Rectal Douching Associated with Receptive Anal Intercourse: A Literature Review

Abstract

To inform the development of HIV-prevention rectal douches, we reviewed the scientific literature and online instructional videos on rectal douching associated with receptive anal intercourse (RAI). Up to 88% of men who practice RAI ever have douched, while 43-64% have douched recently. Of them, 87-97% douche before RAI and 13-48% afterwards. Water, occasionally mixed with soap or salt, is used most often, although up to 31% of men use commercial products. Douching is more common among individuals reporting substance use, sexually transmitted infections, or being HIV-infected. Scant literature is available on women's rectal douching practices, but it is apparently less frequent than among men (32 vs. 70%). Videos advise using 2-3 doses of liquid and retaining it for 10-30 s before expelling. These findings can inform the development of a safe and acceptable rectal douche for HIV prevention.

HIV Antiretroviral Pre‐Exposure Prophylaxis: Development Challenges and Pipeline Promise

“…Proof‐of‐concept for on‐demand strategies is supported by Ipergay's highly protective on‐demand oral TDF/FTC regimen (86% relative risk reduction) and CAPRISA 004's on‐demand VF gel achieving high levels of protection as well (73% relative risk reduction) when adherence was very high . Survey research indicates a large majority of MSM (85–95%) almost always use lubricants with anal sex and 67–80% always or almost always use rectal douches (enemas) prior to anal sex . A recent online survey of 4,751 MSM conducted on Grindr, a popular gay dating application, indicated that among the 78% of respondents who had RAI in the past 3 months, 80% used a rectal douche before sex.…”

“…15,76 Survey research indicates a large majority of MSM (85-95%) almost always use lubricants with anal sex and 67-80% always or almost always use rectal douches (enemas) prior to anal sex. 101 A recent online survey of 4,751 MSM conducted on Grindr, a popular gay dating application, indicated that among the 78% of respondents who had RAI in the past 3 months, 80% used a rectal douche before sex. Nearly all respondents who currently douche (98%) or do not douche (96%) indicated they would likely use an effective rectal microbicide; 95% of respondents practicing insertive anal sex indicated support of their receptive partners using a rectal microbicide douche.…”

The use of inappropriate anal douching tool associates with increased HIV infection among men who have sex with men: a cross-sectional study in Shenyang, China

“…[17] RD timing and the types of RD tools used are two factors that may affect the HIV infection risk of MSM employing this practice. Percentages of MSM using RD is most frequently practiced before anal sex 87%-97%, with only 13%-48% conducting RD post-anal intercourse [18]. Considering this disparity between pre-and post-sex RD practice, it is essential to distinguish between the timings of RD in order to evaluate their impact on HIV infection.…”

Rectal douching before sexual intercourse and inappropriate douching tool use associated with increased HIV infection among men who have sex with men: a cross-sectional study from Shenyang, China

“…[9] RD timing and the types of RD tools used are two factors that may affect the HIV infection risk of MSM employing this practice. Percentages of MSM using RD is most frequently practiced before anal sex 87-97%, with only 13-48% conducting RD postanal intercourse [10]. Considering this disparity between pre-and post-sex RD practice, it is essential to distinguish between the timings of RD in order to evaluate their impact on HIV infection.…”