ResearchGeneral gynecologyDoes douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents
Section snippets
Study participants
This study included all adolescent females aged 12-19 years at baseline from an observational study called the Reaching for Excellence in Adolescent Care and Health (REACH) Project of the Adolescent Medicine HIV/AIDS Research Network. Investigators recruited both HIV-infected and HIV-uninfected adolescents at 16 locations in 13 US cities from March 1996 through November 1999. The study cohort enlisted youth who were infected with HIV through sex or drug-taking behaviors (ie, perinatally
Demographic characteristics
The original REACH cohort contained 411 nonvirginal female adolescents, of whom 262 (63.7%) were HIV positive and 147 were HIV negative as per the selection criteria of the parent cohort study. The annual retention rate for HIV-infected youth in this cohort was 95%. The female annual retention rate for HIV-uninfected adolescents was 88%, with older HIV-uninfected female adolescents having the lowest retention rates.37 In our douching substudy, 43 of the 411 participants were not eligible
Comment
In this prospective cohort of HIV-infected and high-risk uninfected adolescent girls and young women followed up for a median of 3 years, douching was an independent risk factor for STI acquisition. This finding supports the hypothesis that regular douching contributes to the risk of STI acquisition among high-risk female adolescents because the douching behaviors measured in this prospective study antedated the incident STI.
The study addresses directly 1 of the principal limitations in much of
Acknowledgments
The authors acknowledge the contributions of the investigators and staff of the Adolescent Medicine HIV/AIDS Research Network (1994-2001) and the youth who participated in the research. Participating investigators and staff are listed elsewhere (J Adolesc Health 2001;29(Suppl):5-6).
The 16 locations in 13 US cities in which the study was conducted as follows: University of Miami (2 locations), Miami, FL; Children's Hospital of Philadelphia, Philadelphia, PA; Tulane Medical Center, New Orleans,
References (47)
Vaginal douching practices of women in eight Florida Panhandle counties
J Obstet Gynecol Neonatal Nurs
(2006)- et al.
Vaginal douching as a risk factor of ectopic pregnancy among black women
Am J Obstet Gynecol
(1997) - et al.
The risk of low birth weight associated with vaginal douching
Obstet Gynecol
(1998) - et al.
Vaginal douching and preterm birth: an intriguing hypothesis
Med Hypotheses
(2000) - et al.
Risk of preterm birth that is associated with vaginal douching
Am J Obstet Gynecol
(2002) - et al.
Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection
Obstet Gynecol
(1998) - et al.
Douching behaviors reported by adolescent and young adult women at high risk for sexually transmitted infections
J Pediatr Adolesc Gynecol
(2003) - et al.
Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia
Am J Obstet Gynecol
(1996) - et al.
The relationship between vaginal douching and lower genital tract infection in young women
Adolesc Pediatr Gynecol
(1992) - et al.
Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents
J Adolesc Health
(1998)
Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina
Obstet Gynecol
Characteristics of three vaginal flora patterns assessed by gram stain among pregnant womenVaginal Infections and Prematurity Study Group
Am J Obstet Gynecol
HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis
Lancet
The REACH (Reaching for Excellence in Adolescent Care and Health) Project: study design, methods, and population profile
J Adolesc Health
The REACH Project of the Adolescent Medicine HIV/AIDS Research Network: design, methods and selected characteristics of participants
J Adolesc Health
: Douching practices among HIV-infected and uninfected adolescents in the United States
J Adolesc Health
Sexually transmitted infections among HIV infected and HIV uninfected high-risk youth in the REACH study: reaching for Excellence in Adolescent Care and Health
J Adolesc Health
Correlation between urine and cervical specimens for the detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction in a cohort of HIV infected and uninfected adolescents
J Adolesc Health
No change in health risk behaviors over time among HIV-infected adolescents in care: role of psychological distress
J Adolesc Health
Douching beliefs and practices among black and white women
J Womens Health Gend Based Med
Vaginal douching: personal practices and public policies
J Womens Health
Vaginal douching: evidence for risks or benefits to women's health
Epidemiol Rev
Why women douche and why they may or may not stop
Sex Transm Dis
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Trichomoniasis: The "neglected" sexually transmitted disease
2013, Infectious Disease Clinics of North AmericaCitation Excerpt :Patient-delivered partner therapy has been found to be as effective as standard notification, and is an option in states where this strategy is permissible.50,51 Douching is not effective in reducing trichomoniasis; on the contrary, this practice may be a risk factor for T vaginalis and other sexually transmitted infections.2,52 Neither trichomoniasis nor T vaginalis infection is a nationally notifiable condition in the United States.53
A cross cultural study of vaginal practices and sexuality: Implications for sexual health
2010, Social Science and MedicineCitation Excerpt :Studies in the early to mid-1990s mentioned vaginal practices among risks for heterosexual transmission of STI and HIV in relation to women’s sexual relationships (Awusabo-Asare, Anarfi, & Agyeman, 1993), preferences in sexual experiences (Brown & Brown, 2000; Brown, Ayowa, & Brown, 1993; Civic & Wilson, 1996; Dallabetta et al., 1995; Orubuloye, Caldwell, & Caldwell, 1995; Runganga, Pitts, & McMaster, 1992) and disturbances of vaginal flora (Karim, Karim, Soldan, & Zondi, 1995; Sandala et al., 1995). Subsequent discussions correlated vaginal practices – generally labeled “dry sex” despite evidence of diversity in motivations for the practices beyond reducing of vaginal lubrication – with other factors such as bacterial vaginosis (Atashili, Ndumbe, Adimora, & Smith, 2008), and other STI (La Ruche et al., 1999; Rottingen, Cameron, & Garnett, 2001; Tsai, Shepherd, & Vermund, 2009). Indeed, some studies in the Great Lakes region of Africa cite preference for vaginal lubrication in preparation for sex (Vincke, 1991).
Exploring the Vaginal Microbiome and Intravaginal Practices in Postmenopausal Women
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Cite this article as: Tsai CS, Shepherd BE, and Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009;200:38.e1-38.e8.
Ms Tsai is now a medical student at Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL.
The REACH study was funded by grant U01-HD32842 from the National Institute of Child Health and Human Development with cofunding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, and the National Institute of Mental Health. Support for the analytic work was received from the Vanderbilt-Meharry Center for AIDS Research through grant P30AI054999 from the National Institute of Allergy and Infectious Diseases.
Reprints not available from the authors.