Abstract

BackgroundRectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. However, there is limited data on rectal douching behavior in populations practicing AI. We examined the content, types of products, rectal douching practices and risk behaviors among those reporting AI.MethodsFrom August 2011 to May 2012, 1,725 women and men reporting receptive AI in the past 3 months completed an internet-based survey on rectal douching practices. The survey was available in English, French, German, Mandarin, Portuguese, Russian, Spanish, and Thai and included questions on sexual behaviors associated with AI including rectal douching. Differences by rectal douching practices were evaluated using chi-square methods and associations between reported douching practices and other factors including age and reported STI history were evaluated using logistic regression analysis.ResultsRespondents represented 112 countries, were mostly male (88%), and from North America (55%) or Europe (22%). Among the 1,339 respondents (66%) who reported rectal douching, most (83%) reported always/almost always douching before receptive AI. The majority of rectal douchers reported using non-commercial/homemade products (93%), with water being the most commonly used product (82%). Commercial products were used by 31%, with the most common product being saline-based (56%). Rectal douching varied by demographic and risk behaviors. The prevalence of rectal douching was higher among men (70% vs. 32%; p-value < .01), those reporting substance-use with sex (74% vs. 46%; p-value < .01), and those reporting an STI in the past year (69% vs. 57% p-value < .01) or ever testing HIV-positive (72% vs. 53%; p-value < .01). In multivariable analysis, adjusting for age, gender, region, condom and lubricant use, substance use, and HIV-status, douchers had a 74% increased odds of reporting STI in the past year as compared to non-douchers [adjusted odds ratio (AOR) = 1.74; 95% CI 1.01-3.00].ConclusionGiven that rectal douching before receptive AI is common and because rectal douching was associated with other sexual risk behaviors the contribution of this practice to the transmission and acquisition of STIs including HIV may be important.

Highlights

  • Rectal products used with anal intercourse (AI) may facilitate transmission of sexually transmitted infections (STIs)/HIV

  • Frequency and reasons for rectal douching/enema use Among the 1,725 respondents, 62% (n = 1,070) reported rectal douching/enema use before or after AI, with the majority reporting douching before AI (83% douching always or most of the time) and fewer reporting douching after AI (16% douching always or most of the time) (Table 2)

  • In exploring the prevalence of rectal douching before and after AI, we found that among respondents who reported douching before AI ‘always’ or ‘most of the time’, 19% (176/885) reported doing so after AI

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Summary

Introduction

Rectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. Types of products, rectal douching practices and risk behaviors among those reporting AI. Anal intercourse (AI) without condoms represents one of the most efficient modes of sexual transmission of HIV [1] and is a risk factor for the transmission of other sexually transmitted infections (STIs). Cell contact with hyperosmolar solutions (like many lubricants) can cause cells to dry up and collapse. Such injury of the rectal epithelia has been hypothesized to enhance the probability of transmission of pathogens such as HIV [10] and other STIs. In addition to biologic plausibility, a recent epidemiologic study demonstrated that lubricant use during AI was independently associated with rectal STIs [11]

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