Risk Of Bacterial Vaginosis Research Articles

Bacterial Vaginosis and Alcohol Consumption: A Cross-Sectional Retrospective Study in Baltimore, Maryland.

Bacterial vaginosis (BV) is the most cited cause of vaginal complaints among women of reproductive age. Its etiology and associated risk factors are not entirely understood. Here we examined the association between BV and at-risk alcohol consumption in women attending 2 sexually transmitted infection (STI) clinics in Baltimore, MD. This was a retrospective cross-sectional analysis using data from first clinic visits from 2011-2016. At-risk alcohol use was defined as heavy episodic ("binge") drinking within the last 30 days or a self-report of having had vaginal or anal sex in the context of alcohol consumption. Pearson χ2 test and Student t test were used to assess baseline associations. Log binomial models were used to estimate prevalence ratios (PRs) before and after adjustments for potential confounding factors. Of the 10,991 women included in the analysis, 2173 (19.7%) met the clinical diagnostic criteria for BV. Having had vaginal or anal sex in the context of alcohol consumption was associated with an increased risk of BV (PR, 1.25; 95% confidence interval, 1.13-1.37), as was binge drinking (PR, 1.15; 95% confidence interval, 1.04-1.27) after adjustment for confounders. In this population, at-risk alcohol consumption was associated with an increased risk of BV. The mechanisms remain uncertain. Future prospective studies are needed to verify and evaluate causality in these associations.

Vaginal microbiota in pregnant women with inflammatory rheumatic and inflammatory bowel disease: A matched case-control study.

BackgroundRheumatic diseases and vaginal infections both increase the risk of preterm birth. It is unclear whether pregnant women with rheumatic disease are more likely to experience vaginal infections, which might potentially accumulate modifiable risk factors.ObjectiveIn this study, we sought to evaluate the vaginal microbiota of pregnant women with inflammatory rheumatic and inflammatory bowel disease.MethodsA total of 539 asymptomatic women with singleton pregnancy were routinely screened for an abnormal vaginal microbiota between 10 + 0 and 16 + 0 gestational weeks. Vaginal smears were Gram‐stained and microscopically analysed. Those with inflammatory diseases (with or without immunomodulatory therapy) were assigned to the case group and matched in a 1:3 ratio to healthy pregnant controls.ResultsOverall, an abnormal vaginal microbiota occurred more frequently among women of the case group, compared with those of the control group (33.8% vs 15.6%; 95% CI: 1.78–4.27, p < .001). In particular, Candida colonisation (22.3% vs 9.2%; 95% CI: 1.69–4.75, p < .001), but also bacterial vaginosis (14.9% vs 7.2%; 95% CI: 1.25–4.1, p = .006), occurred more often in the case than in the control group. No significant difference was found with regard to the occurrence of an abnormal vaginal microbiota between subgroups with and without immunomodulatory treatment (37.0% vs 27.1%; 95% CI: 0.29–1.35, p = .232).ConclusionPregnant women with inflammatory rheumatic and inflammatory bowel disease are at risk for bacterial vaginosis and Candida colonisation, which might pose a risk for preterm birth. Prospective studies are needed to further evaluate the influence of autoimmune conditions and immunosuppressive therapy on the vaginal microbiota.

Gardnerella Vaginalis Associated Bacterial Vaginosis: A Review Article

Introduction: Gardnerella vaginalis is associated with bacterial vaginosis. Bacterial vaginosis (bacterial vaginosis = BV) is a clinical syndrome due to replacement of Lactobacillus spp. producing hydrogen peroxidase (H2O2) in normal vagina with high concentrations of anaerobic bacteria (eg Bacteroides spp., Mobiluncus spp.), this clinical syndrome also has other names, namely Haemophilus vaginalis vaginitis, nonspecific vaginitis or Gardnerella vaginalis vaginitis. Because the cause of BV is bacteria which are normal vaginal flora, BV is referred to as an endogenous infection in the female reproductive tract. Previous published research on BV has shown disagreements about transmission through sexual contact. Post-puberty women without sexual experience experience BV less frequently than those who have sexual experience. However, longitudinal cohort studies provide evidence that women who have new sexual partners or have multiple sexual partners have an increased incidence of BV.The likelihood that a woman has BV has a 20-fold increase in risk if her partner has BV. This raises the suggestion that it is possible that BV can be transmitted through sexual contact. However, there was no association between the incidence of BV with smoking habits, a history of abnormal Pap smears, menstruation, and menarche. Aim of this article is to review gardnerella vaginalis infection in bacterial vaginosis. Discussion: The presence of sexually transmitted diseases can also increase the risk of bacterial vaginosis. The normal vaginal ecosystem is a complex aspect. Lactobacillius is the dominant bacterial species (normal flora) in the vagina of women of childbearing age, but there are also other bacteria, namely aerobic and anaerobic bacteria. At the time BV appears, there is an overgrowth of some bacterial species which are normally present in low concentrations. Therefore, BV is categorized as an endogenous infection of the female reproductive tract.. Women with positive G. vaginalis cultures do not need routine therapy, unless they have BV symptomatically. All women with symptomatic BV require treatment, including pregnant women. Treatment of BV in pregnant women is to relieve signs and symptoms of vaginal infection, reduce the risk of infectious complications that accompany BV during pregnancy, and decrease other risk factors. Several studies using placebo have shown that treatment of sexual partners of women with BV does not improve clinical outcome of BV or decrease recurrence. Conclusion: BV has a favorable prognosis, and spontaneous improvement is reported in over one-third of cases. With the treatment of metronidazole and clindamycin gave a high cure rate (84 - 96%).Prevention needs to be done to minimize the actions that can be taken to prevent bacterial vaginosis.

Эффективность коррекции цитокинового компонента локального иммунитета в лечении рецидивирующего бактериального вагиноза, ассоциированного с герпетической инфекцией

The risk of bacterial vaginosis (BV) and recurrence rate increase in the presence of herpesviruses, which is associated with changes in local immune response. Objective. To determine the effect of exogenous cytokines on the cytokine component in local immunity and its efficacy in the treatment of recurrent bacterial vaginosis (RBV) associated with herpesvirus infection. Patients and methods. Eighty women of reproductive age with RBV and herpesvirus infection were randomized into two groups: group I (n = 40) received Clindamycin and a complex of exogenous cytokines (Superlymph®), group II – Clindamycin and placebo. The biocenosis and cytokine levels in vaginal discharge were examined. Results. Recovery occurred in 95% (38/40) of patients in group I versus 77.5% (31/40) of those using placebo; p = 0.05, OR = 5.52 (95% CI: 1.11–27.43). The recurrence rate for 12 months was 12.6% (5/40) versus 33.5% (13/40), respectively, p = 0.01, with a 3-fold decrease in the risk of recurrence (OR = 0.30; 95% CI: 0.09–0.93). There was the restoration of vaginal biocenosis and the decrease in viral release and pro-inflammatory cytokine levels by an average of 1.5 times (p &lt; 0.001) compared with baseline values in patients who received Superlymph®. Conclusion. The complex of exogenous cytokines contributes to the normalization of cytokine component in local immune status and vaginal microbiota and to the decrease in recurrence rate of BV associated with herpesvirus infection. Key words: herpes infection, immunomodulatory therapy, recurrent bacterial vaginosis, Superlymph, cytokines

Maternal Fetal Health

Maternal Fetal Health

Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study.

Limited evidence suggests that the nonhormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. Although increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than 6 months of follow-up. This secondary analysis of a human immunodeficiency virus type 1 prevention trial included 2585 African women ages 18-45 followed for up to 33 months. Women reported contraceptive use each month. BV was evaluated by Nugent score in 6-monthly intervals and, if clinically indicated, by Amsel criteria. Andersen-Gill proportional hazards models were used to (1) evaluate BV risk among Cu-IUD users relative to women using no/another nonhormonal contraceptive and (2) test changes in BV frequency before, while using, and following Cu-IUD discontinuation. BV frequency was highest among Cu-IUD users at 153.6 episodes per 100 person-years (95% confidence interval [CI]: 145.2, 162.4). In adjusted models, Cu-IUD users experienced 1.28-fold (95% CI: 1.12, 1.46) higher BV risk relative to women using no/another nonhormonal contraception. Compared to the 6 months prior to initiation, BV risk was 1.52-fold (95% CI: 1.16, 2.00) higher in the first 6 months of Cu-IUD use and remained elevated over 18 months of use (P < .05). Among women who discontinued Cu-IUD, BV frequency was similar to pre-initiation rates within 1 year. Cu-IUD users experienced elevated BV risk that persisted throughout use. Women and their providers may wish to consider BV risk when discussing contraceptive options.

Sexual practices have a significant impact on the vaginal microbiota of women who have sex with women

Women-who-have-sex-with-women (WSW) are at increased risk of bacterial vaginosis (BV). We investigated the impact of practices and past BV on the vaginal microbiota within a two-year longitudinal cohort of Australian WSW. Self-collected vaginal swabs were used to characterise the vaginal microbiota using 16S-rRNA gene sequencing. Hierarchical clustering defined community state types (CSTs). Bacterial diversity was calculated using the Shannon diversity index and instability of the vaginal microbiota was assessed by change of CST and Bray-Curtis dissimilarity. Sex with a new partner increased the bacterial diversity (adjusted-coefficient = 0.41, 95%CI: 0.21,0.60, p < 0.001) and instability of the vaginal microbiota, in terms of both change of CST (adjusted-odds-ratio = 2.65, 95%CI: 1.34,5.22, p = 0.005) and increased Bray-Curtis dissimilarity (adjusted-coefficient = 0.21, 95%CI: 0.11,0.31, p < 0.001). Women reporting sex with a new partner were more likely than women reporting no new partner to have a vaginal microbiota characterised by Gardnerella vaginalis (adjusted-relative-risk-ratio[aRRR] = 3.45, 95%CI: 1.42,8.41, p = 0.006) or anaerobic BV-associated bacteria (aRRR = 3.62, 95%CI: 1.43,9.14, p = 0.007) relative to a Lactobacillus crispatus dominated microbiota. Sex with a new partner altered the vaginal microbiota of WSW by increasing the diversity and abundance of BV-associated bacteria. These findings highlight the influence of practices on the development of a non-optimal vaginal microbiota and provide microbiological support for the sexual exchange of bacteria between women.

Elevated risk of bacterial vaginosis among copper intrauterine device users: a prospective cohort analysis

Elevated risk of bacterial vaginosis among copper intrauterine device users: a prospective cohort analysis

Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana\u2019a city, Yemen

BackgroundIn Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women.MethodsA cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana’a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests.ResultsVaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16–3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09–2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31–0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33–8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC.ConclusionsMore than a third of non-pregnant reproductive-aged women seeking PHC in Sana’a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.

Prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis in pregnant women attending antenatal clinic in the middle belt of Ghana

BackgroundVaginal infections usually caused by Candida sp, organisms responsible for bacterial vaginosis and Trichomonas vaginalis are associated with considerable discomfort and adverse outcomes during pregnancy and child birth. The study determined the prevalence of vulvovaginal candidiasis (VVC), bacterial vaginosis (BV) and trichomoniasis (TV) in pregnant women attending antenatal clinic at the Kintampo Municipal Hospital.MethodsA study adopted a cross sectional design and recruited 589 pregnant women after seeking their informed consent from September, 2014 to March, 2015. Semi-structured questionnaire were administered to participants and vaginal swabs were collected. The samples were analysed using wet mount method and Gram stain (Nugent criteria) for vaginal infection. Univariate and multivariate analysis were used to investigate association of risk factors to vaginal infections.ResultsThe overall prevalence of at least one vaginal infection was 56.4%. The prevalence of vulvovaginal candidiasis, bacterial vaginosis and trichomoniasis were 36.5, 30.9 and 1.4% respectively. Women with more than four previous pregnancies (OR: 0.27, 95% CI: 0.13–0.58) and those in the third trimester of pregnancy (OR: 0.54, CI: 0.30–0.96) were associated with a lower risk of bacterial vaginosis. Douching and antibiotic use were neither associated with VVC or BV.ConclusionThe prevalence of vaginal infections was high among pregnant women in the Kintampo area. There is the need for interventions such as adequate investigations and early treatment of vaginal infections to reduce the disease burden to avoid associated complications.

Desire for Continued Pessary Use Among Women of Hispanic and Non-Hispanic Ethnic Backgrounds for Pelvic Floor Disorders.

This study aimed to describe the association between patient ethnicity/race and desire to continue using a pessary for the treatment of pelvic floor disorders. We performed a secondary analysis of a randomized trial among women presenting for pessary fitting. The primary outcome was the desire to continue using a pessary at 3 months. Bacterial vaginosis by Nugent score and vaginal symptoms (discharge, itching, pain, sores) were also evaluated. Logistic or multiple linear regression was performed with correction for body mass index, education level, parity, Charlson Comorbidity Index, and randomization to TrimoSan gel. One hundred fourteen women (41 Hispanic and 73 non-Hispanic) were eligible for this analysis. Women self-identified as white (65/114; 57%), Hispanic (41/114, 36%), Asian (3/114; 2.6%), Native American (4/114; 3.5%), and "other" (1/114, 0.9%) race, with no self-identified African American women (0/114) meeting the inclusion criteria. No significant difference in desire to continue pessary use was found between Hispanic and non-Hispanic women (58.5% vs 63%; P = 0.69; corrected odds ratio [cOR], 1.11; 95% confidence interval [CI], 0.43-2.90) or across races (P = 0.89). Hispanic women had significantly higher risk of bacterial vaginosis (34% vs 16%; P = 0.04; cOR, 2.91; 95% CI, 1.01-8.39), higher Nugent scores (5.4 ± 2.3 vs 4.3 ± 2.3; P = 0.02; corrected coefficient, 1.10; 95% CI, 0.10-2.10), and more vaginal pain (17.1% vs 2.8%; P = 0.01; cOR, 9.14; 95% CI, 1.37-61.17) at 3 months. Despite increased vaginal pain and vaginal microbiome disturbances in Hispanic women using a pessary, no significant differences in the desire to continue using the pessary existed.

A Prospective Cohort Study of the Association Between Body Mass Index and Incident Bacterial Vaginosis.

Female sex workers aged 16 to 45 years and participating in an open, prospective cohort study in Mombasa, Kenya between 2000 and 2014 were included in this analysis. Up to 2 years of follow-up were included per woman. Body mass index (BMI) was categorized as underweight (≤18.5), normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Bacterial vaginosis was assessed using Nugent scores. Generalized estimating equations were used to estimate relative risks of the association between BMI and BV. At baseline, 32.1% (n = 625) of 1946 women had BV. Half of women were overweight (31.1%, n = 606) or obese (20.1%, n = 391). Participants contributed 14,319 follow-up visits. Adjusting for age, compared to women with normal BMI, overweight (adjusted relative risk, 0.91; 95% confidence interval, 0.81-1.02) and obese (adjusted relative risk, 0.82; 95% confidence interval, 0.71-0.94) women were at lower risk for BV (joint P = 0.03). Obese women had a nearly 20% lower risk of BV compared with women with normal BMI. Potential mechanisms for this effect, including possible effects of diet, obesity-associated changes in the gut microbiome, and systemic estrogen levels, should be explored.

Screening for bacterial vaginosis before and after intrauterine device insertion

Objective To screen for bacterial vaginosis (BV) before and after insertion of intrauterine device (IUD), screen for complications of IUD, and evaluate the relation between BV and complication of IUD. Background IUD is one of the most prevalent and effective reversible methods of contraception worldwide. Users of the IUD may be at increased risk for BV, pelvic inflammatory diseases, and other complications. Patients and methods An observational cohort study was done for 147 women who came for IUD insertion. Complete history was taken, questionnaire was filled out, and vaginal swabs were taken from the posterior vaginal fornix before insertion of IUD and at 1 and 2 months after insertion of IUD. Complications of IUD were recorded. BV was diagnosed using Amsel's criteria and Nugent scoring methods. Results The prevalence of BV was 27.2% before IUD insertion and 9.5% after insertion (fresh diagnosis) at 1 month. The commonest complications of IUD were pelvic pain, vaginal bleeding, followed by abnormal vaginal discharge and dyspareunia. These complications were significantly higher in Gram stain-positive group than Gram stain-negative group. Conclusion The prevalence of BV is within the range of BV found among women of reproductive age group worldwide. The current standard of care does not require screening for BV before IUD insertion. The complication rate appeared significantly higher in patients with BV than those without.

Is the risk of bacterial vaginosis (BV) increased in women with intrauterine devices (IUDs)?

EVIDENCE-BASED ANSWER The answer is unclear. Overall, IUD users have a higher prevalence of BV (7%-47%) than other contraceptive users or no contraceptive users (2%-35%). However, many of these cases are asymptomatic and when race, baseline Nugent scores, and irregular bleeding are controlled for, the increased risk of BV with IUD use may disappear (SOR: C, cohort study and cross-sectional studies of mostly disease-oriented outcomes).

Serum 25-Hydroxyvitamin D and Risk of Self-Reported Bacterial Vaginosis in a Prospective Cohort Study of Young African American Women.

Bacterial vaginosis (BV), the leading cause of vaginal discharge, is associated with multiple adverse health outcomes; however, its etiology is unknown. BV treatment is not very effective, thus prevention approaches are needed. Studies investigating the impact of vitamin D on the risk of BV have had mixed findings, including two studies reporting increased risk of recurrent BV for women with higher vitamin D. Participants were nonpregnant women in a prospective fibroid study of African Americans (ages 23-34 years) from the Detroit area. The exposure was seasonally adjusted annual mean serum 25-hydroxyvitamin D [25(OH)D] at enrollment. The outcome was self-reported doctor-diagnosed BV over ∼20 months between baseline and follow-up. Multivariable-adjusted binomial regression models estimated the risk of BV for a doubling of 25(OH)D and sufficient (≥20 ng/mL) versus deficient (<20 ng/mL) 25(OH)D. In total, 1459 women were included. Median 25(OH)D was 15.2 ng/mL and 73% were deficient. Sixteen percent of participants reported BV diagnoses over follow-up, 78% of whom had recurrent BV. In multivariable-adjusted analyses, a doubling of 25(OH)D was associated with an increased, rather than the hypothesized decreased, risk of self-reported BV (risk ratio [RR] 1.22, 95% confidence interval 1.02-1.48). Sufficient women also had a significantly higher, rather than lower, risk of self-reported BV (RR 1.31). Results were robust to sensitivity analyses, and post hoc analyses showed no evidence of reverse causation. Overall, our findings do not support vitamin D deficiency as a risk factor for BV in these young, nonpregnant African American women.

Does vaginal douching cause bacterial vaginosis?

EVIDENCE-BASED ANSWER Vaginal douching is associated with a 20% higher incidence of bacterial vaginosis, although causation remains unclear (SOR: B, cohort studies with consistent findings). Cessation of douching for 4 weeks does not decrease the risk of bacterial vaginosis (SOR: C, small cohort study).

RETRACTED ARTICLE: Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS

We, the Editors and Publisher of The European Journal of Contraception & Reproductive Health Care, have retracted the following article: Mohamed Rezk, Tarek Sayyed, Alaa Masood & Ragab Dawood (2017) Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS, The European Journal of Contraception & Reproductive Health Care, 22:5, 344–348, DOI: 10.1080/13625187.2017.1365835 Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors have been unable to address the concerns raised and have not been able to provide their original data or sufficient supporting information. As verifying the validity of published work is core to the integrity of the scholarly record, we are therefore retracting the article. The corresponding author listed in this publication has been informed. The authors do not agree with the retraction. We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions. The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as ‘Retracted’.

Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis.

BackgroundBacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women’s views and experiences of the triggering factors associated with BV onset and recurrence.MethodsWomen aged 20–49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV.Results103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical–and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV.ConclusionThese data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.

Pregnant women's attitudes about topical microbicides for the prevention and treatment of bacterial vaginosis during pregnancy.

We sought to understand pregnant women's product preference and likelihood of use of topical microbicides for bacterial vaginosis (BV) prevention and treatment. Pregnant women (N = 196) in a obstetrics clinic completed a survey between June 2014 and January 2015 about vaginal product use for BV. This cross-sectional study explored product preferences, likelihood of product use for BV management and father of the baby (FOB) involvement. Most participants were under 30 (68%) and underrepresented minorities (47% Hispanic, 21% African-American). Most women preferred the gel (69%). Only 30% were likely to use either product for prevention of BV; 76% if high risk for BV; 83% treatment of BV. Anticipated FOB involvement in decision-making included that 46% would ask his opinion, 38% would inform him of the decision and 7% would need approval. Most (87%) would ask the FOB for reminders and 66% for insertion help. Those under 30 were more likely to agree to ask the FOB for reminders (p < 0.01) and insertion help (p = 0.05). African-American women were less likely to have their FOB help with insertion (p < 0.01). Product preferences may be less critical than risk perception. Involvement of the FOB in decision-making may be vital.

Menstrual cups and sanitary pads to reduce school attrition, and sexually transmitted and reproductive tract infections: a cluster randomised controlled feasibility study in rural Western Kenya

ObjectivesConduct a feasibility study on the effect of menstrual hygiene on schoolgirls' school and health (reproductive/sexual) outcomes.Design3-arm single-site open cluster randomised controlled pilot study.Setting30 primary schools in rural western Kenya,...