Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage

Chen, Ying; Bruning, Elizabeth; Rubino, Joseph R.; Eder, Scott Evan

doi:10.1177/1745505717731011

Cited by 75 publications

(109 citation statements)

References 68 publications

(87 reference statements)

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“…The possibility exists that our study may have lacked of power due to too small sample size of young women group to evidence such association. Other factors such as genital toilet or hygiene practice during menses which modify the cervicovaginal ecology [56, 57], or the higher economic status of student women which constitutes per se a multiple risk behavior [58], could be also envisioned.…”

Section: Discussionmentioning

confidence: 99%

High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

et al. 2019

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Background We conducted in 2018 a descriptive, quantitative, population-based, cross-sectional survey estimating the prevalence of cervical high-risk human papillomavirus (HR-HPV) infection and associated risk factors among adult women living in N’Djamena, Chad. Methods Five of the 10 districts of N’Djamena were randomly selected for inclusion. Peer educators contacted adult women in community-churches or women association networks to participate in the survey and come to the clinic for women’s sexual health “ La Renaissance Plus ”, N’Djamena. Medical, socio-demographical and behavioral informations were collected. HPV DNA was detected and genotyped in endocervical swab using Anyplex II HPV28 genotyping test (Seegene, Seoul, South Korea). Results 253 women (mean age, 35.0 years; range, 25–65) including 3.5% of HIV-positive women were prospectively enrolled. The prevalence of HPV infection was 22.9%, including 68.9% of HR-HPV infection and 27.6% being infected with multiple genotypes, providing a total HR-HPV prevalence of 15.8% (95% CI%: 11.3–20.3). The most prevalent HR-HPV genotypes were HPV-58, HPV-35, HPV-56, HPV-31, HPV-16, HPV-45, HPV-52 and HPV-18. HPV types targeted by the prophylactic Gardasil-9 vaccine were detected in nearly 70% (67.5%) and HPV-58 was the most frequently detected. HIV infection was a risk factor strongly associated with cervical infection with any HPV [adjusted Odds ratio (aOR): 17.4], multiple types of HPV (aOR: 8.9), HR-HPV (aOR: 13.2) and cervical infection with multiple HR-HPV (aOR: 8.4). Conclusion These observations highlight the unsuspected high burden of cervical HR-HPV infection in Chadian women, and point the potential risk of further development of HPV-associated cervical precancerous and neoplastic lesions in a large proportion of women in Chad. The high rate of preventable Gardasil-9 vaccine genotypes constitutes the rationale for introducing primary vaccine prevention against cervical cancer in young female adolescents living in Chad.

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Section: Discussionmentioning

confidence: 99%

High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

et al. 2019

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“…Protection against Group B Streptococcus is particularly important for pregnant women as it often colonizes the vagina through the gastrointestinal tract and increases the risk of preterm delivery, neonatal meningitis, and even fetal death. The association of harmful vaginal bacteria, i.e., bacterial vaginosis, with preterm labor and preterm birth is also supported by the literature [1]. Birth mode (cesarean vs. vaginal birth) can have long-term effects on microbial diversity [36], but data suggest that the skin microbiome of a cesarean-born infant can be at least partially restored through vaginal microbial transfer to what would be expected following vaginal birth [37].…”

Section: Discussionmentioning

confidence: 82%

“…Because harsh soaps and surfactants may irritate the sensitive vulvar skin, intimate feminine wash products should be formulated and tested specifically for the vulvar area to ensure they are gentle enough for daily use and also respect the pH and natural microflora of the external genital area. Improper hygiene product usage and hygiene habits can lead to common vulvovaginal disorders [1].…”

Section: Discussionmentioning

confidence: 99%

“…Intimate hygiene products are widely used by women as part of their daily cleansing routine; however, there is a lack of scientific literature about the impact of intimate personal hygiene product use on the vulvar area and even less information is available on the impact on vulvar microbiome stability. Proper feminine hygiene is critical for women's intimate health, as the vulva is a woman's first line of defense to protect the genital tract from infection [1]. Vulvar skin is transitional in nature, changing from keratinized skin to non-keratinized mucosal epithelium, and can be differentiated from other skin sites based on many attributes, such as the level of hydration, friction, and permeability [2].…”

Section: Introductionmentioning

confidence: 99%

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A 28 Day Clinical Assessment of a Lactic Acid-containing Antimicrobial Intimate Gel Wash Formulation on Skin Tolerance and Impact on the Vulvar Microbiome

et al. 2020

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While intimate feminine hygiene products are widely used as part of daily cleansing routines, little is known about how these products impact the vulvovaginal area and its microbiome stability. This 4 week clinical study assessed tolerance of a novel gel wash containing lactic acid (pH 4.2) for external daily use when used on the external genital area and its effects on skin moisturization, vulvar skin pH, and the vulvar microbiome. After a 7 day pre-study conditioning period, 36 healthy females in three balanced age groups (18–29, 30–44, and 45–55 years) used the gel wash to cleanse their external genital area (mons pubis and vulva) and entire body at least once per day for 28 days. Skin tolerance of the gel wash was assessed by the gynecologist. Effects of the gel wash on vulvar skin microbiota were studied by performing bacterial 16S rRNA and fungal internal transcribed spacer (ITS) microbial richness and diversity analysis. Based on gynecologic assessment after 28 days of use, the gel wash showed acceptable tolerance, with no signs of increased dryness, redness, edema, itching, stinging, or burning. Use of the gel wash was associated with a significant increase in both short-term (single application) and longer-term (daily use for 28 days) skin moisturization. There was no significant change in vulvar skin pH over time with daily product use, and the gel wash did not significantly affect the natural vulvar microbiome species richness or diversity for bacteria or fungi. Results showed that this gel wash is a mild, moisturizing cleanser that maintains the natural pH and microbial diversity of vulvar skin. To our knowledge, this was the first study to assess the effect of an antimicrobial feminine gel wash on the natural pH and vulvar microbiome habitat of the skin using bacterial 16S rRNA and fungal ITS genetic sequencing techniques.

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“…Vaginal practices have been noted in certain populations of women, which include practices for intimate female hygiene [ 78 ] and to enhance sexual pleasure [ 79 ]. These practices include washing, douching, and insertion of products, among others [ 80 ].…”

Section: Causes Of Genital Inflammationmentioning

confidence: 99%

Inflammation, HIV, and Immune Quiescence: Leveraging on Immunomodulatory Products to Reduce HIV Susceptibility

Cromarty

Archary

2020

AIDS Research and Treatment

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The relationship between inflammation and HIV has been a focus of research over the last decade. In HIV-infected individuals, increased HIV-associated immune activation significantly correlated to disease progression. While genital inflammation (GI) has been shown to significantly increase the risk of HIV acquisition and transmission, immune correlates for reduced risk remain limited. In certain HIV-exposed seronegative individuals, an immune quiescent phenotype characterized reduced risk. Immune quiescence is defined by specific, targeted, highly regulated immune responses that hinder overt inflammation or immune activation. Targeted management of inflammation, therefore, is a plausible strategy to mitigate HIV risk and slow disease progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as hydroxychloroquine and aspirin have shown encouraging preliminary results in low-risk women by reducing systemic and genital immune activation. A topical NSAID, containing ibuprofen, is effective in treating vulvovaginal inflammation. Additionally, the glucocorticoids (GCs), prednisolone, and dexamethasone are used to treat HIV-associated immune activation. Collectively, these data inform on immune-modulating drugs to reduce HIV risk. However, the prolonged use of these pharmaceutical drugs is associated with adverse effects, both systemically and to a lesser extent topically. Natural products with their reduced side effects coupled with anti-inflammatory properties render them viable options. Lactic acid (LA) has immunomodulatory properties. LA regulates the genital microbiome by facilitating the growth of Lactobacillus species, while simultaneously limiting bacterial species that cause microbial dysbiosis and GI. Glycerol monolaurate, besides being anti-inflammatory, also inhibited SIV infections in rhesus macaques. The proposed pharmaceutical and natural products could be used in combination with either antiretrovirals for treatment or preexposure prophylaxis for HIV prevention. This review provides a summary on the associations between inflammation, HIV risk, and disease progression. Furthermore, we use the knowledge from immune quiescence to exploit the use of pharmaceutical and natural products as strategic interventions to manage inflammation, toward mitigating HIV infections.

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Role of female intimate hygiene in vulvovaginal health: Global hygiene practices and product usage

Cited by 75 publications

References 68 publications

High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

High prevalence of cervical high-risk human papillomavirus infection mostly covered by Gardasil-9 prophylactic vaccine in adult women living in N’Djamena, Chad

A 28 Day Clinical Assessment of a Lactic Acid-containing Antimicrobial Intimate Gel Wash Formulation on Skin Tolerance and Impact on the Vulvar Microbiome

Inflammation, HIV, and Immune Quiescence: Leveraging on Immunomodulatory Products to Reduce HIV Susceptibility

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