Intimate hygiene practices and reproductive tract infections: A systematic review

Abstract

IntroductionWorldwide, women perform a variety of vaginal practices to enhance their intimate hygiene and sexual health.ObjectiveTo conduct a systematic review to assess the different kinds of intimate hygiene practices and their association with reproductive tract infections and complications.MethodsPubMed, Medline and The Cochrane Library were used. Both observational and interventional studies targeting the urogenital infections and their association with hygiene practices were included. Exclusion criteria included studies that assessed the knowledge and attitudes towards intimate hygiene practices rather than their relation to infections. The design of this systematic review complied with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).ResultsFifteen articles were included. Intravaginal practices were found to be associated with reproductive tract infections. Reusable absorbent material used during menstruation increased the risk of Candida infection with an adjusted proportional reported ratio (aPRR) of 1.54 (95% CI 1.2–2.0), but no association with bacterial vaginosis ortrichomonas vaginalisinfection was noted. Bathing or vaginal washing during menstruation with water only showed a higher association with symptoms of urogenital infections when compared with washing with both soap and water during menstruation. Drying reusable pads inside the house and storing them inside the toilet was found to be associated with a higher candida infection prevalence. Moreover, bathing in sitting position during menstruation, not drying the genital area or using cloth for drying it, and not paying attention to hand washing, were all associated with a higher risk of genital infections. Finally, postpartum use of native homemade vaginal preparations might be a risk factor for ascending vaginal infections, and the use of inappropriate material for menstrual blood absorption was associated with secondary infertility.ConclusionSeveral hygiene practices put women at higher risk for reproductive tract infections. We should continue to increase awareness to counter the misinformation resulting from marketing campaigns and common misconceptions.

The association between menstrual hygiene, workplace sanitation practices and self-reported urogenital symptoms in a cross-sectional survey of women working in Mukono District, Uganda

“…Most women using reusable menstrual pads appropriately cleaned them, and there was no difference in symptom prevalence among participants using disposable compared to clean reusable pads. This finding contrasts with previous research which has found urogenital infections were more common in women using reusable materials compared to disposable pads [ 10 , 17 – 23 , 30 , 33 ], however, these studies did not differentiate between improvised reusables and reusable pads. These findings are particularly important in the context of increasing uptake of commercially produced reusable menstrual pads as a cost- and environmentally sustainable alternative to disposable pads.…”

“…Menstrual hygiene practices investigated for their association with urogenital symptoms in past studies were reviewed to inform the variables included and constructed for this study [10,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. A full list of questions used in this study are presented in S1 Table in S1 File.…”

“…A 2022 study nested within a pair-matched cohort study in Odisha, India found that household latrines or bathing areas with access to piped water had a moderate impact on adequate menstrual hygiene practices (adequate frequency of absorbent change, washing the body with soap, and privacy for managing menstruation) but no evidence of effect on self-reported urogenital infection symptoms [ 32 ]. A recent 2022 systematic review [ 33 ] found several menstrual hygiene practices that increased risk of laboratory-confirmed RTIs, including increased risk of VVC with use of reusable materials, drying reusable pads inside the house and storing them inside the toilet. Bathing with water alone showed an increased association with symptoms of urogenital infection compared with washing with soap and water during menstruation.…”

Associations between intravaginal practices and incidence of sexually transmitted infections and bacterial vaginosis among women enrolled in the dapivirine vaginal ring trial (The Ring Study) in southwestern Uganda: a retrospective secondary analysis

“…IVP causes changes to vaginal flora resulting in increased risk of STIs/BV including HIV. A recent systematic review found that IVP increased the risk of vaginal infections (BV, TV and vulvovaginal candidiasis),40 two others found no association between IVP and TV15 or BV 41. One study in South Africa found that IVP was associated with increased risk of HIV infection but not other STIs 42.…”

Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls’ health and education outcomes.

“…Physical health outcomes will include symptoms of urogenital infection or irritation, and healthcare seeking for menstrual pain or disorders. Menstrual hygiene practices and genital care have been linked to reproductive tract irritation and infection 57. Girls will be asked to self-report symptoms of urogenital infection including itching and burning, pain on urination, frequent urination, genital odour and abnormal vaginal discharge.…”