In a recent review of the literature on douching practices among young women, Simpson et al. documented that there have been an increasing number of studies characterizing women who have ever douched. Findings from this review indicate that African-American women overwhelmingly report douching at least once in their lifetime. Other studies have also documented a high prevalence of douching among African-American women. Feeling fresh and removing odor predominate as the main reason for douching among the African-American women who have ever douched in our study as well as in the literature. However, further segmentation of African-American women who have ever douched may provide a more focused profile for intervention purposes. Our study is the first to examine the characteristics associated with frequent douching (>2 times per week) among predominantly never-married, low-income African-American women. We found that within our target population, frequent douchers compared with less frequent douchers were more likely to report douching after sex, after discharge, report a regular sex partner and self-report a history of gonorrhea infection. We found that women who douche two times per month compared with less frequent douchers were also more likely to report douching after discharge and self-report a history of gonorrhea infection, thus strengthening the consistency of some of our findings.

Douching after a discharge may be an indication that some women are trying to self-treat an infection rather than seek a medical evaluation. According to one study, 12 % of women believed douching after sex prevented HIV or STD infections. Clinicians should encourage patients to schedule examinations whenever they see an abnormal discharge and should advise women against douching and the use of medicated douches, particularly as self-treatment measures. Further research should be done to understand the use of douching as an STD/HIV prevention method and the association between sexual risk behaviors and douching practices. viagra jelly

Overall, mothers and grandmothers were the main source of introducing douching to participants in our study. A small percentage of women in our study, most being frequent douchers, reported that they were advised by family members to douche prior to Pap examinations. Our findings have several implications for the practice and policy of clinicians screening for sexually transmitted diseases. Providers should inquire about the frequency and most recent douching episode and have written educational materials readily available for patients. Patients who are scheduled for Pap or gynecologic examinations should be advised to avoid douching prior to examination.

That female family members are main sources of learned douching practices among our study population and in the literature highlights the need to understand the cultural aspects of douching, as douching practices are known to vary by cultural norms. For example, the oral traditions of African-Americans, a way of passing down stories and information to the younger generations, can be traced back to their African culture, prior to enslavement in North and South America. Group discussions involving mothers, grandmothers, daughters and other female relatives about the effects of douching should be tested as an effective intervention approach. In addition,alternative options to douching need to be tested anddiscussed with women who frequently douche to findan acceptable alternative to replace a practice that has the medical and public health community recommend women reduce the practice of douching but commercial advertisements promote the practice of douching, then the community is receiving mixed messages about douching. Subsequently, the African-American community may ignore the recommendations given from the medical establishments, especially given the suspicion the African-American community harbors toward the medical establishment. While further research is necessary to describe the many factors promoting douching, perhaps the convening of trusted community leaders, national public health and medical panels and representatives of commercial douching products would help to outline an appropriate strategy for interventions to reduce the modifiable practice of vaginal douching. generic aciphex

There are limitations in the interpretation of our study. Recall bias regarding douching frequency, past Pap examinations and prior STD diagnoses may have affected some of our findings. The relatively small sample size may have precluded detection of additional statistical associations and limits our causal interpretation and generalizability of the study. Our findings are compelling but not definitive. Despite these limitations, our study is indicative of the need for attention to vaginal douching practices among never-married, low-income African-American women and raises more questions about the rationale for douching. For example, more research among our target population is needed to understand the role a regular sex partner may play on douching practices as well as the related effect on condom use and past STD infections. Not only may clinicians influence the douching practices of our target group, but high-school health education classes may be an effective avenue to inform young women about the effects of and address any misper-ceptions about douching. Finally, future research should focus on identifying effective interventions that affect the cultural dynamics, beliefs and teachings about douching and safer and acceptable alternatives to douching.