Author, year of publication, country	Outcome	Outcome prevalence (%)	Intravaginal practice & prevalence (%)	Effect measure of association
Ali-Risasi et. al, 2015 DRC	Low-grade squamous intraepithelial lesions or worse	7.5	Use of plants for vaginal care: 11.4 Use of chemical products for vaginal care: 26.0	Use of plants for vaginal care: aOR 2.70 [95% CI 1.04 – 7.01] Use of chemical products for vaginal care: aOR 0.65 [95% CI 0.37 – 1.14]
Bayo et. al, 2002 Mali	Invasive Cervical Carcinoma	N/A, case-control study	Douching: Cases: 3.7 Controls: 29.9	Never having practiced vaginal douching & cervical cancer: aOR 17.6 [95% CI 4.2 – 74.7]
Chu et. al, 2011 Taiwan	Non-regression or progression of LSIL	6.1 non-regression, 10.5 progression	Douching: 65	Habit of douching after vaginal intercourse: OR 1.89 [95% CI 1.01 – 3.53] With tap water: OR 1.77 [95% CI 0.94 – 3.35] With saline or detergent: OR 3.14 [95% CI 1.04 – 9.49]
Gardner et. al, 1991 USA	In-situ and invasive cervical carcinoma	N/A, case control-study	Douching: Cases: 69 Controls: 31	Douching 10 or more times in the lifetime & cervical carcinoma: Crude OR 2.5 [95% CI 1.8 – 3.6] Adjusted OR 1.3 [95% CI 0.8 – 1.9] Douching frequency, only >4 times/month associated: Crude OR 6.7 [95% CI 3.6 – 13] Adjusted OR 4.7 [95% CI 1.9 – 11] No specific douching preparations were associated with an increased risk
Mbizvo et. al, 2005 Zimbabwe	Cervical dyskaryosis (mild, moderate, severe)	19 (16 mild, 1.5 moderate, 1.5 severe)	Intravaginal cleansing: 48 Use of intravaginal herbs: 27	Intravaginal cleansing & cervical dyskaryosis: aOR 2.1 [95% CI 1.10 – 4.2] Use of intravaginal herbs & cervical dyskaryosis: aOR 2.16 [95% CI 1.18 – 4.61]
Sagay et. al, 2009 Nigeria	Squamous intraepithelial lesions (SILs)	24.6	Douching: With lime juice: 90.4 With lemon juice: 14.2	Douching with lemon/lime juice & HSIL: aOR 2.13 [95% CI 1.03 – 4.40], P = 0.025 Douching with lemon/lime juice & LSIL/HSIL: aOR 1.76 [95% CI 1.0 – 3.10], P = 0.042 Cervical dysplasia was not associated with greater duration of douching with lemon/lime juice: P-value for trend = 0.20
van de Wijgert et. al, 2000 Zimbabwe	Dysplasia on Pap smear	17.3 in users, 15.3 non-users at follow-up	Intravaginal cleansing: 96 Intravaginal insertion: 47	Dysplasia on Pap smear in users vs. non-users: RR 3.14 [95% CI 0.85 – 17.33] On multivariate analysis: OR 2.42 [95% CI 1.00 – 5.90]