Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia☆,☆☆,★,★★

https://doi.org/10.1016/S0002-9378(96)70382-4Get rights and content

Abstract

OBJECTIVE: Our purpose was to investigate the association between douching (douching agents and timing) and sexually transmitted disease. STUDY DESIGN: A cross-sectional survey of sexually transmitted diseases and habits of vaginal douching was performed on 599 pregnant women who visited a prenatal clinic in Surabaya, Indonesia. RESULTS: Of the 599 pregnant women, 115 (19.2%) had at least one sexually transmitted disease (gonorrhea, chlamydia, syphilis, trichomoniasis, or herpes simplex virus-2). Most women had douched with water (19%) or water and soap (63%) at least once in the preceding month. Approximately 10% of the women had douched in the preceding month with a commercial agent (2%) or betel leaf (8%). Douching with water alone after sex was not associated with sexually transmitted disease. Douching with water and soap or with a betel leaf or commercial agent after sex was associated with sexually transmitted disease; adjusted odds ratios were 2.6 (95% confidence interval 1.0 to 7.1) and 2.7 (95% confidence interval 0.5 to 14.5), respectively. The association was enhanced if the women douched before sex or both before and after sex; adjusted odds ratios were 2.7 (95% confidence interval 1.0 to 7.3) for douching with water and soap and 5.2 (95% confidence interval 1.6 to 16.7) for douching with betel leaf or a commercial agent. Compared with women who never douched, women who always douched with betel leaf or a commercial agent had a substantially increased risk for sexually transmitted disease (adjusted odds ratio 9.4, 95% confidence interval 1.8 to 50.3). CONCLUSIONS: We found a significant association between sexually transmitted disease and douching habits (douching with betel leaf, commercial agents, or water and soap). However, further prospective investigations are needed to evaluate the temporal relationship between douching and sexually transmitted disease. (AM J OBSTET GYNECOL 1996;174:115-9.)

Section snippets

MATERIAL AND METHODS

The study population consisted of 599 pregnant women who visited a prenatal clinic in Surabaya, Indonesia, between April 1992 and June 1993. This is a public clinic that serves mostly low-income families. Trained nurses administered a questionnaire to the pregnant women. The questionnaire included questions on socioeconomic status, attitudes toward and use of condoms, sexually transmitted disease and acquired immunodeficiency syndrome knowledge, beliefs, attitudes, and habits of vaginal

RESULTS

Of the 599 pregnant women, 115 (19.2%) had at least one sexually transmitted diseases (gonorrhea, chlamydia, syphilis, trichomoniasis, or HSV-2). The sexually transmitted disease prevalences were 0.8% for gonorrhea, 8.2% for chlamydia, 0.7% for syphilis, 9.9% for HSV-2, and 4.8% for trichomoniasis. No pregnant woman had a positive HIV serologic test.

Nearly all women (91%) had douched at least once in the preceding month. Most women douched with water (19%) or water and soap (63%). Except for

COMMENT

The current study found that a substantial number of women douched during pregnancy. However, only 10% who douched did so by inserting something (betel leaf or commercial agents) into the vagina. The betel leaf contains chavicol paraallyphenol, which has both antiseptic and irritant properties.13 Commercial douching agents (all women in this study used Betadine solution) also have antiseptic properties. Because both betel leaf and commercial agents contain antiseptic properties and both agents

Acknowledgements

We thank United States Naval Medical Research Unit 2, Jakarta, Indonesia, L. Valleroy, A. Kambodji, and A. Warsanto for their assistance in this study.

References (18)

  • W-H Chow et al.

    Vaginal douching as a potential risk factor for tubal ectopic pregnancy

    AM J OBSTET GYNECOL

    (1985)
  • HH Neumann et al.

    Douching and pelvic inflammatory disease [Letter]

    N Engl J Med

    (1976)
  • P Wolner-Hanssen et al.

    Association between vaginal douching and acute pelvic inflammatory disease

    JAMA

    (1990)
  • D Scholes et al.

    Vaginal douching as a risk factor for acute pelvic inflammatory disease

    Obstet Gynecol

    (1993)
  • JR Daling et al.

    Vaginal douching and the risk of tubal pregnancy

    Epidemiology

    (1991)
  • RS Phillips et al.

    The effect of cigarette smoking, Chlamydia trachomatis infection, and vaginal douching on ectopic pregnancy

    Obstet Gynecol

    (1992)
  • JM Chow et al.

    The association between Chlamydia trachomatis and ectopic pregnancy: a matched-pair, case-control study

    JAMA

    (1990)
  • MJ Rosenberg et al.

    Does douching promote ascending infection? [Review]

    J Reprod Med

    (1992)
  • A Messiah et al.

    Factors correlated with homosexually acquired human immunodeficiency virus infection in the era of “safer sex”: was the prevention message clear and well understood? Alain Brugeat Physician Group

    Sex Transm Dis

    (1993)
There are more references available in the full text version of this article.

Cited by (0)

☆

From the Division of Sexually-Transmitted Diseases/Human Immunodeficiency Virus Prevention,athe International Health Program Office,band the Division of Viral and Rickettsial Diseases,cCenters for Disease Control and Prevention, and the Departments of Obstetrics and Gynecologydand Microbiology,eSchool of Medicine, University of Airlangga.

☆☆

Supported by grant No. 497-0298 from the United States Agency for International Development Mission in Jakarta.

★

Reprint requests: M.R. Joesoef, MD, Division of STD/HIV Prevention, Mailstop E02, Centers for Disease Control and Prevention, Atlanta, GA 30333.

★★

6/1/66344

View full text
Copyright © 1996 Published by Mosby, Inc.