Limited data are available describing the effects of vaginal douching on vaginal flora, and the key determinants for why women douche are not well understood and have not been studied prospectively. This dissertation research will evaluate the risk for bacterial vaginosis (BV) in a douching cessation trial and explore the longitudinal patterns of vaginal douching in an observational prospective study.
Study #1: Methods. Thirty-nine reproductive-age women who reported use of vaginal douche products were enrolled into a 20-week study consisting of a 4-week douching observation phase followed by a 12-week douching cessation phase. Participants then chose to either resume douching or continue cessation (4 weeks). Self-collected vaginal samples were obtained twice-weekly in the first 16 weeks and one sample was collected in week 20. BV was diagnosed by Nugent's Gram stain score ≥ 7. Conditional logistic regression was used to evaluate the individual-level effect of douching cessation on the risk of BV. Results. The adjusted odds ratio (aOR) for BV in douching cessation compared to the douching observation phase was 0.76 (95% CI: 0.33-1.76). Among women who reported that their primary reason for douching was to clean after menstruation, BV was significantly reduced during douching cessation (aOR: 0.23; 95% CI: 0.12-0.44).
Study #2: Methods. Non-pregnant women (n=3620) were assessed quarterly for one year at 12 public clinics in Alabama. Conditional logistic regression was applied in a case-crossover analysis to determine the individual-level factors that vary between a woman's douching and non-douching intervals. Findings were compared to a population-level analysis utilizing generalized estimating equations. Results. The case-crossover analysis indicated a woman was more likely to douche when reporting “fishy” vaginal odor (OR:2.74; 95% CI:1.55-4.84), vaginal irritation (OR:1.52; 95% CI:1.10-2.11), summer month (OR:1.37, 95% CI:1.13-1.67) or increase in number of sex partners (≥3, OR:2.42, 95% CI:1.11-5.26). BV/trichomoniasis treatment (OR:0.72, 95% CI:0.59-0.89) and absent menses (OR:0.37, 95% CI:0.28-0.50) were negatively associated with douching. These odds ratios were farther from the null than comparable population-level estimates.
Conclusion. Vaginal douching after menstruation may contribute to disruption of vaginal flora. Predictors of feminine hygiene practice can be utilized in developing douching cessation and prevention interventions.
|Advisor:||Zenilman, Jonathan M., Gravitt, Patti E.|
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 69/04, Dissertation Abstracts International|
|Subjects:||Medicine, Public health, Epidemiology|
|Keywords:||Bacterial vaginosis, Douching, Menstruation, Vaginal douching, Vaginal flora|
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