Rectal Douching Practices Associated with Anal Intercourse: Implications for the Development of a Behaviorally Congruent HIV-Prevention Rectal Microbicide Douche

  • Alex Carballo-Dieguez
  • Rebecca GiguereEmail author
  • Cody Lentz
  • Curtis Dolezal
  • Edward J. Fuchs
  • Craig W. Hendrix
Original Paper


Tenofovir administration via rectal douching results in higher rectal-mucosa drug concentration than oral administration. Many who engage in receptive anal intercourse (RAI) use cleansing rectal douches. To inform development of a behaviorally-congruent tenofovir douche, 4751 individuals ≥ 18 years-old, born male, from all US states/territories, who engaged in anal intercourse responded to an online survey. Of those who reported RAI in the prior 3 months, 80% douched beforehand, 82% within 1 h, mean 2.9 consecutive applications; 27% douched afterwards, 83% within 1 h, mean 1.7 consecutive applications. Among multidose users, 78% applied doses within 2 min, and 76% retained liquid < 1 min. Most used tap water (89%) in an enema bottle (50%) or rubber bulb (43%), and douched for cleanliness (97%), to avoid smelling bad (65%), and to enhance pleasure (24%). 98% reported high likelihood of using an HIV-prevention douche. An ideal product will protect within a user’s typical number of applications, within 1 h, and be dissolvable in tap water.


Rectal douching Enemas HIV-prevention Rectal microbicides 


La administración de tenofovir por medio de una ducha rectal resulta en una concentración de droga en la mucosa rectal más alta que por vía oral. Muchos de los que tienen sexo anal receptivo (SAR) usan duchas rectales para limpiarse. Para informar el desarrollo de una ducha rectal congruente con los comportamientos habituales de los usuarios, 4751 individuos mayores de 18 años, nacidos varones, de todos los estados y territorios de los EEUU, que tenían sexo anal respondieron a una encuesta por Internet. De los que reportaron SAR en los últimos 3 meses, 80% usaron una ducha previamente, 82% dentro de una hora, con un promedio de 2.9 aplicaciones consecutivas; 27% usaron una ducha posteriormente, 83% dentro de una hora, con un promedio de 1.7 aplicaciones consecutivas. De los que usaron múltiples dosis, 78% aplicaron las dosis dentro de 2 minutos, y 76% retuvieron el líquido < 1 minuto. La mayoría usó agua corriente (89%) en una botella de enema (50%) o un bulbo de goma (43%), y se ducharon para estar limpios (97%), para evitar feos olores (65%), y para aumentar el placer (24%). 98% reportó alta probabilidad de usar una ducha que prevenga el VIH. El producto ideal debería proteger dentro del número típico de aplicaciones del usuario, dentro de una hora, y ser soluble en agua corriente.



We would like to thank the study participants, who took the time to complete the survey to contribute to our knowledge of douching practices, and the entire DREAM U19 study team for their input on the survey content. The study was funded by a U19 Grant under the Integrated Preclinical-Clinical Program for HIV Topical Microbicides (IPCP-HTM), Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) (AI113127). This work was also supported by a Center Grant from the NIMH to the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University (P30-MH43520; PI: Remien, PhD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with Ethical Standards

Conflicts of interest

None to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2018_2336_MOESM1_ESM.docx (135 kb)
Supplementary material 1 (DOCX 134 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia UniversityNew YorkUSA
  2. 2.Division of Clinical PharmacologyJohns Hopkins UniversityBaltimoreUSA

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