Objective: Changes in vaginal flora as a result of douching may increase the risk of HIV infection among women. We describe the douching practices of high-risk women in the United States.

Design: Cross-sectional data from a cohort study at 5 sites (Chicago, New York (2), Philadelphia, Providence)

Methods: HIV-1 antibody (-) women were eligible if they reported drug injection in the previous 6 months, or in the previous year had exchanged sex for money or drugs, used crack, had 5 or more male partners or were diagnosed with a sexually transmitted disease. Women also were eligible if they had a current relationship with a male at high risk of HIV infection. Questions on douching practices were asked at the 24-month visit.

Results: Of 604 women, 70% had douched in the previous 6 months, 25% had douched in the past but not in the past 6 months and 5% had never douched. Among 417 women who recently douched, 83% were <20 years old when they first douched and 64% learned to douche on their own; 87% of the remaining women learned to douche from a family member. Most women who douched in the last 6 months (55%) douched >2 times/month; the main reasons for douching were to clean after menstruation (92%) or sex (73%). One-third of women douched to prevent infection. 56% of women who recently douched had been told that douching was unhealthy. Of the 150 women who douched in the past but not in the past 6 months, 76% stopped douching because they beard it was better not to and 41% because it caused irritation or discomfort. Women who douched in the last 6 months were more likely to report unprotected vaginal sex in the previous 6 months compared to women who douched in the past but not recently (66% vs. 57%; p=0.07).

Conclusion: A large proportion of women at high risk of HIV infection continue to douche despite prevention messages encouraging them not to do so. Better educational approaches need to be developed to result in significant change in a widely performed practice.

Beryl Koblin
New York Blood Center
310 East 67th Street
New York, NY