Intravaginal Practices and Risk of Bacterial Vaginosis and Candidiasis Infection Among a Cohort of Women in the United States

Brown, Joelle M. PhD, MPH; Hess, Kristen L. PhD, MPH; Brown, Stephen MD; Murphy, Colleen PGDip; Waldman, Ava Lena MPH; Hezareh, Marjan PhD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31828786f8
Original Research
Abstract

OBJECTIVE: To measure intravaginal practices among women of differing ages, ethnicities, and human immunodeficiency virus status and the association between intravaginal practices and bacterial vaginosis and candidiasis infection.

METHODS: Between 2008 and 2010, we recruited and followed sexually active women aged 18–65 years living in Los Angeles. At the enrollment and month 12 visit, participants completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, vaginal symptoms, and intravaginal practices over the past month. At each visit, bacterial vaginosis and candidiasis infection were diagnosed by Nugent criteria and DNA probe, respectively.

RESULTS: We enrolled 141 women. Two thirds (66%) reported an intravaginal practice over the past month; 49% reported insertion of an intravaginal product (other than tampons) and 45% reported intravaginal washing. The most commonly reported practices included insertion of commercial sexual lubricants (70%), petroleum jelly (17%), and oils (13%). In univariable analysis, intravaginal use of oils was associated with Candida species colonization (44.4% compared with 5%, P<.01). In multivariable analysis, women reporting intravaginal use of petroleum jelly over the past month were 2.2 times more likely to test positive for bacterial vaginosis (adjusted relative risk 2.2, 95% confidence interval 1.3–3.9).

CONCLUSION: Intravaginal insertion of over-the-counter products is common among women in the United States and is associated with increased risk of bacterial vaginosis. The context, motivations for, and effects of intravaginal products and practices on vaginal health are of concern and warrant further study.

LEVEL OF EVIDENCE: III

In Brief

Intravaginal insertion of over-the-counter products is common among women in the United States and is associated with increased risk of bacterial vaginosis.

Author Information

University of California and the AIDS Research Alliance of America, Los Angeles, and the University of California, San Francisco, San Francisco, California.

Corresponding author: Joelle M. Brown, PhD, MPH, University of California, San Francisco, 50 Beale Street, Suite 1200, San Francisco, CA 94105; e-mail: BrownJ@globalhealth.ucsf.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Supported by the California HIV/AIDS Research Program (CR07-LA-582; CR07-ARA-581) and the UCLA AIDS Institute (CH05-LA-608).

© 2013 The American College of Obstetricians and Gynecologists