Introduction Intravaginal practices (IVP) are highly prevalent and commonly performed in many countries for a variety of purposes related to genital health, personal hygiene, and sexual pleasure. However, IVP may also have harmful side effects. Previous research supports an association between IVP and bacterial vaginosis and HIV. Our objective is to understand the prevalence and motivations for IVP among rural Malawian women participating in a community survey on sexual and reproductive health.

Methods We used baseline survey data from a community-based cohort study conducted among 650 women in rural Lilongwe District, Malawi. Participants answered questions assessing frequency of use for different types of IVP and reasons for performing IVP.

Results Most women reported at least some experience with IVP in the past 30 days: 88% reported internal vaginal cleansing with water, 87% reported cleansing with soap and water, and 84% reported inserting cotton, cloth or tissue. Only 5% of women reported no IVP; most (60%) reported at least three practices. Approximately half of women reported very frequent engagement in at least one type of IVP: among those who inserted cotton, cloth or tissue, 43% did so more than once a day; among those who cleansed internally with soap and water, 51% did so more than once a day. Among IVP engagers, 57% reported sexual- and hygiene-related reasons, 36% only hygiene reasons, 4% neither, and 3% only sexually-related motivations. We found no significant association between motivations for IVP (for hygiene vs. sexual reasons) and frequency of IVP.

Conclusion Intravaginal practices are highly prevalent and frequently performed among these rural Malawian women. Women’s motivations for IVP were not associated with IVP frequency, and therefore IVP cessation programs targeted to motivations may be unsuccessful in this population. The next phase of this research program will investigate the association between IVP and STI prevalence.

Disclosure of interest statement The authors have no conflicts of interest or financial disclosures to report.