Author, year of publication, country Outcome Outcome prevalence (%) Intravaginal practice & prevalence (%) Effect measure of association
Bui et. al, 2018
Cambodia
HPV infection (number of infecting HPV genotypes) 47.0 Intravaginal washing: 90
Intravaginal wiping: 29
Intravaginal insertion: 5.5
Ever performed intravaginal washing: IRR 0.59 [95% CI 0.41 – 0.85], P = 0.005
Often performed intravaginal washing shortly before vaginal sex in lifetime: IRR 0.92 [95% CI 0.85 – 1.01], P = 0.086
Often performed intravaginal washing shortly after vaginal sex in lifetime: IRR 0.88 [95% CI 0.81 – 0.97], P = 0.007
No significant associations for the solution used for intravaginal washing
Ever performed intravaginal wiping: IRR 0.82 [95% CI 0.60 – 1.12], P = 0.208
No significant associations for performing intravaginal wiping before/after vaginal sex
No significant associations for frequency of intravaginal wiping
Ever performed intravaginal insertion: IRR 0.81 [95% CI 0.43 – 1.52]
Bui et. al, 2016
USA
HPV infection (number of infecting HPV DNA types) 48.6 Douching*: 23 Douched in past 6 months & higher number of HPV DNA types: RRR 1.56 [95% CI 1.28 – 1.90], P <0.001
Frequency of douching in the past 6 months (unadjusted analyses):
<1 time/month (82 participants): RRR 1.49 [1.09 – 2.05], P=0.013
1 time/month (91 participants): RRR 1.54 [1.14 – 2.09], P=0.005
2-4 times/month (85 participants): RRR 1.63 [1.21 – 2.21], P=0.002
5 or more/month (7 participants): RRR 1.77 [0.71 – 4.42], P= 0.22
Ebrahim et. al, 2016
South Africa
HPV prevalence 76.3 Vaginal insertion practices: 32.1 Vaginal insertion practices & HPV infection:
Crude OR: 2.12 (95% CI 1.02 – 4.41), P = 0.045
Adjusted OR: 1.98 [95% CI 0.88 – 4.48], P = 0.099
Esber et. al, 2016 (full publication)
Malawi
High-risk HPV infection 22 Intravaginal cleansing:
  • With soap & water: 47
  • With cotton, cloth or tissue: 94
Intravaginal insertion: 5
Cleansing with soap and water: PR 1.03 [95% CI 0.51 – 2.08]
Cleansing with cotton, cloth or tissue: PR 0.73 [95% CI 0.25 – 2.08]
Other products: PR 1.96 [95% CI 0.69 – 5.5]
IVP frequency and hr-HPV:
  • Any IVP: PR 0.98 [95% CI 0.52 – 1.85]
  • Soap and water: PR 0.48 [95% CI 0.19 – 1.20]
Houlihan et. al, 2014 (full publication)
Tanzania
HPV infection 8.4 Intravaginal cleansing: 20.9
Intravaginal insertion: 0.2
Intravaginal cleansing: aOR 2.19 [95% CI 1.09 – 4.39]
Dose-response relationship between cleansing frequency and HPV DNA detection: aOR 1.54 [95% CI 1.17 – 2.03]
Lee et. al, 2014
South Korea
HPV infection 7.9 Douching: 92.5 Douching:
  • Every other day or more: OR 0.32 [95% CI 0.13 – 0.77]
  • 1 – 2 times/month: OR 1.79 [95% CI 0.13 – 24.38]
Moscicki et. al, 2013
USA
HPV16 DNA redetection on cervical sample 18.1 redetection within 8.5 years Douching: Not reported Association of douching with redetection of human papillomavirus Type 16 (HPV16) DNA Among Women who had evidence of HPV16 DNA infection and clearance: aOR 2.35 [95% CI 1.02 – 5.41]
Seay et. al, 2017
(full publication)
Haiti
High-risk HPV infection 11 Douching: 97.1 Douching with pigeon pea infusion & high-risk HPV: aOR 5.01 [95% CI 1.56 – 16.05]
Shaw et. al, 2016
Brazil
HPV 1-year period prevalence; transient HPV infection, persistent HPV infection 39.3 Douching: Not reported Douching frequent vs. infrequent & Subgenus 2 (carcinogenic) HPV: OR 1.29 [95% CI 0.83 – 2.00]
Douching frequent vs. infrequent: OR 1.10 [95% CI 0.60 – 2.00] for transient infection, 1.12 [95% CI 0.62 – 2.01] for persistent infection
No association for substance used (Natural/Medical/Unknown)
Sun et. al, 2005
Taiwan
HPV prevalence 68.5 Douching: 64.7 Frequent vaginal douching: OR 1.48 [95% CI 1.12 – 1.97]
  • With tap water OR 1.426 [95% CI 1.08 – 1.89]
  • With normal saline or detergent OR 2.230 [95% CI 1.08 – 4.61]
Vaginal douche after sexual intercourse: aOR 1.48 [95% CI 1.12 – 1.97]
Tarkowski et. al, 2004
USA
HPV infection 64 Douching: 41.3 Douching during the last 90 days: aOR 2.1 [95% CI 1.2 – 3.6]
Douching frequency during the last 90 days
  • 0: OR 1.6 [95% CI 0.9 – 3.1]
  • 1 or 2: OR 2.6 [95% CI 1.4 – 5.0]
  • 3 or more: OR 5.2 [95% CI 2.4 – 11.2]