Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States.

OBJECTIVE To measure intravaginal practices among women of differing ages, ethnicities, and human immunodeficiency virus status and the association between intravaginal practices and bacterial vaginosis and candidiasis infection. METHODS Between 2008 and 2010, we recruited and followed sexually active women aged 18-65 years living in Los Angeles. At the enrollment and month 12 visit, participants completed a self-administered, computer-assisted questionnaire covering demographics, sexual behaviors, vaginal symptoms, and intravaginal practices over the past month. At each visit, bacterial vaginosis and candidiasis infection were diagnosed by Nugent criteria and DNA probe, respectively. RESULTS We enrolled 141 women. Two thirds (66%) reported an intravaginal practice over the past month; 49% reported insertion of an intravaginal product (other than tampons) and 45% reported intravaginal washing. The most commonly reported practices included insertion of commercial sexual lubricants (70%), petroleum jelly (17%), and oils (13%). In univariable analysis, intravaginal use of oils was associated with Candida species colonization (44.4% compared with 5%, P<.01). In multivariable analysis, women reporting intravaginal use of petroleum jelly over the past month were 2.2 times more likely to test positive for bacterial vaginosis (adjusted relative risk 2.2, 95% confidence interval 1.3-3.9). CONCLUSION Intravaginal insertion of over-the-counter products is common among women in the United States and is associated with increased risk of bacterial vaginosis. The context, motivations for, and effects of intravaginal products and practices on vaginal health are of concern and warrant further study. LEVEL OF EVIDENCE III.