title: Prevalence and self-reported health consequences of vaginal practices in KwaZulu-Natal, South Africa: findings from a household survey.
abstract: OBJECTIVE
  To investigate population-level prevalence of vaginal practices, their frequency and self-reported health consequences in KwaZulu-Natal, South Africa.
  
  
  METHODS
  A household survey using multi-stage cluster sampling was conducted in 2007. Women aged 18-60 (n = 867) were interviewed on demographics, sexual behaviours and vaginal practices, focusing on intravaginal practices. Design-based analysis used multivariate logistic regression to identify factors associated with intravaginal or any practice.
  
  
  RESULTS
  Most women currently perform vaginal practices (90.2%), with 34.8% reporting two and 16.3%≥3 practices. Internal cleansing, the commonest practice (63.3% of women), is undertaken frequently (61.6% cleansing twice daily; 20.0% using ≥2 products). Fewer report application (10.1%), insertion (11.6%) or ingestion (14.3%) practices. Hygiene is a common motivation, even for the 23.2% of women reporting intravaginal practices around the time of sex. Prevalence of any practice was lower among women with tertiary education than those without primary education (AOR = 0.26, 95% CI = 0.08-0.85), nearly twice as common in sexually active women (95% CI = 1.05-3.56) and increased as overall health status declined. Adjusted odds of intravaginal practices were 1.8-fold higher in women reporting unprotected sex (95% CI = 1.11-2.90). Few reported health problems with current practices (0.6%); though, 12.6% had ever-experienced adverse effects.
  
  
  CONCLUSIONS
  Vaginal practices are common in KwaZulu-Natal. Although self-reported health problems with current practices are rare, high lifetime risk of adverse events and potential for asymptomatic but clinically important damage make continued research important.
authors.affiliation: Maternal, Adolescent and Child Health, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa. jsmit@match.org.za
authors.forename: J
authors.initials: J
authors.lastname: Smit
authors.forename: M F
authors.initials: MF
authors.lastname: Chersich
authors.forename: M
authors.initials: M
authors.lastname: Beksinska
authors.forename: B
authors.initials: B
authors.lastname: Kunene
authors.forename: N
authors.initials: N
authors.lastname: Manzini
authors.forename: A Martin
authors.initials: AM
authors.lastname: Hilber
authors.forename: F
authors.initials: F
authors.lastname: Scorgie
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D006920:Hygiene; D016488:Medicine, African Traditional / Q000379:methods; D008875:Middle Aged; D018456:Reproductive Medicine; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D013019:South Africa; D014621:Vagina / Q000601:surgery; D044364:Vaginal Douching / Q000009:adverse effects / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult