title: Intravaginal practices among female sex workers in Kibera, Kenya.
abstract: OBJECTIVE
  To assess vaginal cleansing and lubricant use among female sex workers (FSW) in Kenya participating in a 6-month, prospective study of the acceptability of the use of the diaphragm.
  
  
  METHODS
  The study is based on 140 FSW in Nairobi, who completed 140 baseline visits and 390 bi-monthly follow-up visits. Participants were instructed to wear the diaphragm for all coital acts during follow-up and to refrain from vaginal cleansing while wearing the diaphragm. Logistic regression was used to identify predictors of recent vaginal cleansing to 'tighten' the vagina reported at baseline; recent vaginal cleansing to prevent infection reported at baseline; recent vaginal cleansing with the diaphragm in place reported during follow-up; and recent use of oil-based lubricant during coitus reported at baseline.
  
  
  RESULTS
  At baseline, 99% of women reported vaginal cleansing in the previous 2 weeks for purposes of hygiene or to remove evidence of past coitus. Approximately 41% of women also reported cleansing in the past 2 weeks to 'tighten' the vagina. Women reported vaginal cleansing with the diaphragm in place in the past 2 weeks at 14% of follow-up visits in which the diaphragm was used. Predictors of such cleansing included young age, 6-month study visit, being divorced or widowed and higher educational level.
  
  
  CONCLUSIONS
  While vaginal cleansing is a modifiable behaviour, given that cleansing for hygiene was almost universal among this study population at baseline and that more women reported cleansing while wearing the diaphragm as the study progressed, the complete eradication of the practice would probably be difficult.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA. mgallo@cdc.gov
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nguti
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: April J
authors.initials: AJ
authors.lastname: Bell
authors.forename: David A
authors.initials: DA
authors.lastname: Eschenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D006920:Hygiene; D007434:Intrauterine Devices / Q000706:statistics & numerical data*; D007630:Kenya; D008875:Middle Aged; D017060:Patient Satisfaction; D011477:Sex Work / Q000706:statistics & numerical data*; D014622:Vaginal Creams, Foams, and Jellies / Q000627:therapeutic use; D044364:Vaginal Douching / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D014622:Vaginal Creams, Foams, and Jellies