Prevalence and types of rectal douches used for anal intercourse: results from an international survey

Abstract

BackgroundRectal 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.MethodsFrom 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.ResultsRespondents 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].ConclusionGiven 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.

Is rectal douching and sharing douching equipment associated with anorectal chlamydia and gonorrhoea? A cross-sectional study among men who have sex with men

“…Previous studies have demonstrated that douching practices by MSM are associated with an increased prevalence of STI like chlamydia,10 gonorrhoea,9 LGV8 11 and self-reported STI 3 4. Differences in the design of previous work and this study could explain the contrast between findings.…”

“…In a Peruvian study among 824 MSM, 27% reported a history of rectal douching through a computer-assisted self-interview 2. In two large self-reported internet surveys, 35%–66% reported rectal douching 3 4. In these two surveys, MSM who used rectal douches were more often HIV positive, had more sex partners, had more CAS and more often identified as both receptive and insertive than those who did not use rectal douches.…”

“…Differences in the design of previous work and this study could explain the contrast between findings. Except for the case control study by Macdonald et al , no other study has included both the anatomical location of the STI3 4 9 10 and sexual position 3 4 8–10. When we performed a multivariable analysis with all 994 participants and omitted the variable sexual position, we found similar results to other studies—a significant association between douching and anorectal STI (data not shown).…”

“…Many MSM use rectal douches in preparation for sex,2–6 mainly for hygienic reasons 3 4. It has been suggested that rectal douching breaks down the mucosal barrier function and facilitates the acquisition of STI pathogens 7 8.…”

“…Several studies have shown higher STI prevalence among people who use rectal douches 3 4 8–11. These studies, however, were limited by their design as they did not consider the anatomical location—urethral, pharyngeal or anorectal—of the STI, except for two case-control studies that only assessed Lymphogranuloma venereum (LGV) 8 11.…”