Research on Douching Reveals Little Association to Sexually Transmitted Infections

via AIDSmap.com, by Gus Cairns

Neither rectal douching nor vaginal washing appear to be as significantly associated with sexually transmitted infections as had been feared, the International Microbicides Conference in Sydney heard yesterday.

In the case of women, vaginal washing and other vaginal health practices have been associated with bacterial vaginosis (BV), an imbalance in the types of bacteria that colonise the mucous surfaces of the vagina. BV can cause pelvic inflammatory disease and premature delivery in pregnant women and is associated with a higher risk of both acquiring and transmitting HIV.

The HPTN 035 trial of the candidate microbicide PRO2000 therefore included a survey of vaginal health practices, counselling against ones associated with a raised risk of BV, and assessing any link between these practices and BV. It found none, though a smaller study of women in Los Angeles did find an association not with douching and BV, but between the use of petroleum jelly as a lubricant and BV.

In the case of rectal douching in women and gay men, there is very little we currently know about the practice. However, findings over the last couple of years that the use of lubricants for anal sex, particularly water-based ones, is associated with higher rates of sexually transmitted infections have raised concerns that other practices that impact on the fragile rectal mucosa may also raise the risk of sexually transmitted infections (STIs) and HIV. International Rectal Microbicide Advocates (IRMA) have therefore conducted a survey of rectal douching practice. Interim results were presented yesterday and the survey is still ongoing.

Vaginal and rectal practices in women in HPTN 035 and in Los Angeles

In HPTN 035, vaginal hygiene practices were assessed at quarterly visits and the 3087 participants were counselled to try not to use the practices. They were divided into women who did not practise vaginal washing, ones who only used water and ones who used other products such as soap and water or commercial douches (Kasaro).

The proportion of women not practising any vaginal hygiene fell from 60% at baseline to 36.5% at last visit, and this was a steady fall over time, not just occurring immediately after the baseline visit.
Bacterial vaginosis (BV) was common at baseline and the proportion of women with it did not change over time – at any visit 36 to 38% of women had BV. There was no association between vaginal hygiene practices and BV.

Another study of women in Los Angeles (Brown) assessed vaginal hygiene and lubricant practices in an observational cohort of 141 women. The cohort was structured to reflect a mix of ethnicity and HIV serostatus: 26% had HIV and 40% were black, 34% white and 26% Latina. Their median age was 33 (range 18-65).

Read the Rest.


[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

How Do You Douche or Don't? Please Take Our Rectal Hygiene Survey

International Rectal Microbicides Advocates (IRMA) and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help us better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

We are trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse.

It is a brief survey (takes less than fifteen minutes) and is completely anonymous. It is also available in many different LANGUAGES! This includes English, Spanish, French, Chinese, Russian, Portuguese, Thai, and German!

We have been having trouble getting women to take the survey, and we really want to include their perspectives and experiences in the results, as well. Take the survey and if you could, email this to your listservs and help promote the survey! Anyone can take the survey whether they use douches/enemas or not! Thanks so much for your time! You can find our survey here: http://www.keysurvey.com/votingmodule/s180/survey/382277/d7a7/

If you have any questions please feel free to contact me at nthakkar@aidschicago.org

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

IRMA Survey On Rect Douching and Enemas in 5 Languages - Please Participate!

IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

Take the survey in English, Spanish, French, Chinese, or Russian.

We're trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse and hope you - yes YOU - will fill out this brief anonymous survey (estimated time to complete: less than 15 minutes).

Please take the survey NOW and share this link widely!

[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Calling all Women and Spanish Speakers- Please Take our Survey!

Dear Women and Spanish Speakers,

We need your help with our Rectal Douching and Enema Survey! IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help us better understand the types of products people use rectally for anal sex including lubricants and enemas or douches. We are trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse. It is a brief survey (takes less than fifteen minutes) and is completely anonymous.

We have been running this survey for about a month now, and the participation level has been high. However, of the hundreds of responses we have received, less than 10% have been from women! We need more feedback on these anal products from women! We are asking you, ladies, to please take our survey or forward it to anyone you know who may be interested. Women’s opinions and experiences matter in all things anal, and we desperately want to take them into consideration so that women can be better protected from sexually transmitted infections.

Also, with many thanks to IRMA's chapter based in Lima, Peru, we now have a Spanish translation of the survey available! So IRMA blog followers, please forward the survey to anyone you may know who needs the Spanish translation. Thanks IRMA-ALC Lima!

You can click here for the survey or on the "Rectal Douching & Enenma Survey" logo at the top of the page. Thanks again for all of your help!

How do you douche?

TOOT TOOT HEY BEEP BEEP!

IRMA has teamed up with UCLA on another survey - this one on the very exciting and super relevant topic of rectal douching and enemas.

The survey is now available in English.

IRMA and researchers at the University of California, Los Angeles (UCLA) School of Public Health are conducting a brief survey to help us better understand the types of products people use rectally for anal sex including lubricants and enemas or douches.

We are trying to gain a better understanding of rectal practices and behaviors that may affect the risk for sexually transmitted infections among people who practice anal intercourse. We hope you will fill out this brief anonymous survey (estimated time to complete: less than 15 minutes).

Spanish, French, Portuguese, Chinese and Russian versions of the survey are in the works now. Watch this space - we will let you know when they are ready.

In the meantime, please take the survey in English if appropriate, and share this link widely. Thanks!





[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Insert Discourse: Rectal Douching Among Young HIV-Positive and HIV-Negative Men Who Have Sex with Men in Vancouver, Canada

Via Sexulaity and Culture by Arn J. Schilder, Treena R. Orchard, Christopher S. Buchner, Steffanie A. Strathdee, Robert S. Hogg

Abstract:
 Douching is a common practice among certain groups of women and MSM, and it is conducted for the purpose of cleanliness as part of bodily hygiene maintenance. Although there has been considerable research about female vaginal douching, understandings of rectal douching (RD) for MSM are limited.

In the epidemiological and medical literature, RD is presented as a behaviour that removes beneficial bacteria and the surface epithelium layer of the colon, which can, potentially, increase the risk of HIV transmission in MSM. The paucity of research on male douching practices is curious given the primacy of anal sex in HIV prevention initiatives and the widespread nature of rectal douching among this population.

This paper provides preliminary data on RD and is intended to engender a dialogue about male douching and the need for additional research into the cultural construction of the body among MSM, namely with respect to the anus. Findings were derived from qualitative interviews with 12 young HIV-positive men who had recently become HIV-infected and 12 HIV-negative age-matched counterparts who were participating in a prospective cohort study. Beliefs about RD differed according to HIV serostatus; HIV-positive men discussed the practice much more openly than their counterparts did.

Pre-coital RD is an embedded behaviour about which very little is known. However, it is a critical issue to include in the development of effective HIV prevention strategies and warrants an acknowledgement of importance of the anus in the lives, sexual practices, and identities among MSM.

For the full study click here.

Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex with Men

via CDC

A study by IRMA Steering Committee members Alex Carballo-Dieguez, Ken Mayer and colleagues:

"Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex with Men" Sexually Transmitted Diseases (04..10):: Alex Carballo-Diéguez; José Bauermeister; Ana Ventuneac; Curtis Dolezal; Kenneth Mayer

The authors undertook the current study to explore the age of onset of rectal douching among men who have sex with men (MSM) and the reasons for continuing to douche, as well as to consider whether rectal douches containing microbial agents would be acceptable for men at risk of HIV infection. In stage one of the research, the team used qualitative methods to assess douching behavior in a sample of 20 MSM. The researchers then developed a structured questionnaire that was administered to 105 MSM in stage two.

Despite being advised not to do so, more than half of the participants who completed stage one douched during the trial. Of the 105 HIV-negative MSM in stage two, 51 percent reported rectal douching in the previous six months; 47 percent reported douching before anal intercourse; and 25 percent reporting doing so after anal sex. Most participants reported douching frequently or always. Men reported douching on average about two hours before anal intercourse or one hour after. Average age of beginning to douche was late 20s. Most respondents said they douched because they wanted to be clean, or because their partners encouraged them to do so. In addition, some men thought post-intercourse douching could prevent STDs.

"Rectal douching appears to be a popular behavior among men who have receptive anal intercourse," the authors concluded. "It is necessary to identify harmless douches. If [HIV] or [STD] preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of one type douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use)."

Original abstract:
Carballo-Diéguez A, Bauermeister J, Ventuneac A, Dolezal C, Mayer K. “Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex With Men,” Sexually Transmitted Diseases: April 2010 - Volume 37 - Issue 4 - pp 228-233.

Rationale: To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.

Methods: In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.

Results: More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.

Conclusion: Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

For the full study click here.

New Fleet enema for health, cleanliness

via Joe.My.God

“We’ve always known that some of our consumers were using Fleet enemas for reasons other than to relieve constipation, so we wanted to develop a product that would meet the needs of those users and provide them with a safe way to cleanse and frequently if desired,” [Fleet brand manager Emily] Klopp said. Fleet sells about $30 million in enemas annually and dominates the market, Klopp said. It’s unclear the exact size of the market because Wal-Mart and other stores sell private-label brands and do not disclose their sales. The new version hits shelves at CVS drug stores and Target this month, followed by Walgreens next month and Rite-Aid in June. Wal-Mart is the only major retailer so far to balk at carrying it, Klopp said.

Read the whole post.

Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex With Men

Abstract via Sexually Transmitted Diseases

Carballo-Diéguez, Alex PHD; Bauermeister, José PHD; Ventuneac, Ana PHD; Dolezal, Curtis PHD; Mayer, Kenneth MD

Rationale: To explore age of onset of rectal douching among men who have sex with men (MSM) and reasons leading to and maintaining douching behavior; and to consider whether rectal douches containing microbicidal agents might be acceptable for men at HIV risk.

Methods: In stage 1, we used qualitative methods to explore douching behavior in a sample of 20 MSM. Subsequently, we developed a structured questionnaire that was administered in stage 2 to 105 MSM.

Results: More than half of participants who completed stage 1 douched during the trial despite having been advised not to do so. Of the 105 human immunodeficiency virus uninfected participants in stage 2, 51% reported using rectal douches in the prior 6 months; 47% douched before and 25% after anal intercourse. Most participants reported douching frequently or always. On average, men reported douching about 2 hours before or 1 hour following intercourse. Average age of onset was late 20s. Most men who douched wanted to be clean or were encouraged to douche by their partners. Some men thought douching after sex could prevent sexually transmitted infections.

Conclusion: Rectal douching appears to be a popular behavior among men who have receptive anal intercourse. It is necessary to identify harmless douches. If human immunodeficiency virus or sexually transmitted infections preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of 1 type of douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use).

(C) Copyright 2009 American Sexually Transmitted Diseases Association