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Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex With Men

Carballo-Diéguez, Alex PHD*; Bauermeister, José PHD; Ventuneac, Ana PHD*; Dolezal, Curtis PHD*; Mayer, Kenneth MD‡§

Sexually Transmitted Diseases: April 2010 - Volume 37 - Issue 4 - p 228-233
doi: 10.1097/OLQ.0b013e3181bf9b2d
Original Study

Rationale: To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.

Methods: In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.

Results: More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.

Conclusion: Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

This study explored behavioral aspects of rectal douching associated with risky sexual intercourse among men who have sex with men, and determined that douches that incorporate rectal microbicides could be an important alternative prevention tool.

From the *Department of Infectious Diseases Division, HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY; †Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; ‡Fenway Institute, Fenway Community Health, Boston, MA; and §Miriam Hospital, Brown University, Providence, RI.

The authors thank all the participants who contributed their time and effort to participate in this study. The authors also thank William O'Brien for his efficient coordination of the study and Rodney Vanderwarker for logistic support.

Supported by the NICHD (R01 046060–01) (to A.C.D.). Additionally, supported by a training grant from the National Institute of Mental Health (T32 MH19139, Behavioral Sciences Research in HIV Infection; principal investigator: Anke A. Ehrhardt, PhD) (to J.B.). Also by the National Institute of Mental Health to the HIV Center for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University (P30-MH43520; principal investigator: Anke A. Ehrhardt, PhD).

The content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD or the NIH.

Correspondence: Alex Carballo-Diéguez, PhD, Unit 15, New York State Psychiatric Institute, 1051 Riverside Drive, NY 10032. E-mail:

Received for publication February 24, 2009, and accepted September 3, 2009.

© Copyright 2010 American Sexually Transmitted Diseases Association