TY - JOUR
T1 - Why Do Women Douche? A Longitudinal Study with Two Analytic Approaches
AU - Brotman, Rebecca M.
AU - Klebanoff, Mark A.
AU - Nansel, Tonja
AU - Zhang, Jun
AU - Schwebke, Jane R.
AU - Yu, Kai F.
AU - Zenilman, Jonathan M.
AU - Andrews, William W.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2008/1
Y1 - 2008/1
N2 - Purpose: Although vaginal douching is associated with several adverse outcomes, the reasons why women douche have not been studied prospectively. Methods: Non-pregnant (N = 3620) women aged 15 to 44 years presenting for routine care at 12 clinics in Birmingham, Alabama, participated in a longitudinal study of vaginal flora (1999-2003). Participants were assessed quarterly for 1 year. The authors applied conditional logistic regression in a case-crossover analysis to determine the individual-level factors that vary between a woman's douching and non-douching intervals. Findings were compared to a population-level analysis utilizing generalized estimating equations. Results: Thirty percent of participants douched in every interval; 28% douched in some but not all intervals. The case-crossover analysis indicated a woman was more likely to douche when reporting "fishy" vaginal odor (odds ratio [OR]:2.74; 95% confidence interval [CI]: 1.55, 1.84), vaginal irritation (OR: 1.52; 95% CI: 1.10, 2.11), summer month (OR: 1.37, 95% CI: 1.13, 1.67), or increase in number of sex partners (≥3, OR: 2.42, 95% CI: 1.11, 5.26). Bacterial vaginosis/trichomoniasis treatment (OR: 0.72, 95% CL: 0.59, 0.89) and absent menses (OR: 0.37, 95% CI: 0.28, 0.50) were negatively associated with douching. These ORs were farther from the null than comparable population-level estimates. Conclusions: Programs targeting these predictors may decrease the untoward sequelae associated with douching. Furthermore, a case-crossover analysis applied to prospective studies can provide insights into time-varying factors.
AB - Purpose: Although vaginal douching is associated with several adverse outcomes, the reasons why women douche have not been studied prospectively. Methods: Non-pregnant (N = 3620) women aged 15 to 44 years presenting for routine care at 12 clinics in Birmingham, Alabama, participated in a longitudinal study of vaginal flora (1999-2003). Participants were assessed quarterly for 1 year. The authors applied conditional logistic regression in a case-crossover analysis to determine the individual-level factors that vary between a woman's douching and non-douching intervals. Findings were compared to a population-level analysis utilizing generalized estimating equations. Results: Thirty percent of participants douched in every interval; 28% douched in some but not all intervals. The case-crossover analysis indicated a woman was more likely to douche when reporting "fishy" vaginal odor (odds ratio [OR]:2.74; 95% confidence interval [CI]: 1.55, 1.84), vaginal irritation (OR: 1.52; 95% CI: 1.10, 2.11), summer month (OR: 1.37, 95% CI: 1.13, 1.67), or increase in number of sex partners (≥3, OR: 2.42, 95% CI: 1.11, 5.26). Bacterial vaginosis/trichomoniasis treatment (OR: 0.72, 95% CL: 0.59, 0.89) and absent menses (OR: 0.37, 95% CI: 0.28, 0.50) were negatively associated with douching. These ORs were farther from the null than comparable population-level estimates. Conclusions: Programs targeting these predictors may decrease the untoward sequelae associated with douching. Furthermore, a case-crossover analysis applied to prospective studies can provide insights into time-varying factors.
KW - Vaginal Douching
KW - Vaginosis, Bacterial
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U2 - 10.1016/j.annepidem.2007.05.015
DO - 10.1016/j.annepidem.2007.05.015
M3 - Article
C2 - 18063240
AN - SCOPUS:36549052237
SN - 1047-2797
VL - 18
SP - 65
EP - 73
JO - Annals of epidemiology
JF - Annals of epidemiology
IS - 1
ER -