(01)00148-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe feminine hygiene practices and douching behavior in adolescent women. DESIGN A cross-sectional anonymous survey. SUBJECTS Adolescents (majority rural) admitted to a correctional institution for girls. MAIN OUTCOME MEASURES Description of feminine hygiene practices, prevalence of vaginal douching, types of substances used, reported reasons for, and timing of douching. RESULTS In a period of 16 weeks, 104 girls were surveyed within a week of admission. The mean age was 15.4 (SD 1.5; range 12-18) yr, and age at sexual debut 13.1 (SD 1.4) yr. Use of feminine hygiene products was reported by: 9% for feminine suppository, 33% towelettes, 40% spray, 67% feminine wash; only 18% reported no use of those feminine hygiene products listed. A history of ever having douched was reported by 79%; the mean first douching age was 14.0 (SD 1.3; range 11-16). Douching product users were significantly more likely to know someone who douches regularly (P <.0001) and have watched douche commercials (P =.0001) than those who did not douche. A majority used store-bought products, vinegar in water and scented solution being the most popular; baking soda, Betadine, Pine-sol, and Lysol were other products used. Commonly cited reasons for douching included to feel good and fresh (60%), and to rid of odor and of blood (47% each). Other reasons cited were to please partner (12%) and to avoid going to a doctor (6%). Timing of douching included: after period (69%), after sex (52%), before sex (16%), before going to a doctor (17%). Among those who douched, 51% douched once a month, and an additional 32% more often than that. CONCLUSION This study provides troublesome findings regarding the feminine hygiene practices of mostly rural southern teenagers who have been incarcerated.
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Affiliation(s)
- M Kim Oh
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233-1711, USA.
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