title: Post-coital vaginal douching is risky for non-regression of low-grade squamous intraepithelial lesion of the cervix.
abstract: BACKGROUND
  Vaginal douching is a common practice worldwide. Its effect on the natural history of the early lesion of human papillomavirus (HPV) infection, low-grade squamous intraepithelial lesion (LSIL), is unknown.
  
  
  METHODS
  In a prospective nation-wide cohort (n=1332), epidemiological variables including habit of vaginal douching after intercourse and outcomes of LSIL were studied. Colposcopy-confirmed LSIL women (n=295) were followed every 3 months. Parameters of HPV infection, sexual behavior, personal hygiene and environmental exposures were compared with the follow-up outcomes.
  
  
  RESULTS
  There was a 15% chance of HSIL co-existing with the LSIL cytology result. Eight percent of colposcopy-confirmed LSIL were found with HSIL in 1 year. With a follow-up of up to 36 months, 83% LSIL regressed, 11% progressed and 6% persisted. The mean time (95% CIs) to regression and progression were 5.2 (4.7-5.8) and 8.0 (5.8-10.3) months, respectively. Risk factors of the non-regression of LSIL included HPV prevalence on enrollment, habit of vaginal douching after intercourse with a hygiene product and non-regular Pap screening, with odd ratio of 4.4 (1.9-10.3), 3.14 (1.04-9.49) and 2.12 (1.24-3.62), respectively. HPV prevalence and vaginal douching also conferred a slower regression of LSIL (8.0 vs. 4.1 months, P<.001 and 8.0 vs. 5.6 months, P=0.02, respectively).
  
  
  CONCLUSIONS
  The study disclosed a transient but warning nature of cytological LSIL. Practicing of vaginal douching after intercourse, especially with hygiene products, is associated with non-regression of LSIL.
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzuchi General Hospital, Tzuchi University, Hualien, Taiwan. tychu@mail2000.com.tw
authors.forename: Tang-Yuan
authors.initials: TY
authors.lastname: Chu
authors.forename: Chao Agnes
authors.initials: CA
authors.lastname: Hsiung
authors.forename: Chi-An
authors.initials: CA
authors.lastname: Chen
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Ho
authors.forename: Tsai-Yen
authors.initials: TY
authors.lastname: Chien
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Chang
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Chou
authors.forename: Jui-Der
authors.initials: JD
authors.lastname: Liou
authors.forename: Yuen-Yee
authors.initials: YY
authors.lastname: Kan
authors.forename: Chang-Yao
authors.initials: CY
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000821:virology; D015331:Cohort Studies; D003075:Coitus; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification; D011446:Prospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000209:etiology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000209:etiology* / Q000821:virology