Are vaginal/genital ‘health’ products bad for vaginal/genital health?

An ‘exploratory’ survey (1,435 respondents) reported in a recent paper in BMC Women’s Health by Crann & O’Doherty (C&D) indicates the widespread use (>95%) of ‘health and hygiene’ products by Canadian women in and around the vagina. The researchers also investigate, in a preliminary way, the relationship between their use and the experience of vaginal and genital symptoms.

Concern about this issue has often focused on douching practices amongst African women (and sex workers (FSW) in particular) on account of the probable link between BV and HIV transmission (Schmid & Koumans (STI)). Baeten & Clelland (STI) report a 40% reduction of lactobacillus in laboratory samples following douching; Fonck & Temmerman (STI) find a link between between douching practices and incidence of BV among Kenyan FSW (see also Reed & Wirawan (STI) on FSW in Bali). In the light of such evidence studies have been conducted to investigate the impact on vaginal health of douching cessation – with mixed results (Esber & Turner (STI); Masese & Kurth (STI)). Curiously, Low & Mayaud (STI) report a ‘protective effect’ of douching in relation to HPV 6/11 in Burkina Faso.

By and large, these studies are concerned only with douching, though Brotman & Zenilman (STI) investigate the impact on microbiota of lubricant use among US Afro-Caribbeans. C&D extend the range of products to include: vaginal/genital moisturizers; anti-itch creams, feminine wipes, washes; suppositories; sprays; powders. They also consider the use of products not specifically designed for vaginal/genital use such as: baby wipes; body creams; baby oil.

What emerges from their survey is, first, the extent of Canadian use of these products (95% of those surveyed). Moreover, a high proportion of product users use their product on a daily basis: wipes (externally), 29.7% of users; powders (externally), 46.7%; washes (externally), 35.4%; baby wipes (externally), 18.4%. C&D also assess associations between these practices and respondents reporting ever having suffered adverse genital health conditions. Overall, they report three-fold higher odds in those reporting use of vaginal/genital health products. They also give odds ratios for association of individual product types with specific conditions: e.g. use of moisturizers/lubricants with 2.5-fold higher risk of yeast infections, and gel sanitizers with 8-fold higher risk; or feminine wipes with double the odds of UTI. Of course, the researchers have no way of establishing whether it is the symptom the leads to use of the product, or use of the product that leads to the symptom. The direction of causality in these associations is unknown.

The study is, on the authors’ own admission, largely exploratory, and does not seek to attribute adverse conditions to specific products – or even types of product. Their aim is rather to draw attention to the increasing availability, and widespread use, of a variety of products whose impact on vaginal/genital health remains largely unknown. They also point to the need for information to assist women in making informed choices, health providers in guiding those women, as well governments in the regulation and labelling of products.

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