Introduction Many women engage in intravaginal practices (IVP) to improve genital hygiene and sexual pleasure. However, IVP can disrupt the genital mucosa, possibly increasing acquisition risk of HIV and the reproductive tract infection bacterial vaginosis. Limited prior research also suggests an association between IVP and HPV. In this analysis, we examine associations between IVP, precancerous lesions and high risk HPV (hr-HPV).
Methods At a rural clinic in Lilongwe District, Malawi, we began enrolling women in a cross-sectional study in January 2015. As of end of March, 96 women have been enrolled and partial results are available. Enrollment is expected to conclude by May 2015; hr-HPV testing to be complete by June 2015. Eligible women are aged 18 and older and presenting at the clinic with genitourinary symptoms. All women undergo visual inspection of the cervix with acetic acid (VIA) and clinician-collected cervical sampling for hr-HPV testing. Women also answer a questionnaire capturing the type and frequency of IVP.
Results IVP were commonly reported among participants: 97% reported cleansing the vagina with cotton, cloth or tissue; 44% cleansed with soap and water; and 8% inserted alum or other powder, herbs, leaves, castor oil or traditional products. IVP was also very frequent, with 85% of women reporting at least one practice daily. Twelve women (15%) had abnormal lesions identified during VIA. We observed no significant association between frequency or type of IVP and the presence of abnormal lesions.
Conclusion Our data confirm that intravaginal practices are common in Malawi among care-seeking women. As our sample size increases, any associations will become more precise. If IVP is associated with abnormal cervical lesions or hr-HPV prevalence, these practices could represent a modifiable risk factor to target in future health interventions in this region.
Disclosure of interest statement The authors have no conflicts of interest or financial disclosures to report.