Background Bacterial vaginosis (BV) has been associated with HIV acquisition and transmission. Intravaginal practices may affect women's vulnerability to BV and HIV/STIs, and may influence results of trials of microbicides for HIV prevention through effects on the vaginal environment and on adherence to investigational microbicidal products. We measured the prevalence and frequency of intravaginal hygiene and lubricant use and their association with BV among both HIV-positive and HIV-negative women.

Methods Between October 2008 and June 2009, we recruited women aged 18 years and older in Los Angeles. At the enrolment visit and 12 months later, participants underwent a self-administered, web-based questionnaire covering demographics, sexual behaviours, intravaginal hygiene, and lubricant use. HIV was diagnosed by rapid ELISA, with confirmation by Western blot. BV was diagnosed by Nugent criteria from a self-collected vaginal swab. Here we report data collected at enrolment.

Results We enrolled 141 women (34% identified as White, 40% Black, 26% Hispanic; the median age was 33 years (IQR=25–44)). Overall, 56% of women reported intravaginal cleaning and 45% reported douching over the past month. Overall, nearly three-quarters (73.8%) reported intravaginal insertion of a lubricating product over the past month; commercial lubricant (42.6%), lotion (12.1%), petroleum jelly (10.6%), and oil (7.8%) were the most commonly reported lubricants. The prevalence of BV was 21% and HIV was 27%. In multivariable analysis, intravaginal insertion of oil, lotion, or petroleum jelly (aOR=3.4 (95% CI=1.2 to 9.7)) was associated with BV controlling for douching, age, race, HIV status, and multiple sexual partners.

Conclusion Use of intravaginal lubricating products not specifically designed for sexual intercourse is common among women. The use of such lubricants and their association with BV is of particular concern and warrants further study; not only in light of the direct association with BV, but also because of the link between BV and HIV infection.