Enema use or douching is a
risk factor for HIV/STI in men who have sex with men (MSM). However, few studies
have explored enema use practices.
We examined the frequency of enema use, type
of products used, and reasons to use and not to use before and after receptive anal sex in
a large sample of MSM (N = 4,992) recruited from 16 U.S. cities. Through online
surveys, we examined personal, behavioral, and environmental factors associated
with enema use.
Most (52 %) participants reported having douched at least once and
35 % reported douching within
the last 3 months. While most (88 %) reported enema use before receptive anal sex,
28 % douched after receptive anal sex.
Most participants (65 %) used water to douche, 24 % added salt, soap, and/or antibacterial
products to water, and 30 % reported using commercially available products.
Being
a man of color, HIV-positive, diagnosed with an STI, identifying as "versatile"
in sex, and having more than two unprotected sex partners were significantly associated
with recent enema use.
Douching behavior
appears closely associated with HIV/STI risk. Douching with
water may be a concern since it may increase HIV/STI infection by damaging the epithelium.
Development and promotion of a non-damaging, non-water based enema specifically
for use in anal sex are
recommended.
In addition, the seemingly contradictory recommendations that water-based
lubricant is recommended for anal sex but
water-based enemas are dangerous need to be reconciled into a single consistent
message.
Reasons not to use enema before anal sex (N=4301)
| Reasons not to douche before anal sex | n | % |
|---|---|---|
| I do not have receptive anal sex | 866 | 20.1 |
| I do not like douche, find it painful or uncomfortable | 256 | 5.9 |
| No need, I prefer it to be spontaneous/not planned | 1975 | 45.9 |
| I do not mind/prefer anal sex being “dirty”/“natural” | 424 | 9.8 |
| HIV/STI prevention | 156 | 3.6 |
| I don’t know about douching or haven’t thought about it | 1141 | 26.5 |
| Other | 264 | 6.1 |
Full article at:
- 1Division of Epidemiology and Community Health, University of Minnesota School of Public Health (http://www.sph.umn.edu/), WBOB-300, 1300 2nd St. South, Minneapolis, MN, 55454, USA, snoor@umn.edu.
- Arch Sex Behav. 2014 May;43(4):755-69. doi: 10.1007/s10508-013-0203-0. Epub 2013 Dec 18.
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