title: A cross cultural study of vaginal practices and sexuality: implications for sexual health.
abstract: Between 2005 and 2006, we investigated vaginal practices in Yogyakarta, Indonesia; Tete, Mozambique; KwaZulu-Natal, South Africa; and Bangkok and Chonburi, Thailand. We sought to understand women's practices, their motivations for use and the role vaginal practices play in women's health, sexuality and sense of wellbeing. The study was carried out among adult women and men who were identified as using, having knowledge or being involved in trade in products. Further contacts were made using snowball sampling. Across the sites, individual interviews were conducted with 229 people and 265 others participated in focus group discussions. We found that women in all four countries have a variety of reasons for carrying out vaginal practices whose aim is to not simply 'dry' the vagina but rather decrease moisture that may have other associated meanings, and that they are exclusively "intravaginal" in operation. Practices, products and frequency vary. Motivations generally relate to personal hygiene, genital health or sexuality. Hygiene practices involve external washing and intravaginal cleansing or douching and ingestion of substances. Health practices include intravaginal cleansing, traditional cutting, insertion of herbal preparations, and application of substances to soothe irritated vaginal tissue. Practices related to sexuality can involve any of these practices with specific products that warm, dry, and/or tighten the vagina to increase pleasure for the man and sometimes for the woman. Hygiene and health are expressions of femininity connected to sexuality even if not always explicitly expressed as such. We found their effects may have unexpected and even undesired consequences. This study demonstrates that women in the four countries actively use a variety of practices to achieve a desired vaginal state. The results provide the basis for a classification framework that can be used for future study of this complex topic.
authors.affiliation: Department of Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Burn, Finkenhubelweg 11, 3012 Bern, Switzerland. Electronic address: amartinhilber@ispm.unibe.ch.
authors.forename: Adriane
authors.initials: A
authors.lastname: Martin Hilber
authors.affiliation: Australian Demographic and Social Research Institute, The Australian National University, Australia.
authors.forename: Terence H
authors.initials: TH
authors.lastname: Hull
authors.affiliation: HIVAIDS Networking organisation (HIVAN), Durban, South Africa.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Preston-Whyte
authors.affiliation: Department of Anthropology, The University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bagnol
authors.affiliation: Reproductive Health and HIV Research Unit, University of the Witwatersrand, Durban, South Africa.
authors.forename: Jenni
authors.initials: J
authors.lastname: Smit
authors.affiliation: Faculty of Nursing, Burapha University, Thailand.
authors.forename: Chintana
authors.initials: C
authors.lastname: Wacharasin
authors.affiliation: Women's Health Foundation, Jakarta, Indonesia.
authors.forename: Ninuk
authors.initials: N
authors.lastname: Widyantoro
mesh_terms: D000293:Adolescent; D000328:Adult; D003431:Cross-Cultural Comparison; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D007214:Indonesia; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009073:Mozambique; D019529:Sexuality / Q000523:psychology*; D013019:South Africa; D013785:Thailand; D014623:Vaginal Diseases / Q000517:prevention & control*; D044364:Vaginal Douching / Q000706:statistics & numerical data*; D055815:Young Adult