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Understanding Women’s Vaginal Douching Behaviors and Practices for Consideration in the Development of a Potential Future Vaginal Microbicide Douche for HIV Prevention: A Systematic Review of the Literature

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Abstract

Despite clinicians consistently advising against vaginal douching, 29–92% of women worldwide report douching. This review documents women’s douching practices, motivations for douching, and specific associations (or absence of associations) between vaginal douche use and vaginal outcomes thought to be associated with douching. Understanding women’s existing douching behaviors and vaginal health outcomes is critical for developing a safe vaginal microbicide douche that can be used as HIV pre-exposure prophylaxis (PrEP). A vaginal douche as PrEP could help prevent new HIV infections, since emerging evidence shows some women discontinue oral PrEP. We performed a systematic review of the literature using the guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Articles included in the analysis (N = 48) were published 2009–2019 in English and focused on women’s experiences with douching. Two trained independent reviewers assessed these articles for content on vaginal douching, including racial/ethnic focus of studies, study design, sampling, women’s reasons for douching, contents of douche solutions, and associations between vaginal douching and vaginal health outcomes. Several studies focused on Black women (N = 12 studies) or had no racial/ethnic focus (N = 12). Just over half of all studies (N = 24) were cross-sectional and involved a self-reported questionnaire and lab samples. Studies sampled women from health clinics where they were (N = 13) or were not (N = 14) presenting for vaginal health complaints. Women’s primary motivation for douching was for “general cleanliness” (N = 13), and most douche solutions contained water (N = 12). There was little empirical agreement between vaginal douche use and most vaginal health outcomes. Future studies of PrEP vaginal douches should be well controlled and prioritize safety to ensure positive vaginal health outcomes.

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Funding

The first author is supported by a K01 Award (K01 MH115785; Principle Investigator: Christine Rael, Ph.D.) from the National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30 MH43520; Center Principle Investigator: Robert Remien, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA

    Christine Tagliaferri Rael, Cody Lentz, Alex Carballo-Diéguez & Rebecca Giguere

  2. Molecular and Cell Biology, University of California Berkeley, Berkeley, USA

    Doyel Das

  3. School of Nursing, University of Pennsylvania, Philadelphia, USA

    Jose Bauermeister

  4. MedStar Health Research Institute and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, D.C., USA

    Rachel K. Scott

  5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA

    Craig W. Hendrix

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  1. Christine Tagliaferri Rael
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Contributions

CTR, JB, CWH, and AC-D conceptualized this manuscript; CTR and DD performed the literature review; CTR drafted the manuscript, and CTR, JB, CWH, and AC-D, and RKS, along with RG, DD, and CL critically revised the work.

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Correspondence to Christine Tagliaferri Rael.

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Conflict of interest

Dr. Craig Hendrix has received financial support for clinical research from Gilead, Merck, and ViiV/GSK. He has also served in the past on scientific advisory boards for Gilead, Merck, ViiV/GSK, and Population Council. Dr. Rachel Scott has received funds to complete investigator-sponsored research from Gilead. The remaining authors have no conflicts to declare.

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Rael, C.T., Das, D., Bauermeister, J. et al. Understanding Women’s Vaginal Douching Behaviors and Practices for Consideration in the Development of a Potential Future Vaginal Microbicide Douche for HIV Prevention: A Systematic Review of the Literature. AIDS Behav 25, 2992–3010 (2021). https://doi.org/10.1007/s10461-021-03290-0

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  • DOI: https://doi.org/10.1007/s10461-021-03290-0

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