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Understanding Women's Vaginal Douching Behaviors and Practices for Consideration in the Development of a Potential Future Vaginal Microbicide Douche for HIV Prevention: A Systematic Review of the Literature. AIDS Behav 2021; 25:2992-3010. [PMID: 33977356 DOI: 10.1007/s10461-021-03290-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
Despite clinicians consistently advising against vaginal douching, 29-92% of women worldwide report douching. This review documents women's douching practices, motivations for douching, and specific associations (or absence of associations) between vaginal douche use and vaginal outcomes thought to be associated with douching. Understanding women's existing douching behaviors and vaginal health outcomes is critical for developing a safe vaginal microbicide douche that can be used as HIV pre-exposure prophylaxis (PrEP). A vaginal douche as PrEP could help prevent new HIV infections, since emerging evidence shows some women discontinue oral PrEP. We performed a systematic review of the literature using the guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Articles included in the analysis (N = 48) were published 2009-2019 in English and focused on women's experiences with douching. Two trained independent reviewers assessed these articles for content on vaginal douching, including racial/ethnic focus of studies, study design, sampling, women's reasons for douching, contents of douche solutions, and associations between vaginal douching and vaginal health outcomes. Several studies focused on Black women (N = 12 studies) or had no racial/ethnic focus (N = 12). Just over half of all studies (N = 24) were cross-sectional and involved a self-reported questionnaire and lab samples. Studies sampled women from health clinics where they were (N = 13) or were not (N = 14) presenting for vaginal health complaints. Women's primary motivation for douching was for "general cleanliness" (N = 13), and most douche solutions contained water (N = 12). There was little empirical agreement between vaginal douche use and most vaginal health outcomes. Future studies of PrEP vaginal douches should be well controlled and prioritize safety to ensure positive vaginal health outcomes.
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Aslan E, Bechelaghem N. To ‘douche’ or not to ‘douche’: hygiene habits may have detrimental effects on vaginal microbiota. J OBSTET GYNAECOL 2018; 38:678-681. [DOI: 10.1080/01443615.2017.1395398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Erdogan Aslan
- Department of Obstetrics and Gynaecology, Medicine Faculty, Near East University, Nicosia, Cyprus
| | - Nadia Bechelaghem
- Microbiology and Plant Biology Laboratory, Faculty of Nature and Life Sciences, University of Abdelhamid Ibn Badis, Mostaganem, Algeria
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Yeoman CJ, Thomas SM, Miller MEB, Ulanov AV, Torralba M, Lucas S, Gillis M, Cregger M, Gomez A, Ho M, Leigh SR, Stumpf R, Creedon DJ, Smith MA, Weisbaum JS, Nelson KE, Wilson BA, White BA. A multi-omic systems-based approach reveals metabolic markers of bacterial vaginosis and insight into the disease. PLoS One 2013; 8:e56111. [PMID: 23405259 PMCID: PMC3566083 DOI: 10.1371/journal.pone.0056111] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 01/09/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is the most common vaginal disorder of reproductive-age women. Yet the cause of BV has not been established. To uncover key determinants of BV, we employed a multi-omic, systems-biology approach, including both deep 16S rRNA gene-based sequencing and metabolomics of lavage samples from 36 women. These women varied demographically, behaviorally, and in terms of health status and symptoms. PRINCIPAL FINDINGS 16S rRNA gene-based community composition profiles reflected Nugent scores, but not Amsel criteria. In contrast, metabolomic profiles were markedly more concordant with Amsel criteria. Metabolomic profiles revealed two distinct symptomatic BV types (SBVI and SBVII) with similar characteristics that indicated disruption of epithelial integrity, but each type was correlated to the presence of different microbial taxa and metabolites, as well as to different host behaviors. The characteristic odor associated with BV was linked to increases in putrescine and cadaverine, which were both linked to Dialister spp. Additional correlations were seen with the presence of discharge, 2-methyl-2-hydroxybutanoic acid, and Mobiluncus spp., and with pain, diethylene glycol and Gardnerella spp. CONCLUSIONS The results not only provide useful diagnostic biomarkers, but also may ultimately provide much needed insight into the determinants of BV.
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Affiliation(s)
- Carl J. Yeoman
- Department of Animal and Range Sciences, Montana State University, Bozeman, Montana, United States of America
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Susan M. Thomas
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Margret E. Berg Miller
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Alexander V. Ulanov
- Biotechnology Center, University of Illinois, Urbana, Illinois, United States of America
| | - Manolito Torralba
- J. Craig Venter Institute, Maryland Campus, Rockville, Maryland, United States of America
| | - Sarah Lucas
- J. Craig Venter Institute, Maryland Campus, Rockville, Maryland, United States of America
| | - Marcus Gillis
- J. Craig Venter Institute, Maryland Campus, Rockville, Maryland, United States of America
| | - Melissa Cregger
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Andres Gomez
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Mengfei Ho
- Department of Microbiology, University of Illinois, Urbana, Illinois, United States of America
| | - Steven R. Leigh
- Department of Anthropology, University of Illinois, Urbana, Illinois, United States of America
| | - Rebecca Stumpf
- Department of Anthropology, University of Illinois, Urbana, Illinois, United States of America
| | - Douglas J. Creedon
- The Department of Obstetrics and Gynecology, The Mayo Clinic, Rochester, Minnesota, United States of America
| | - Michael A. Smith
- Department of Obstetrics and Gynecology, Christie Clinic, Urbana, Illinois, United States of America
| | - Jon S. Weisbaum
- Department of Obstetrics and Gynecology, Carle Clinic, Urbana, Illinois, United States of America
| | - Karen E. Nelson
- J. Craig Venter Institute, Maryland Campus, Rockville, Maryland, United States of America
| | - Brenda A. Wilson
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
- Department of Microbiology, University of Illinois, Urbana, Illinois, United States of America
| | - Bryan A. White
- The Institute for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
- Department of Animal Sciences, University of Illinois, Urbana, Illinois, United States of America
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Ekpenyong CE, Etukumana EA. Ethnicity, family socioeconomic inequalities, and prevalence of vaginal douching among college students: the implication for health. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2013; 61:222-230. [PMID: 23663126 DOI: 10.1080/07448481.2013.787620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study assessed the association between ethnicity and family socioeconomic status (SES) as it relates to the prevalence of vaginal douching among female undergraduates in a university community. PARTICIPANTS AND METHODS This was a cross-sectional survey conducted between September 2011 and February 2012 among 1,535 female undergraduates using a semistructured behavioral questionnaire adapted by the authors from previous research related to vaginal douching practice. RESULTS The overall prevalence of vaginal douching was 79.35% and the practice was significantly associated with the mother's age, ethnicity, low SES (educational level, occupation, and monthly income), and area of residence. The father's age and SES were statistically nonsignificant. CONCLUSION Ethnicity and low SES of mothers were significantly associated with a higher prevalence of douching in daughters. These factors should be considered among others in any intervention to discourage vaginal douching among college women.
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Affiliation(s)
- Christopher E Ekpenyong
- Department of Physiology, College of Health Sciences, University of Uyo, Uyo, Akwa Ibom State, Nigeria.
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Abstract
Genital malodor is a common distressing complaint that brings a woman to her physician's office. Vaginal infections, primarily bacterial vaginosis and trichomoniasis, still remain the commonest causes and are relatively easy to diagnose and treat. However, in approximately one third of women who present with malodor, no cause is identified. Although data on the management of vaginal discharge are extensive, the management of genital odor beyond common vaginal infections remains poorly studied. This presents a frustrating situation for both the patient and her physician. Often, patients resort to home remedies and over-the-counter preparations, which, while providing short-term relief for some women, almost never address the cause and, in some cases, can exacerbate symptoms. In this review, we have attempted to consolidate the known and documented causes of genital malodor including the nonvaginal causes and provide case studies that will help clinicians understand the possible settings for the various causes. We also provide an algorithm for the management of this symptom beyond vaginal infections.
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Douching for perceived vaginal odor with no infectious cause of vaginitis: a randomized controlled trial. J Low Genit Tract Dis 2011; 15:128-33. [PMID: 21263351 DOI: 10.1097/lgt.0b013e3181fb4270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate the effectiveness of medical-grade stainless steel Water Works Douching Device for treating abnormal vaginal odor in comparison with a commercially available over-the-counter plastic douching device. MATERIALS AND METHODS In a multicenter study, 140 women with perceived vaginal odor with no vaginal infection were randomized to either Water Works or control group in a 1:1 ratio and were douched daily for 4 weeks. A visual analog scale (VAS) was used to assess the intensity of vaginal odor. Primary outcome included subject assessment of odor improvement and Nugent Gram stain score of vaginal secretions. Secondary outcome compared the efficacy and safety of Water Works with control douching device. Each patient underwent baseline, week 2, and week 4 visits. RESULTS The final analytic sample consisted of 96 women. Success score at 4 weeks was 78% for the Water Works group and 38.5% for the control group. Mean VAS was significantly reduced, and Nugent and Lactobacillus scores were maintained in both groups. In the Water Works group, VAS was reduced from 7.3 ± 0.3 to 1.8 ± 0.6 (p < .001) after 4 weeks. In the control group, baseline versus 4 weeks VAS was 7.2 ± 0.3 and 3.4 ± 0.8 (p < .003). CONCLUSIONS Women reported significant reduction of vaginal odor after douching with water for 4 weeks without any alteration of vaginal flora. The Water Works Douching Device was superior to over- the-counter device in reducing vaginal odor.
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