title: Prevalence and types of rectal douches used for anal intercourse: results from an international survey.
abstract: BACKGROUND
  Rectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. However, there is limited data on rectal douching behavior in populations practicing AI. We examined the content, types of products, rectal douching practices and risk behaviors among those reporting AI.
  
  
  METHODS
  From August 2011 to May 2012, 1,725 women and men reporting receptive AI in the past 3 months completed an internet-based survey on rectal douching practices. The survey was available in English, French, German, Mandarin, Portuguese, Russian, Spanish, and Thai and included questions on sexual behaviors associated with AI including rectal douching. Differences by rectal douching practices were evaluated using chi-square methods and associations between reported douching practices and other factors including age and reported STI history were evaluated using logistic regression analysis.
  
  
  RESULTS
  Respondents represented 112 countries, were mostly male (88%), and from North America (55%) or Europe (22%). Among the 1,339 respondents (66%) who reported rectal douching, most (83%) reported always/almost always douching before receptive AI. The majority of rectal douchers reported using non-commercial/homemade products (93%), with water being the most commonly used product (82%). Commercial products were used by 31%, with the most common product being saline-based (56%). Rectal douching varied by demographic and risk behaviors. The prevalence of rectal douching was higher among men (70% vs. 32%; p-value < .01), those reporting substance-use with sex (74% vs. 46%; p-value < .01), and those reporting an STI in the past year (69% vs. 57% p-value < .01) or ever testing HIV-positive (72% vs. 53%; p-value < .01). In multivariable analysis, adjusting for age, gender, region, condom and lubricant use, substance use, and HIV-status, douchers had a 74% increased odds of reporting STI in the past year as compared to non-douchers [adjusted odds ratio (AOR) = 1.74; 95% CI 1.01-3.00].
  
  
  CONCLUSIONS
  Given that rectal douching before receptive AI is common and because rectal douching was associated with other sexual risk behaviors the contribution of this practice to the transmission and acquisition of STIs including HIV may be important.
authors.affiliation: Department of Epidemiology, Fielding School of Public Health, University of California, 90095-1772 Los Angeles, CA, USA. javan@ucla.edu.
authors.forename: Marjan
authors.initials: M
authors.lastname: Javanbakht
authors.forename: Shauna
authors.initials: S
authors.lastname: Stahlman
authors.forename: Jim
authors.initials: J
authors.lastname: Pickett
authors.forename: Marc-André
authors.initials: MA
authors.lastname: LeBlanc
authors.forename: Pamina M
authors.initials: PM
authors.lastname: Gorbach
mesh_terms: D000328:Adult; D001003:Anal Canal; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006679:HIV Seropositivity / Q000453:epidemiology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation / Q000706:statistics & numerical data*; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents