Intravaginal Practices in Female Sex Workers in Cambodia: A Qualitative Study

Abstract

Intravaginal practices (IVPs) are associated with several adverse health outcomes, including HIV infection. However, few studies have examined this topic in Asian cultures, particularly in female sex workers (FSWs). This theory-based qualitative study aimed to describe the IVPs and to identify salient determinants of these practices in FSWs in Phnom Penh, Cambodia. We conducted in-depth interviews using open-ended questions with 30 FSWs in July–August 2014. We analyzed data using thematic content analysis, with thematic codes based on the constructs of the theory of planned behavior. The results showed that the most common IVP was a combination of intravaginal washing and wiping, to which we refer as intravaginal cleansing. There was a clear and close connection between IVP and sex work. Perceived benefits of intravaginal cleansing were numerous, while the perceived risks were few. As a result, the attitude toward intravaginal cleansing was favorable. A common misperception of benefit was that intravaginal cleansing could prevent sexually transmitted infections. Local physicians considerably influenced the subjective norm related to IVP. Intention to quit IVPs was suboptimal. In conclusion, the psychological factors associated with IVPs in FSWs were somewhat different from those in the general population of Cambodian women and women in other countries. Behavioral beliefs, attitude, and subjective norms appeared salient and important factors in IVPs. Interventions aimed at reducing IVPs should target these constructs as well as the sex-work-associated economic motives. Local physicians may be an agent to change IVP and an effective channel to deliver interventions.

Intravaginal practices and genital human papillomavirus infection among female sex workers in Cambodia

“…Moreover, because IVPs may be deeply embedded in sociocultural norms of womanhood or may become a favored habit, harm reduction instead of complete elimination of IVPs may be more practical. 45,48,49 So, intravaginal washing at different times (e.g., before sex, during menses) should be discouraged, but intravaginal washing after sex may not.…”

“…Definitions of IVPs used in our study were based on the IVP classification developed by the World Health Organization’s Gender, Sexuality and Vaginal Practices Study Group, 1–3 and our previous qualitative work. 45 Specifically, intravaginal washing was explained to participants as washing inside their vagina by using fingers and/or a device to introduce a stream of water or solution. Intravaginal wiping meant to wipe inside the vagina by using a material (e.g., cotton, cloth, tissues) with little or no water or solution.…”

“…Specimens were tested for 37 HPV DNA genotypes by using Roche Linear Array HPV Genotyping. Of these 37 genotypes, 16 were classified as low-risk genotypes (6,11,40,42,54, 55, 61, 62, 64, 71, 72, 81, 82 subtype IS39, 83, 84, and 89) and 21 were classified as high-risk genotypes (16,18,26,31,33,35,39,45,51,52,53,56,58,59, 66, 67, 68, 69, 70, 73, and 82). 30 Although most HPV infections are asymptomatic, 46 HPV types 6 and 11 can cause genital warts and, thus, may result in more intravaginal cleansing to relieve symptoms.…”

“…In HIV-positive FSWs who frequently expose to various HPV types yet their immunogenesis is compromised, the practice may be also beneficial with regard to reducing the likelihood of HPV acquisition with a new genotype. Moreover, because IVPs may be deeply embedded in sociocultural norms of womanhood or may become a favored habit, harm reduction instead of complete elimination of IVPs may be more practical 45,48,49. So, intravaginal This lack of association may be true but may also be due tosome biases.…”

Vaginal washing and lubrication among female sex workers in the Mexico-US border region: implications for the development of vaginal PrEP for HIV prevention

“…Intravaginal practices vary across regions and cultures and are influenced by a number of socio-contextual factors [ 30 – 32 ], but are often motivated by hygiene, health, and sexuality [ 33 ]. Among FSWs, intravaginal practices are further motivated by a desire to prevent STIs and meet clients’ expectations related to cleanliness and sexual pleasure [ 34 , 35 ]. Because intravaginal cleansing has been linked to several adverse gynecologic and reproductive health outcomes, BV, HIV, other sexually transmitted infections (STIs) [ 36 – 40 ], previous research has also examined women’s intravaginal practices to inform the development of acceptable vaginal PrEP products that are also safe and effective [ 23 , 32 ].…”