Content uploaded by Elif Gursoy
Author content
All content in this area was uploaded by Elif Gursoy on Apr 29, 2020
Content may be subject to copyright.
IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e- ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 7, Issue 3 Ver. V (May-June .2018), PP 01-07
www.iosrjournals.org
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 1 | Page
The Prevalence of Vaginal Douching and Associated Factors in
Married Women and the Role of Education in Stopping Vaginal
Douching?
Nebahat Ozerdogan1, Yurdagul Yagmur2, BerrakMizrak Sahin3, Elif Gursoy3,
Engin Karadag4
1Eskisehir Osmangazi University, Faculty of Health Sciences, Midwifery Department, Eskisehir, Turkey
2Inönü University, Faculty of Health Sciences, Nursing Department, Malatya, Turkey
3 Eskisehir Osmangazi University, Faculty of Health Sciences, Nursing Department, Eskisehir, Turkey
4 Eskisehir Osmangazi University, Faculty of Education, Eskisehir, Turkey
Corresponding author:BerrakMizrakSahin
Abstract:Vaginal douche is a traditional practice widespread among the women all over the world. Advices
and education from health professionals are of utmost importance in preventing and halting VD. There are only
two studies on the prevention of VD practice in Turkey. Aim: The aim of this study to analyze the prevalence of
vaginal douche among married women between aged 15 and 49 years from two districts of the Western and
Eastern Turkey, and to identify the socio-demographic factors which effect this procedure. In addition, we
aimed to evaluate the role of education in stopping vaginal douche. Methods:The study was carried out in two
stages between February 2014 and August 2014 in Eskisehir and Malatya city centers. The first stage is a cross-
sectional to determine the prevalence of the vaginal douche and the second stage is intervention to prevent
douching.The sample size was identified as 702 in Malatya and 352 in Eskisehir with a confidence interval of
95% and error margin of 5%. Results:Of 1,088 women, 203 (18.7%) practiced vaginal douche. Old age, low
level of education and income, large family, increase in number of children, being uninformed about the
harmful effects of vaginal douching were identified as the independent risk factors of vaginal douching. There
was a significant difference between women’s habit of practicing vaginal douche before and after education
(p<0.001). Conclusion:The rate of vaginal douche among women in this study is lower than many other
studies. However, it was found that approximately two of every 10 women practice vaginal douche. Vaginal
douche should be considered as an important public health problem due to the risks and economic losses that it
creates. Health professional working in the field of women’s health should support women in developing healthy
genital hygiene habits.
Keywords: Education, Prevalence, Turkey, Vaginal Douching, Women’s Health
---------------------------------------------------------------------------------------------------------------------------------------
Date of Submission: 16-05-2018 Date of acceptance: 31-05-2018
---------------------------------------------------------------------------------------------------------------------------------------
I. Introduction
Vaginal douche (VD) is a traditional practice widespread among the women all over the world.
Nevertheless, particularly in Asian and African countries where the number of Muslim women is higher, and in
African-American black women in the US, the rate of practicing VD is higher (27.7%-76.7%) (Grimley,
Annang, Foushee, Bruce, & Kendrick, 2006; Heng, Yatsuya, Morita, & Sakamoto, 2010; Shaaban, Youssef,
Khodry, & Mostafa, 2013). It has been estimated that 32% of the American women practice VD, and the
majority of those who practice VD are of African-American origin (Chandra, Martinez, Mosher, Abma, &
Jones, 2005). Several studies conducted in Turkey have shown that VD is a common procedure and the rate of
practicing VD varies between 9.5 and 80.66% (Arslantas, Karabagli, & Koc, 2010; Güzel, Kuyumcuoğlu, &
Celik, 2011; Hacıalioğlu, Nazik, & Kılıç, 2009; Hadimli et al., 2012; Sunay, Kaya, & Ergun, 2011; Yanikkerem
& Yasayan, 2016).
Culture, ethnicity, religious belief affect VD practices (Cottrell, 2010). Vaginal douche is mostly
practiced for hygienic and aesthetic reasons or for religious reasons. Women practice this procedure to clean
blood and semen, prevent odor, feel clean and fresh after menstruation and sexual intercourse (Brotman,
Klebanoff, et al., 2008; Grimley et al., 2006; Hacıalioğlu et al., 2009; Hadimli et al., 2012; Heng et al., 2010;
Shaaban et al., 2013; Sunay et al., 2011). It is also rarely practiced to prevent pregnancy (Hadimli et al., 2012;
Sunay et al., 2011).More than half of the Muslim women perceive the procedure as a religious requirement. In
some sects of the Islam, according to their beliefs, women believe that they need to perform ritual ablution of
the whole body to be completely clean. They accept VD as a part of the ritual ablution and therefore practice
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 2 | Page
VD after sexual intercourse and menstruation (Caliskan, Subasi, & Sarisen, 2006; Hacıalioğlu et al., 2009). In
previous studies, low level of education and income (Arbour, Corwin, & Salsberry, 2009; Brotman, Klebanoff,
et al., 2008; Caliskan et al., 2006; Güzel et al., 2011) and old age (Arbour et al., 2009; Caliskan et al., 2006;
Misra, Trabert, & Atherly-Trim, 2006) were found to be the socio-demographic factors correlated with the
increased VD frequency. Recent studies in the US have revealed that VD is a common procedure among
adolescent girls and young women(Diclemente et al., 2012).
In addition, VD affects the vaginal flora and causes gynecologic and obstetric problems in women
(Cottrell, 2010). Lactobacilli in the flora maintain vagina’s acidic pH and prevent infections. However, VD
alters the lactobacilli count and affects vaginal pH, increasing the risk of bacterial vaginosis, sexually
transmitted infections, and pelvic inflammatory disease risk (Cottrell, 2006; Klebanoff et al., 2006). Increased
vaginal infections can lead to premature labor, ectopic pregnancy, and cervical cancer (Cottrell, 2010; Mandal,
Raina, & Balodi, 2014).
Advices and education from health professionals are of utmost importance in preventing and halting
VD. There are only two studies on the prevention of VD practice in Turkey (Mete, Yenal, Tokat, & Serçekuş,
2012; Okumuş & Demirci, 2016). These studies and other studies performed in other countries have
demonstrated that interventions from health professionals are effective on the interception of VD (Brotman,
Ghanem, et al., 2008; Cottrell, 2006; Klebanoff et al., 2006). This study was performed to analyze the
prevalence of VD among married women between aged 15 and 49 years from two districts of the Western and
Eastern Turkey, and to identify the socio-demographic factors which effect this procedure. In addition, we
aimed to evaluate the role of education in stopping VD.
II. Material and Methods
Study design
The study was carried out in two stages between February 2014 and August 2014 in Eskisehir and
Malatya city centers. The first stage is a cross-sectional to determine the prevalence of the VD and the second
stage is intervention to prevent douching. Setting and sample
Population comprised women aged between 15 and 49 years in one central district of Eskisehir and two
central districts of Malatya. The sample size was identified as 702 in Malatya and 352 in Eskisehir with a
confidence interval of 95% and error margin of 5%. The study was completed with a total of 1,088 women, 702
of which are from Malatya and 386 of which are from Eskisehir, which were chosen by convenience sampling
method.
Ethical considerations
The study was conducted based on voluntariness, the aim of the study was explained to women, and
their informed consents were obtained. During the study, the principles of the Declaration of Helsinki and Good
Clinical Practice Guide were followed, which were put in force by the Republic of Turkey Ministry of Health in
15.07.2013, were considered and research ethics were followed.
Measurements/Instruments
To identify the socio-demographic and obstetric characteristics of the women, whether they practice
VD and their attitude towards VD, a question form comprising 47 questions prepared based on the literature by
the researchers was used (Caliskan et al., 2006; Mandal et al., 2014; Mete et al., 2012).
Data collection
Whether the women perform VD was determined by the question: “have you washed your vagina with
a liquid substance using your fingers or any other equipment within the past three months?” (Brotman,
Klebanoff, et al., 2008). The question form was revised through a pilot study performed in 20 women. The
question form was implemented in home visits through face-to-face meetings. During the questions, women
were left alone in a comfortable environment. Immediately after the implementation of the question form, one-
to-one education on the negative effects of VD on health was provided to women who were practicing VD.
Education subjects were as follows: explanation of the female reproductive organs and their functions, healthy
vaginal environment, practices which disrupt the vaginal environment, the effects of VD on vaginal
environment and its and adverse consequences, whether VD is a religious requirement, and the statement of the
Religious Affairs Administration on this subject. After the education, women were given an information
booklet. Three months after the education which took 20 minutes, the women were called by phone and asked if
they continued practicing VD.
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 3 | Page
Data analysis
Data analysis was done using SPSS version 21.0 software (IBM Corporation, Armonk, NY, USA). In
group comparisons, the chi-square test was used for categorical variables, while the Mann-Whitney U test was
used for continuous variables. Comparison of the rate of practicing VD before and after education was done
using the Mc-Nemar test. As the dependent variable of the study, practicing VD, is not ordered in itself, and has
two categories as practicing and not practicing, Binary Logistic Regression Analysis was used. The Enter
method was used in the measurement of the dependent variable, practicing VD. Explanatoriness of the model
was evaluated using the Nagelkerke R Square. A p value of .05 was considered statistically significant.
III. Results
The mean age of 1,088 women was 33.87 years (SD 8.04; range 16-49). A total of 44.7% of the women
were primary school graduates and 84.2% were housewives. Most of the women (87.4%) had a nuclear family
and the mean time of marriage was 13.11±8.83. Half of the women had middle income.
Of 1,088 women, 203 (18.7%) practiced VD. They were practicing VD primarily to feel clean and
comfortable (80.0%), and secondly, for religious reasons (53.7%). Other reasons were as follows: respectively:
to prevent infection (29.4%) and odor (24.9%), to smell nice for their partner (15.9%), to prevent pregnancy
(13.9%), and to practice a tradition passed on from the elders of their family (11.9%). 38.4% of the women
learned to practice VD by themselves, 23.1% from their mother, 22.7% from a friend, 9.9% from religious
professionals, 5.9% from health professionals. 88.3% of the women practiced VD at least once or twice a week.
For VD, women used water (66.8%), water and soap (29.8%), and rarely, commercial products (3.4%). 18.6%
of the women received information from health professionals on the harmful effects of VD. The correlation
between some of the socio-demographic characteristics of women and their habit of practicing VD was
investigated (Table 1). A significant correlation was detected between the age, educational level, family income
level, family type and VD (p<0.05). Old age (OR 0.965, 95% CI 0.946-0.985), low educational level (OR 1.180,
95% CI 1.008-1.382), low family income level (OR 1.361, 95% CI 1.052-1.762), and large family type (OR
0.507, 95% CI 0.333-0.772) were identified as the independent risk factors for VD.
Table 1. Socio-demographic characteristics of women according to vaginal douching practice
Socio-demographic
characteristics
Vaginal douching practice
Significance
test
p
Odds ratio (95%
confidence interval)a
p
Yes. n (%)
No. n (%)
Mean age ±SD.years
35.94±7.40
33.38±8.08
Z = -4.347
<0.001
0.965 (0.946-0.985)
.001
Living place
Malatya
127 (18.1)
575 (81.9)
= .419
.517
0.879 (0.636-1.214)
.433
Eskisehir
76 (19.7)
310 (80.3)
Education level
Primary school
110 (22.6)
376 (77.4)
=12.819
.005
1.180 (1.008-1.382)
.039
Secondary school
32 (20.5)
124 (79.5)
High school
43 (14.1)
262 (85.9)
University
18 (12.8)
123 (87.2)
Occupation
Working
31 (18.0)
141 (82.0)
= .054
.816
0.868 (0.551-1.366)
.540
Housewife
172 (18.8)
744 (81.2)
Family income
Low
18 (24.7)
55 (75.3)
= 11.952
.003
1.361 (1.052-1.762)
.019
Middle
119 (21.8)
426 (78.2)
High
66 (14.0)
404 (86.0)
Family type
Small family
163 (17.1)
788 (82.9)
=14.581
.001
0.507 (0.333-0.772)
.002
Large family
40 (29.2)
97 (70.8)
A Adjusted for age, living place, education level, occupation, family income and family type.
(Nagelkerke R Square=.60)
The number of children, preterm labor, history of genitourinary infection, and awareness on the
harmful effects of practicing VD were found to be significantly correlated with practicing VD (p<0.05). Increase
in the number of children (OR 0.732, 95% CI 0.624-0.857), history of genitourinary infection within the past
year (OR 1.684, 95% CI 1.162-2.439) and within the past month (OR 1.481, 95% CI 1.023-2.144), being
uninformed about the harmful effects of vaginal douching (OR 0.482, 95% CI 0.316-0.735) were identified as
the independent risk factors for VD (Table 2).
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 4 | Page
Table 2. Vaginal douching knowledge, obstetric and reproductive history of women according to vaginal
douching practice
Obstetric and
reproductive
characteristics
Vaginal douching practice
Significance
test
p
Odds ratio (95%
confidence interval)b
p
Yes
n (%)
No
n (%)
The number of children
Absent
3 (13.0)
20 (87.0)
= 18.677
.001
0.732 (0.624-0.857)
<.001
1
24 (11.0)
195 (89.0)
2
57 (17.2)
275 (82.8)
3
50 (20.4)
195 (79.6)
4+
69 (25.7)
200 (74.3)
Number of abortion
Absent
97 (18.2)
436 (81.8)
= 1.516
.679
1.095 (0.900-1.334)
.365
1
66 (17.7)
306 (82.3)
2
27 (21.8)
97 (78.2)
3+
13 (22.0)
46 (78.0)
History of preterm labor
Present
21 (27.6)
55 (72.4)
=4.205
.040
1.597 (0.915-2.787)
.099
Absent
179 (18.2)
810 (81.8)
History of low birth weight infant
Present
23 (22.5)
79 (77.5)
=1.051
.305
0.839 (0.494-1.425)
.517
Absent
177 (18.4)
786 (81.6)
History of genitourinary infection within the past year
Yes
75 (27.1)
202 (72.9)
=17.350
<.001
1.684 (1.162-2.439)
.006
No
128 (15.8)
683 (84.2)
History of genitourinary infection within the past month
Yes
73 (26.6)
201 (73.4)
=15.383
<.001
1.481 (1.023-2.144)
.038
No
130 (16.0)
684 (84.0)
Getting information about harmful effects of VD
Yes
30 (10.7)
250 (89.3)
=17.335
<.001
0.482 (0.316-0.735)
.001
No
173 (22.0)
613 (78.0)
a Adjusted for the number of children, number of abortion, history of low birth weight infant, history of
genitourinary infection within the past year,history of genitourinary infection within the past month ,getting
information about harmful effects of VD (Nagelkerke R Square=.76)
bDiagnosed by a doctor
There was a significant difference between women’s habit of practicing VD before and after education
(p<0.001). After the education, the rate of those who practice VD decreased by 18.7% and dropped to 10.7%
(Table 3).
Table 3. The effect of education on women’s habit of practicing VD
Vaginal douching application
Before education
After education
X2ª;p
n
%
n
%
Practicing vaginal douching
203
18.7
116
10.7
566.067 ; < .001
Not practicing vaginal douching
885
81.3
972
89.3
χ2ªMc Nemar Test
IV. Discussion
Vaginal douche is a traditional practice widely performed by women all over the world. In previous
studies performed in Turkey, the rate of practicing VD was usually over 50% (Akın, Ege, & Erdem, 2006;
Caliskan et al., 2006; Hacıalioğlu et al., 2009; Hadimli et al., 2012; Sunay et al., 2011). The rate of practicing
VD in our study was lower (18.7%). Arslantas et al. (2010) found that the rate of women actively practicing VD
was 9.5% in the study they performed in one of the cities also included in our study, Eskisehir (Arslantas et al.,
2010). Compared to other studies Erbil et al. (2011) reported 38.6%, and Yanikkerem et al. (2016) reported
26.5%, which are also similar to the rates found in our study (Erbil, Alışarlı, Terzi, Özdemir, & Kuş, 2011;
Yanikkerem & Yasayan, 2016). This finding suggest that the rate of practicing VD depend on the socio-cultural
characteristics of the region, age range and educational level of the study group, and the use of different research
methodologies.
In the study, the majority of women practiced VD to feel clean and comfortable, whereas the second
reason was to perform ritual ablution for their religious reasons. Many studies also identified the primary reason
behind practicing VD is to maintain genital hygiene (Arslantas et al., 2010; Brotman, Klebanoff, et al., 2008;
Caliskan et al., 2006; Cottrell & Close, 2008; Erbil et al., 2011; Hacıalioğlu et al., 2009; Hadimli et al., 2012;
Yanikkerem & Yasayan, 2016). Nevertheless, in some studies performed in Egypt and Turkey, the primary
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 5 | Page
reason behind practicing VD was reported as religious belief (Güzel et al., 2011; Shaaban et al., 2013; Sunay et
al., 2011).
In this study, the women practiced VD by primarily using water or water and soap. Other studies
performed in Turkey also reported that women practiced VD by using water or water and soap, and rarely used
commercial products (Caliskan et al., 2006; Erbil et al., 2011; Hacıalioğlu et al., 2009; Sunay et al., 2011;
Yanikkerem & Yasayan, 2016). This result could be due to the economic factors or the fact that commercial
products are not widely available in Turkey. In studies performed in U.S.A, it was observed that women mostly
use the commercial products sold in supermarkets (Cottrell, 2010; Grimley et al., 2006). Women from Asian
and African countries prefer homemade products for VD(Misra et al., 2006).
Furthermore, VD is accepted as a traditional practice formed by social and cultural norms and passed
on from generation to generation(Short, Black, & Flynn, 2010). In this study, it was found that approximately
half of the women learned to practice VD from their mothers or close friends. The rate of those who learnt VD
by themselves was %38.4. Smith et al. (2005) reported that 57% of the women in their study practiced VD after
being influenced from their mothers.(Smith et al., 2005) Other studies also reported similar results (Caliskan et
al., 2006; Güzel et al., 2011; Hadimli et al., 2012; Sunay et al., 2011). In a study with African-American
adolescents, the rate of those performing VD after being influenced from their mothers was lower
(7.4%)(Diclemente et al., 2012). In our study group, similar to the study by Akin et al (Akın et al., 2006), the
rate of those who learnt VD from religious professionals was higher (9.9%) than the other studies (3.8 to 5%)
(Arslantas et al., 2010; Caliskan et al., 2006). Although Religious Affairs Administration of Turkey stated that
VD is not obligatory in Islamic faith, the result of the study show that some of the religious professionals
mislead women(Beşer, 2007). The rate of those who learned that VD should be practiced from the health
professionals (5.9%) is similar to other studies (5 to 7.8%) (Akın et al., 2006; Caliskan et al., 2006; Yanikkerem
& Yasayan, 2016). It is thought-provoking that this practice, which has harmful effects on women’s health, is
recommended by the health professionals. Women are not informed enough on the harmful effects of VD
(Cottrell, 2010). Only 18.6% of the women included in this study had received information from health
professionals on the harmful effects of VD. This rate was 27.1% in the study by Arslantas and et al., %4.1 by
Caliskan et al., and 8% by Akın et al. (Akın et al., 2006; Arslantas et al., 2010; Caliskan et al., 2006) 64% of
women included in the study by Cotrell received information on the harmful effects of VD. 30.9% of these
women were informed by the midwife and nurse, and 40.3% from the doctor (Cottrell, 2006).
In the multivariate analysis, of the socio-demographic factors, old age, low educational level and
income level, and traditional large family type were identified as the independent risk factors for practicing VD
(Table 1). Similarly, in the previous studies, old age(Arbour et al., 2009; Caliskan et al., 2006; Misra et al.,
2006), low educational level (Akın et al., 2006; Arbour et al., 2009; Brotman, Klebanoff, et al., 2008; Caliskan
et al., 2006; Erbil et al., 2011; Güzel et al., 2011; Yanikkerem & Yasayan, 2016) and low income level (Akın et
al., 2006; Arbour et al., 2009; Brotman, Klebanoff, et al., 2008; Caliskan et al., 2006; Erbil et al., 2011; Güzel et
al., 2011; Sunay et al., 2011; Yanikkerem & Yasayan, 2016) were found to be the risk factors for VD.
Longitudinal studies are required to determine why this practice is more common among women of older age
than the women of younger age. Thus, the factors that incline women towards practicing VD can be determined.
The reason behind the higher rates of practicing VD in women in large families than the women in nuclear
families could be the effect of traditional culture and higher level of communication between generations.
In the multivariate analysis, increased parity (number of births) and being uninformed about the
harmful effects of VD were independent risk factors for VD. The rates of having genitourinary infection within
the past month and last year were higher in women practicing VD. In the bivariate analysis, there was
significant correlation between preterm labor and VD. The rate of preterm labor was higher in women practicing
VD (Table 2). Cottrel (2006) found that the rate of bacterial vaginosis was 2.75-fold higher in women practicing
VD at least once a week than women not practicing VD (Cottrell, 2006). Those with a history of bacterial
vaginosis have an increased rate of preterm labor. Chandra et al. (2005) found that the prevalence of pelvic
inflammatory disease (PID) was higher in women practicing VD (Chandra et al., 2005). Heng et al. (2010)
found that there was no significant correlation between VD and BV and trichomoniasis infections; however,
there was significant correlation with candidiasis (Heng et al., 2010). Similarly, in other studies, a correlation
between genitourinary infection and VD was reported (Brotman, Ghanem, et al., 2008; Hacıalioğlu et al., 2009).
In general, women become estranged from VD once being informed about its harmful effects. In our
study, the rate of practicing VD (10.7%) after being informed was half of that before being informed (22%). The
rate of VD among the informed women was lower than the uninformed women in Cotrell’s study (2006). In the
aforementioned study, it was reported that even after being informed, 40% of the women still continued
practicing VD(Cottrell, 2006) In their study which included theory-based education of young women and
adolescents aged between 14 and 23 years, Grimley et al. (2005) achieved a 50% decrease in the rate of
practicing VD(Grimley, Oh, Desmond, Hook III, & Vermund, 2005). In this study, after the education, it was
found that almost half (42.8%) of women of reproductive age stopped practicing VD. These results show that
even if they are informed about the harmful effects of VD, some women still continue practicing VD. Previous
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 6 | Page
studies also showed that educating women gives positive results in stopping the practice of VD (Brotman,
Ghanem, et al., 2008; Klebanoff et al., 2006; Mete et al., 2012; Okumuş & Demirci, 2016). In their study which
included young women, Funkhouser et al. (2002) found that the most influential people for women in
convincing them to stop practicing VD is health professionals (Funkhouser, Hayes, & Vermund, 2002).
Midwives, nurses, and doctors should warn and inform women on the harmful effects of VD.
Nonetheless, this study has some limitations. The data on VD are based on the individuals’ own
accounts. Sampling method used in the study can affect the rate of VD frequency. Despite these limitations, the
study is one of the rare studies performed with a large sample size on women of reproductive age in Turkey.
V. Conclusion
In conclusion, the rate of VD among women in this study is lower than many other studies. However, it
was found that approximately two of every 10 women practice VD mostly due to hygienic and religious reasons.
This practice is common among women of low educational and income level and traditional large family type.
The rate of those informed about the harmful effects of the practice is low. The majority of the women were not
informed by the health professionals on this subject. Family and friends of women, religious professionals and
rarely, health professionals encourage them to practice VD. Education on the harmful effects of VD is effective
in stopping the practice of VD. Nevertheless, more than half of the women educated on the harmful effects of
the practice continue practicing VD. For the interception of this practice, which has connections with cultural
and social norms. It is critical that nurses understand the reasons, attitudes and beliefs about women douche.
Repeating the education with regular intervals, and including health professionals and religious professionals in
these educations will be helpful. Nurses are in a position to provide women with accurate information on the
complications associated with douching. Nurses working in the field of women’s health should support women
in developing healthy genital hygiene habits.If possible,this information could be communicated to woman’s
partner and her female relative.
References
[1]. Akın, B., Ege, E., & Erdem, H. (2006). Vaginal douching (vd) practice and adverse health effects of 15-49 years married women.
Journal of Human Sciences, 3(2).
[2]. Arbour, M., Corwin, E. J., & Salsberry, P. (2009). Douching patterns in women related to socioeconomic and racial/ethnic
characteristics. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(5), 577-585.
[3]. Arslantas, D., Karabagli, H., & Koc, F. (2010). Vaginal douching practice in Eskisehir in Turkey. Journal of Public Health and
Epidemiology, 2(9), 245-250.
[4]. Beşer, F. (2007). Hanımlara Özel İlmihal (Ilmihal for Women): Paradoks Yayınevi.
[5]. Brotman, R. M., Ghanem, K. G., Klebanoff, M. A., Taha, T. E., Scharfstein, D. O., & Zenilman, J. M. (2008). The effect of vaginal
douching cessation on bacterial vaginosis: a pilot study. American journal of obstetrics and gynecology, 198(6), 628. e621-628.
e627.
[6]. Brotman, R. M., Klebanoff, M. A., Nansel, T., Zhang, J., Schwebke, J. R., Kai, F. Y., . . . Andrews, W. W. (2008). Why do women
douche? A longitudinal study with two analytic approaches. Annals of epidemiology, 18(1), 65-73.
[7]. Caliskan, D., Subasi, N., & Sarisen, O. (2006). Vaginal douching and associated factors among married women attending a family
planning clinic or a gynecology clinic. European Journal of Obstetrics & Gynecology and Reproductive Biology, 127(2), 244-251.
[8]. Chandra, A., Martinez, G. M., Mosher, W. D., Abma, J. C., & Jones, J. (2005). Fertility, family planning, and reproductive health of
US women: data from the 2002 National Survey of Family Growth. Vital and health statistics. Series 23, Data from the National
Survey of Family Growth(25), 1-160.
[9]. Cottrell, B. H. (2006). Vaginal douching practices of women in eight Florida panhandle counties. Journal of Obstetric, Gynecologic,
& Neonatal Nursing, 35(1), 24-33.
[10]. Cottrell, B. H. (2010). An updated review of of evidence to discourage douching. MCN: The American Journal of Maternal/Child
Nursing, 35(2), 102-107.
[11]. Cottrell, B. H., & Close, F. T. (2008). Vaginal douching among university women in the southeastern United States. Journal of
American College Health, 56(4), 415-421.
[12]. Diclemente, R., Young, A., Painter, J., Wingood, G., Rose, E., & Sales, J. (2012). Prevalence and correlates of recent vaginal
douching among African American adolescent females. Journal of Pediatric and Adolescent Gynecology, 25(1), 48-53.
[13]. Erbil, N., Alışarlı, A., Terzi, H. Ç., Özdemir, K., & Kuş, Y. (2011). Vaginal douching practices among Turkish married women.
Gynecologic and obstetric investigation, 73(2), 152-157.
[14]. Funkhouser, E., Hayes, T. D., & Vermund, S. H. (2002). Vaginal douching practices among women attending a university in the
southern United States. Journal of American College Health, 50(4), 177-182.
[15]. Grimley, D. M., Annang, L., Foushee, H. R., Bruce, F. C., & Kendrick, J. S. (2006). Vaginal douches and other feminine hygiene
products: women's practices and perceptions of product safety. Maternal and child health journal, 10(3), 303-310.
[16]. Grimley, D. M., Oh, M. K., Desmond, R. A., Hook III, E. W., & Vermund, S. H. (2005). An intervention to reduce vaginal
douching among adolescent and young adult women: a randomized, controlled trial. Sexually transmitted diseases, 32(12), 752-758.
[17]. Güzel, A. I., Kuyumcuoğlu, U., & Celik, Y. (2011). Vaginal douching practice and related symptoms in a rural area of Turkey.
Archives of gynecology and obstetrics, 284(5), 1153-1156.
[18]. Hacıalioğlu, N., Nazik, E., & Kılıç, M. (2009). A descriptive study of douching practices in Turkish women. International journal of
nursing practice, 15(2), 57-64.
[19]. Hadimli, A., Can, H., Sogukpinar, N., Bozkurt, Ö., Akmese, Z., & Koçak, Y. (2012). Do women make vaginal lavage with the aim
of genital hygiene. NWSA-Medical Sciences, 7(3), 16-27.
[20]. Heng, L. S., Yatsuya, H., Morita, S., & Sakamoto, J. (2010). Vaginal douching in Cambodian women: its prevalence and
association with vaginal candidiasis. Journal of epidemiology, 20(1), 70-76.
The prevalence of vaginal douching and associated factors in married women and the role of
DOI: 10.9790/1959-0703050107 www.iosrjournals.org 7 | Page
[21]. Klebanoff, M. A., Andrews, W. W., Yu, K. F., Brotman, R. M., Nansel, T. R., Zhang, J., . . . Schwebke, J. R. (2006). A pilot study
of vaginal flora changes with randomization to cessation of douching. Sexually transmitted diseases, 33(10), 610-613.
[22]. Mandal, G., Raina, D., & Balodi, G. (2014). Vaginal douching: Methods, practices and health risks. American Association for
Science and Technologhy, 1(4), 50-57.
[23]. Mete, S., Yenal, K., Tokat, M. A., & Serçekuş, P. (2012). Effects of vaginal douching education on Turkish women's vaginal
douching practice. Research and theory for nursing practice, 26(1), 41-53.
[24]. Misra, D. P., Trabert, B., & Atherly-Trim, S. (2006). Variation and predictors of vaginal douching behavior. Women's Health
Issues, 16(5), 275-282.
[25]. Okumuş, F., & Demirci, N. (2016). Vaginal Douching Cessation in Rural Turkish Women with Vaginitis. International Journal,
9(1), 236.
[26]. Shaaban, O. M., Youssef, A. E. A., Khodry, M. M., & Mostafa, S. A. (2013). Vaginal douching by women with vulvovaginitis and
relation to reproductive health hazards. BMC women's health, 13(1), 23.
[27]. Short, M. B., Black, W. R., & Flynn, K. (2010). Discussions of vaginal douching with family members. Journal of Pediatric and
Adolescent Gynecology, 23(1), 39-44.
[28]. Smith, L. V., Rudy, E. T., Ivie, S. D., Lee, D., Visscher, B., & Kerndt, P. (2005). Characterization of frequent douchers attending a
community clinic primarily serving African-American women. Journal of the National Medical Association, 97(10), 1386.
[29]. Sunay, D., Kaya, E., & Ergun, Y. (2011). Vaginal douching behavior of women and relationship among vaginal douching and
vaginal discharge and demographic factors. Journal of Turkish Society of Obstetrics and Gynecology, 8(4), 264-271.
[30]. Yanikkerem, E., & Yasayan, A. (2016). Vaginal douching practice: Frequency, associated factors and relationship with
vulvovaginal symptoms. JPMA. The Journal of the Pakistan Medical Association, 66(4), 387-392.
Nebahat Ozerdogan "The Prevalence of Vaginal Douching and Associated Factors in Married
Women and the Role of Education in Stopping Vaginal Douching?” IOSR Journal of Nursing
and Health Science (IOSR-JNHS) , vol. 7, no.3 , 2018, pp. 01-07.
