Prevalence and self-reported health consequences of vaginal practices in KwaZulu-Natal, South Africa: findings from a household survey

OBJECTIVES 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