1. Why Some Women Douche and Why Other Women Never Start: Results from a National Survey
Lucy Annang, PhD, MPH
Diane M. Grimley, PhD
UAB School of Public Health
Department of Health Behavior
2006 National STD Prevention Conference

2. Background
Vaginal douching has been linked to numerous reproductive health consequences
Bacterial Vaginosis (Ness et al., 2002; Schwebke et al., 2004; Cottrell 2006)
PID (Jossens et al., 1996; Zhang et al., 1997; Ness et al., 2002)
STIs (Scholes et al., 1998; Peters et al., 2000; Foch et al., 2001)

3. Background (con’t)
Despite these relationships, women continue to douche
27% of all females
55% of African American females (NCHS, 1997)
Reasons why some women douche and others never initiate the behavior is unclear

4. Methodology Random-digit-dial CATI
English speaking U.S. females ages 18-44
“Women’s health issues” questionnaire measured
Demographic characteristics
Gynecologic history
Douching behaviors
Other feminine hygiene product use

5. Methodology (con’t) Participants not offered incentive
Closed and open-ended questions
Descriptive analyses of quantitative and qualitative items
Full details available: Grimley et al., 2006 MCHJ

6. Results— Demographic Characteristics (N=2,602)
White
Black
Hispanic
2,081 (79.9)
314 (12.1)
207 (8.0)
Age
Mean = 32.8 yrs
Married
1,476 (56.7)
Employed
Homemaker
1,688 (64.8)
422 (16.2)
Some college
High school/GED
791 (30.4)
700 (26.9)

7. Results— Douching Behavior

8. Results— Douching Behavior by Race/Ethnicity%

9. Results— Behavioral Characteristics by Douching Status (%)
Current Douchers
N=307
Never Douchers
N=1,241
From whom do you get your health information?
Physicians
Nurses
Family members
Internet
54.2
40.7
33.9
29.3
54.1
39.3
34.2
34.0
STI history*
14.1
6.0
BV history*
10.7
8.9
PID history
3.6
3.1
P < 0.05

10. Results— Behavioral Characteristics by Douching Status (con’t) (%)
Current Douchers
N=307
Never Douchers
N=1,241
Feminine hygiene product use
Wipes*
Sprays*
Powder*
30.3
24.1
21.8
10.4
2.9
3.4
P < 0.05

11. Results— Current Douchers’ Reasons for Starting to Douche%

12. Results— Recommenders of Douching Behavior%

13. Results— Never Douchers’ Reasons for Never Starting to Douche%

14. Results— Recommenders of Never Douching%

15. Conclusions Douching prevalence on the decline
Associations with BV and STIs
Two major reasons emerged for both current douchers and never douchers
Cleanliness and recommendations
Unnecessary behavior and recommendations

16. Conclusions (con’t)
Efforts to prevent women from initiating or modifying the frequency of douching should acknowledge these motivational cues

17. Limitations Low response rate Only English speaking population
Representative?

18. Future Directions
Consider motivation for douching (and never initiating) by race/ethnicity

19. Acknowledgements Terry Hooks, BA ASPH/CDC Grant #S1451
The findings and conclusions in this presentation have not been formally disseminated by the CDC/ATSDR and should not be construed to represent any agency determination or policy.
Please note