ORIGINAL RESEARCHORIGINAL RESEARCH–WOMEN'S SEXUAL HEALTH: Beyond Douching: Use of Feminine Hygiene Products and STI Risk among Young Women
Introduction
Feminine hygiene products such as douches, feminine wipes, feminine sprays, and yeast creams represent a multimillion dollar market, and are commonly used by young women 1, 2. However, little is known about product use, and only douching has been studied in relation to sexually transmitted infections (STI) 2, 3, 4. This link between genital cleansing and STI is important, as adolescent and young adult women have the highest age-specific rates of gonorrhea and chlamydia, with their attendant short- and long-term morbidities [5]. Even if feminine hygiene products are not causative of STI, the use of these products may cause symptoms that mimic STIs, such as discharge or irritation, or may mask symptoms of a true STI, delaying diagnosis and treatment.
Among adolescents, cross-sectional studies show associations between douching and cervicitis [3], and bacterial vaginosis (BV) [6]. Among adults, cross-sectional studies also show associations with cervicitis [7] and BV [8], as well as herpes simplex virus infection [9], pelvic inflammatory disease [10], and human immunodeficiency virus (HIV) infection [11]. However, it has been unclear in which direction this operates: Does douching cause STI? Or do women with STI douche in response to symptoms? Longitudinal adult data show prospective associations neither between douching and gonorrhea or chlamydia infections [12], nor between douching and incident HIV infection [11].
Section snippets
Aims
Our objectives in this exploratory study are to describe the use of feminine hygiene products in adolescent women at high risk for STI, and then to examine the association of sexual risk and protective factors, and sexually transmitted infection (STI), with feminine hygiene product use. Of particular interest are developmental risk and protective factors, such as age at first sexual experience or number of lifetime partners, and risk and protective factors directly related to STI acquisition,
Methods
As part of a larger longitudinal cohort study of risk and protective factors for STI (for additional details, see Fortenberry, 2005 [13] or Sayegh, 2005 [14]), 295 adolescent women, 14.0 to 17.9 years of age at enrollment, were recruited from primary care adolescent clinics, and were followed for up to 4 years. The clinics serve primarily low- and middle-income residents living in communities with high rates of early sexual onset and STIs. Sexual experience was not an inclusion criterion;
Main Outcome Measures
Genital hygiene behaviors were measured by self-report. Participants were told, “Young women do different things to keep their genitals feeling clean. During the past 3 months, how often have you done any of these things?” and specifically asked about, “douched after my period,”“douched before sex,”“douched after sex,”“used a feminine hygiene spray,”“used a feminine wipe,” and “used some vaginal medicine for yeast infections (cream, suppositories, pills).” Douching items showed a high level of
Results
Participants were 90% African American, 7% white, and 3% other or multiracial. The 295 participants, together, contributed 1,606 quarterly interviews, giving an average of 5.4 interviews per participant (SD 2.0; range, 1 to 9 interviews). The mean age at the time of the interviews was 17.6 years (SD 1.9 years). Genital hygiene behaviors were common. On a participant level, 254 of 295 participants (86%) reported use of any product, and 163 (55%) reported using two or more in a 3-month period.
Discussion
Adolescent African American females at high risk for STI frequently use feminine hygiene products. This represents a significant investment of money and time on genital hygiene. The few associations among genital hygiene, STI, and risk and protective behaviors have both STI prevention, developmental, and cultural implications.
Consistent with prospective adult studies [12], this well powered, within-subject analysis showed no associations between douching or the use of other feminine hygiene
Category 1
- (a)
Conception and Design
J. Dennis Fortenberry
- (b)
Acquisition of Data
J. Dennis Fortenberry
- (c)
Analysis and Interpretation of Data
J. Dennis Fortenberry; Mary A. Ott; Susan Ofner
Category 2
- (a)
Drafting the Article
Mary A. Ott
- (b)
Revising It for Intellectual Content
J. Dennis Fortenberry; Susan Ofner
Category 3
- (a)
Final Approval of the Completed Article
J. Dennis Fortenberry; Mary A. Ott; Susan Ofner
Acknowledgments
This work was funded by NIH/NICHD (R01 HD 044387 and 1 K23 HD 049444-01A2), and NIH/NIAID (U19 AI031494-15). These data were presented at the 2006 North American Society for Pediatric and Adolescent Gynecology annual meeting in Orlando, Florida, on May 18, 2006.
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