title: Prevalence, motivations, and adverse effects of vaginal practices in Africa and Asia: findings from a multicountry household survey.
abstract: BACKGROUND
  Women worldwide use various vaginal practices to clean or modify their vulva and vagina. Additional population-level information is needed on prevalence and motivations for these practices, characteristics of users, and their adverse effects.
  
  
  METHODS
  This was a household survey using multistage cluster sampling in Tete, Mozambique; KwaZulu-Natal, South Africa; Yogyakarta, Indonesia; and Chonburi, Thailand. In 2006-2007, vaginal practices and their motivations were examined using structured interviews with women 18-60 years of age (n=3610).
  
  
  RESULTS
  Prevalence, frequency, and motivations varied markedly. Two thirds of women in Yogyakarta and Chonburi reported one or more practices. In Yogyakarta, nearly half ingest substances with vaginal effects, and in Chonburi, external washing and application predominate. In Tete, half reported three or four current practices, and a quarter reported five or more practices. Labial elongation was near universal, and 92% of those surveyed cleanse internally. Two third's in KwaZulu-Natal practiced internal cleansing. Insertion of traditional solid products was rare in Chonburi and Yogyakarta, but one tenth of women in KwaZulu-Natal and nearly two thirds of women in Tete do so. Multivariate analysis of the most common practice in each site showed these were more common among less educated women in Africa and young urban women in Asia. Explicit sexual motivations were frequent in KwaZulu-Natal and Tete, intended for pleasure and maintaining partner commitment. Practices in Chonburi and Yogyakarta were largely motivated by femininity and health. Genital irritation was common at African sites.
  
  
  CONCLUSIONS
  Vaginal practices are not as rare, exotic, or benign as sometimes assumed. Limited evidence of their biomedical consequences remains a concern; further investigation of their safety and sexual health implications is warranted.
authors.affiliation: Australian Demographic and Social Research Institute, Australian National University, Canberra, Australia.
authors.forename: Terence
authors.initials: T
authors.lastname: Hull
authors.forename: Adriane Martin
authors.initials: AM
authors.lastname: Hilber
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bagnol
authors.forename: Aree
authors.initials: A
authors.lastname: Prohmmo
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smit
authors.forename: Ninuk
authors.initials: N
authors.lastname: Widyantoro
authors.forename: Iwu Dwisetyani
authors.initials: ID
authors.lastname: Utomo
authors.forename: Isabelle
authors.initials: I
authors.lastname: François
authors.forename: Nazarius Mbona
authors.initials: NM
authors.lastname: Tumwesigye
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D002562:Ceremonial Behavior; D003430:Cross-Sectional Studies; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D009073:Mozambique / Q000453:epidemiology; D015995:Prevalence; D012725:Sexual Behavior / Q000208:ethnology* / Q000523:psychology; D012747:Sexual Partners; D013019:South Africa / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D014623:Vaginal Diseases / Q000208:ethnology; D044364:Vaginal Douching / Q000009:adverse effects / Q000706:statistics & numerical data*; D016387:Women's Health / Q000208:ethnology*; D055815:Young Adult