Intravaginal Practices among a Cohort of Rural Malawian Women

Background:

Intravaginal practices (IVP) are highly prevalent and commonly performed in many countries for a variety of purposes related to genital health, hygiene and sexual pleasure. However, IVP may also have harmful side effects, including associations with bacterial vaginosis and HIV.

Methods:

The prevalence and motivations for IVP among 650 women participating in the baseline survey of a community-based cohort study on sexual and reproductive health in rural Lilongwe District, Malawi, were characterised. Key variables included the type and frequency of IVP, and motivations for engaging in IVP.

Results:

Most women (95%) had engaged in IVP in the past 30 days: 88% reported internal vaginal cleansing with water only, 87% reported cleansing with soap and water, and 84% reported inserting cotton, cloth or tissue. A majority (60%) reported at least three practices. Very frequent engagement in at least one type of IVP was also common; among those who inserted cotton, cloth or tissue, 43% did so more than once a day; among those who cleansed internally with soap and water, 51% did so more than once a day. Women reported many reasons for using IVP. The most commonly reported reasons were to remove odours (91%), to remove extra moisture (58%), to prevent disease (49%), to relieve symptoms of disease (41%) and to improve sex for a partner (40%).

Conclusion:

IVP are highly prevalent and frequently performed among these rural Malawian women. Future research should investigate the associations between IVP and sexually transmissible infection prevalence.

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By:  Allahna Esber A D, Abigail Norris Turner B, Gladson Mopiwa C and Alison H. Norris A B 

A Division of Epidemiology, The Ohio State University, 1841 Neil Avenue, Columbus, OH 43210, USA. B Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, 410 W. 10th Columbus, OH 43210, USA. C Child Legacy International, Umoyo wa Thanzi Research, P.O.Box 1927, Lilongwe, Malawi. D Corresponding author. Email: esber.8@osu.edu 

Sex Health. 2016 Apr 14. doi: 10.1071/SH15139.

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Motivations for Intravaginal Product Use among a Cohort of Women in Los Angeles

Objective

Intravaginal practices—including behaviors such as intravaginal cleansing and insertion of products—have been linked to a number of adverse reproductive health outcomes, including increased risk for bacterial vaginosis, sexually transmitted infections, and HIV. Currently, little is known about the motivations for intravaginal practices among women in the United States. The objective of this study was to identify and describe motivations for intravaginal washing and intravaginal insertion of products among women of differing ages and racial/ethnic groups.

Methods

Between 2008 and 2010, we enrolled a convenience sample of sexually active women aged 18–65 years living in Los Angeles recruited through community education and outreach activities in HIV/AIDS service organizations, women’s health clinics, community-based organizations, and HIV testing sites. At the enrollment visit, women completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, intravaginal practices, and motivations for intravaginal practices over the past month and past year.

Results

We enrolled 141 women; 34% of participants were Caucasian, 40% African American, and 26% Latina. Peri-sexual intravaginal washing was common in all groups, whether to clean up after sex (70%) or to prepare for sex (54%). African American women were more likely to report learning to wash intravaginally from their mothers compared to Latina or Caucasian women (70% vs. 49%, P = 0.04). Sixty-one percent of African American women reported using a douching device over the past year compared to 41% of Latina and 40% of Caucasian women (p = 0.02). Younger women were more likely to report that their male partners wanted them to wash intravaginally than older women (77% vs. 24%, P<0.01), and more likely to report the removal of odors as a motive than older women (65% vs. 40%, P = 0.04). The most commonly used intravaginal products included sexual lubricants, petroleum jelly, body lotions, oils, and wet wipes. Use of these products varied by race, and motives given included increasing lubrication, preparing for sex, smelling good, and preventing sexually transmitted infections.

Conclusion

Women’s intravaginal practices and motivations for these practices differ across race and age. Motivations for use also vary by type of intravaginal product used. Given that some intravaginal practices have been shown to be harmful, interventions, programs and counseling messages to encourage less harmful practices are needed, and should consider underlying motivations that influence women’s vaginal practices. Practitioners may use these results to better support women in achieving vaginal health.

Below:  Motivations for intravaginal insertion of products during last vaginal intercourse, by type of product used

Full article at:   http://goo.gl/kvUVBe

By:  

Joelle M. Brown, Eugenie Poirot
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America

Joelle M. Brown, Kristen L. Hess, Michele Vertucci
Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America

Stephen Brown, Michele Vertucci, Marjan Hezareh
AIDS Research Alliance of America, Los Angeles, California, United States of America

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Intravaginal Practices among HIV-Negative Female Sex Workers Along the US-Mexico Border & Their Implications for Emerging HIV Prevention Interventions

OBJECTIVE:

To describe intravaginal practices (IVPs) among female sex workers (FSWs) who inject drugs in two cities-Tijuana and Ciudad Juarez-on the border between the USA and Mexico.

METHODS:

Data for a secondary analysis were obtained from interviews conducted as part of a randomized controlled trial in FSWs who injected drugs between October 28, 2008, and May 31, 2010. Eligible individuals were aged at least 18 years and reported sharing injection equipment and having unprotected sex with clients in the previous month. Descriptive statistics were used to assess frequency and type of IVPs. Logistic regression was used to assess correlates of IVPs.

RESULTS:

Among 529 FSWs who completed both surveys, 229 (43.3%) had performed IVPs in the previous 6 months. Factors independently associated with IVPs were reporting any sexually transmitted infection in the previous 6 months, three or more pregnancies, and having clients who became violent when proposing condom use, which are all factors related to inconsistent condom use.

CONCLUSION:

Screening for IVPs could help to identify FSW at increased risk of HIV, and facilitate conversations about specific risk-reduction methods.

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By:  Seidman D1, Rusch M2, Abramovitz D3, Stockman JK3, Martinez G4, Rangel G5, Vera A3, Ulibarri MD6, Strathdee SA7.

• 1Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
• 2Population Health and Epidemiology, Island Health, Victoria, BC, Canada; School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada.
• 3Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA.
• 4Community Health and Development of Ciudad Juarez and the Mexican Federation of Private Associations, Ciudad Juarez, Mexico.
• 5El Colegio de la Frontera del Norte, Tijuana, Mexico.
• 6Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
• 7Division of Global Public Health, University of California, San Diego, La Jolla, CA, USA. Electronic address: sstrathdee@ucsd.edu. 
• Int J Gynaecol Obstet. 2016 Jan 28. pii: S0020-7292(16)00037-0. doi: 10.1016/j.ijgo.2015.09.025.

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Intravaginal Practices in Female Sex Workers in Cambodia: A Qualitative Study

Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). 

This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phnom Penh, Cambodia. We conducted in-depth interviews using open-ended questions with 30 FSWs in July-August 2014. We analyzed data using thematic content analysis, with thematic codes based on the constructs of the theory of planned behavior. 

The results showed that the most common IVP was a combination of intravaginal washing and wiping, to which we refer as intravaginal cleansing. There was a clear and close connection between IVP and sex work. Perceived benefits of intravaginal cleansing were numerous, while the perceived risks were few. As a result, the attitude toward intravaginal cleansing was favorable. 

A common misperception of benefit was that intravaginal cleansing could prevent sexually transmitted infections. Local physicians considerably influenced the subjective norm related to IVP. Intention to quit IVPs was suboptimal. 

In conclusion, the psychological factors associated with IVPs in FSWs were somewhat different from those in the general population of Cambodian women and women in other countries. Behavioral beliefs, attitude, and subjective norms appeared salient and important factors in IVPs. Interventions aimed at reducing IVPs should target these constructs as well as the sex-work-associated economic motives. Local physicians may be an agent to change IVP and an effective channel to deliver interventions.

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By:  Bui TC1, Tran LT2, Hor LB3, Scheurer ME4, Vidrine DJ5, Markham CM6.

• 1Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA. thanh.bui@aya.yale.edu.
• 2Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA.
• 3National AIDS Authority, Phnom Penh, Cambodia.
• 4Department of Pediatrics, Dan L. Duncan Cancer Center, Baylor College of Medicine and Texas Children's Cancer Center, Houston, TX, USA.
• 5Stephenson Cancer Center and Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
• 6Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA. 
• Arch Sex Behav. 2016 Jan 7.

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A Cross-Sectional Study of Bacterial Vaginosis, Intravaginal Practices & HIV Genital Shedding; Implications for HIV Transmission & Women's Health

Bacterial vaginosis (BV) is associated with an increased risk of HIV transmission, and intravaginal practices (IVP) are an important risk factor for developing BV. The relationship between IVP, BV and HIV lower genital shedding, responsible for HIV transmission, has not been examined in women receiving antiretrovirals in Zambia.

Setting: Community Health Center in Lusaka, Zambia.

Participants were HIV-infected women receiving antiretroviral therapy and engaging in IVP (n=128). Participants completed audio computer-administered self-interviews to assess IVP and underwent a vaginal examination. BV was diagnosed using Nugent criteria. HIV-1 lower genital shedding was assessed by measuring HIV-1 RNA in cervicovaginal lavages.

Most women engaged in IVP daily (114, 89.0%) and 81 (63.3%) of the participants had BV. HIV-1 genital shedding was detected in 18 (14.2%) participants. BV was associated with daily use of IVP and weekly use of traditional medicines for IVP. The only factor associated with HIV-1 lower genital shedding was plasma viraemia. Neither IVP nor BV were associated with HIV shedding.

Despite the frequency of IVP and high prevalence of BV, plasma viraemia was the primary factor associated with HIV lower genital shedding. These findings support early initiation of antiretrovirals as an HIV prevention tool. Given adverse health outcomes associated with BV, the association between frequent IVP and BV, and the powerful local norms and traditions encouraging IVP, there is a need for studies assessing culturally tailored interventions to decrease BV in high-prevalence settings.

Full article at:  http://goo.gl/EmtqVd

By: Alcaide ML1, Chisembele M2, Malupande E2, Arheart K3, Fischl M1, Jones DL4.

• 1Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA.
• 2University of Zambia, University Teaching Hospital, Lusaka, Zambia.
• 3Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA.
• 4Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA. 

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