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Jemds.com Original Research Article
J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 41 / Oct. 11, 2021 Page 6808
Perineal Hygienic Practices in Patients of Himalayan Foothills -
A Descriptive Study
Shashi Prateek1, Ankita Yadav2, Latika Chawla3, Deepti Chaudhary4,
Neetu Kochhar5, Shailja Sharma6, Rakhi Gaur7, Nitika Grover8
1, 2, 3, 4, 5, 6, 8 Department of Obstetrics and Gynecology, AIIMS Rishikesh, Dehradun, Uttarakhand, India. 7 Akal
College of Nursing, Eternal University, Baru Sahib (HP).
AB S TR AC T
BACKGROUND
It has been said that health is wealth and when it comes to reproductive health of a
women it has a significant value indeed. There is lot of loops and holes in perineal
hygiene practices due to incomplete knowledge and various myth that is transferred
from generation to generation in a family. The aim of the study was to study the
perineal hygiene practices in women of Himalayan foothills.
METHODS
This is an observational study performed between March 2019 to February 2020 at
AIIMS Rishikesh. Data was extracted from OPD records of patients which included
details on perineal hygiene, routinely asked in one of the three units in department
of obstetrics and gynaecology at AIIMS Rishikesh.
RESULTS
Total of 2400 women participated in the study. The mean age of subjects was 32±
6.9(Range 12 - 80 years). Maximum patients were married (92 %), mostly Hindus
(48 %) belonging to upper lower class (37.5 %) according to modified Kuppuswamy
socioeconomic scale. In this study we studied the routine perineal cleaning
practices, Attention is being drawn to the fact that only 15 % of the subjects cleaned
the genital area with water after urination, 5 % while changing pads during
menstruation, only 1.5 % washed the genitalia immediately after sexual intercourse
In present study the commonest method removal of perineal hair was shaving (38.4
%). While analysing menstrual hygiene, in present study, 42.5 % of study
population was using sanitary pads from market and 35 % used homemade cloth
pads. Ninety eight point seven percent of women avoided sexual intercourse during
menstruation in present study.
CONCLUSIONS
Female genital hygiene is a vital topic. Awareness should be increased regarding
maintenance of hygienic practices through health education programmes. More
studies need to be performed in order to provide directions for proper female
genital hygiene, as well as guidelines.
KEY WORDS
Perineal Hygiene, Pubic Hair Grooming, Menstrual Hygiene, Perineal Itching,
Perineal Rashes, Long Mirror for Self Examination.
Corresponding Author:
Dr. Ankita Yadav,
Senior Resident,
Department of Obstetrics & Gynaecology,
AIIMS Rishikesh, Uttarakhand, India.
E-mail: ankitayadav28101992@gmail.com
DOI: 10.14260/jemds/2021/0000
How to Cite This Article:
Prateek S, Yadav A, Chawla L, et al.
Perineal hygienic practices in patients of
himalayan foothills - a descriptive study. J
Evolution Med Dent Sci 2021;10(41):0000-
0000, DOI: 10.14260/jemds/2021/0000
Submission 25-03-2021,
Peer Review 29-05-2021,
Acceptance 05-06-2021,
Published 27-09-2021.
Copyright © 2021 Shashi Prateek et al.
This is an open access article distributed
under Creative Commons Attribution
License [Attribution 4.0 International (CC
BY 4.0)]
Jemds.com Original Research Article
J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 41 / Oct. 11, 2021 Page 6809
BA C KG RO UN D
“It has been said that Health is wealth and when it comes to
the reproductive health of a woman it has a significant value
indeed.” Perineal hygiene is one of the least concern areas for
most of the women. While on one hand, women are more
conscious about their looks, on the other hand, they are not
paying enough attention to cleanliness of genital organs. This
is because these body parts are hidden beauties and need
internal strength of superior level consciousness for taking
care of these important body parts. Carelessness towards
grooming of pubic hair, use of unsterilized cloth instead of
sterilised sanitary pads. Cleaning practices, after nature’s call
and sexual activity, are some examples which portray the
picture of a women’s reproductive health among rural as well
as urban community. Despite common anatomical structure
of reproductive organs of all women, attitude towards
hygienic practices vary among countries, cultures, societies
and individuals.1
The term perineal hygiene is used for caring and
maintaining the external genital and perianal area. A wide
variety of friendly microorganisms are found in the female
genital tract which are commonly known as commensal
which play a significant role in maintenance of pH of
perineum and are responsible for its health. Lack of
awareness, misinformation and poor hygienic conditions may
change the flora which may become pathogenic and cause
various types of infections.2 In developing countries like
India, 43 - 88 % women are using cloth during menstruation.
Many a times these may be unclean and may lead to perineal
rash and infections. Such kind of practices are usually passed
from one generation to another as a part of their cultural
practices.3 Women’s genital anatomy is also a contributing
factor for making them more prone to infections than man.1
Reproductive tract infections (RTIs) including sexually
transmitted infections (STIs) can be prevented if women are
educated regarding proper perineal hygiene.4 Unsupported
family, illiteracy, lack of resources and unawareness are some
of significant contributing factors responsible for poor
perineal hygiene practices among women.2
Present study was carried out to identify and explore the
perineal hygiene practices of women along with details on
type of sanitary napkins used, hygiene during menstruation
and sexual activity so that appropriate measures can be
planned to educate women and promote reproductive health.
ME T HO DS
This is an observational study approved by institutional
committee and was performed between March 2019 to
February 2020. Since the study was a observational study
between March 2019 and Feb 2020, all the patient attending
opd between this time duration were included in the study,
there was no predefined sample size.
Et h ic al S ta te me nt
Ethical clearance for the study was taken from AIIMS
RISHIKESH and the study was conducted in the department
of obstetrics and gynaecology, the data was extracted from
the OPD records of the patients
Da t a Co ll ec ti on P ro ce du re
Data was extracted from OPD records of patients which
included details on perineal hygiene, routinely asked in one
of the three units in department of obstetrics and
gynaecology at AIIMS Rishikesh.
An a ly ti ca l Ap pr oa ch
The data collected were encoded into Microsoft Excel sheet
and analysed using SPSS version 21. Data was analysed using
appropriate statistical tests like frequency and percentage for
demographic characteristics and perineal hygiene practices.
RE S UL TS
During the study period, data of Twenty four hundred
females was recorded. Demographic profile of subjects is
shown in Table 1.
Age in Years (Range 12 - 80 years)
32±6.9
Variable
%
No.
Religion
Hindu
48.5
1164
Muslim
36.5
876
Other
15
360
Education
Illiterate
3.5
84
Just literate
24
576
Primary level
36
864
Secondary level
16
384
Senior secondary level
10
240
Graduate and above
10.5
252
Marital status
Unmarried
4.2
101
Married
92
2208
Widow / Divorce
3.8
91
Socioeconomic status
(Modified Kuppuswamy scale)
Lower class(<5)
30.5
732
Upper lower (5 - 10)
37.5
900
Lower middle(11 - 15)
17.5
420
Upper middle(16 - 25)
9.5
228
Upper class(26 - 29)
5
120
Body mass index
Underweight ( < 18.5)
11
264
Normal (18.5–25)
52
1248
Overweight (25–30)
31.5
756
Obese (> 30)
5.5
132
Table 1 Demographic Profile of Study Subject
The mean age of subjects was 32± 6.9(Range 12 - 80
years). Maximum patients were married (92 %), mostly
Hindus (48 %) belonging to upper lower class (37.5 %)
according to modified Kuppuswamy socioeconomic scale.
The majority of women took bath daily and washed
perineum during bath with soap and water (99 %). More than
99 % women were washing perineum after defecation (99.87
%). There were 5 women who used water in routine but in
case of emergency when out of home, used soil lump to clean
after defecation. Only 15 % washed perineum after
micturition, cleaning material used by maximum women was
water (10 %), tissue (2.5 %) and other over the counter
products (2.5 %). It was very interesting to find that only 5 %
of women who washed perineum after micturition had
history of drying the perineum with tissue paper (65 %) or
towelette (35 %) and as far as use of fresh towelette is
concerned majority of women washed it daily (81.06 %).
In present study 97.7 % women reported removing pubic
hair at some point of time, the frequency of removal of
perineal hair was every 15 days in 5.25 %, once a month in
Jemds.com Original Research Article
J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 41 / Oct. 11, 2021 Page 6810
53.04 %, more than 2 months is 15.33 % and whenever
feasible or required in 24.08 %. The method used for hair
removal was primarily a razor blade (28.4 %), but other
methods, such as trimming with electric trimmer or scissors,
cream, and waxing was also reported.
Variables
%
No.
Perineal cleaning practices
Cleaning during bath
100
2400
Cleaning after urination
15
360
Cleaning after defecation
99.87
2397
Cleaning while changing pads during
periods
5
120
Cleaning material used for
cleaning the perineum
during bath
Water only
1
24
Soap and water
99
2376
Cleaning material used for
cleaning perineum after
urination
Nil:
85
2040
Water
10
240
Tissue
2.5
60
Traditional antiseptics (chlorhexidine /
soap, iodine solution, chloroxylenol)
2.5
60
Underwear material
Cotton
37.5
900
Synthetic
21
504
Other (silk, Satan)
10
240
Not using underwear
31.5
754
Using underwear at sleeping
time
No
76
1824
Yes
24
576
Habit of drying perineum
after urination and
defecation
No (95 %)
95
2280
Yes (5 %)
Tissue paper
65
78
Towelette
35
42
Frequency of use of fresh
towelette with urination
Every time after use
2.3
1
Daily
81.06
34
Less than weekly
9.5
4
Weekly
7.14
3
More than a week
Nil
Nil
Frequency of perineal hair
removal
Never
2.3
55
Every 15 days
5.25
126
Once a month
53.04
1273
More than 2 months
15.33
368
Whenever required / feasible
24.08
578
Method of removal of
perineal hair
Razor blade
28.4
682
Trim (electric hair trimmer)
13.46
323
Trim (scissor)
12.7
305
Cream
13.15
315
Wax
12.29
295
Vary time to time)
20
480
Table 2. Variables of Routine Perineal Cleaning
Variable
%
No
Menstrual blood
absorbent / collector
Pad
42.5
1020
Cloth
35.5
852
Tampons
4.46
107
Menstrual cup
0.04
1
Not required (before menarche,
amenorrhoea or post - menopausal)
17.5
420
Sexual intercourse during
menstruation
No
98.7
2369
Yes
1.3
31
Practices in relation
intercourse
Urination immediately before intercourse
51.5
1236
Urination immediately after intercourse
13.5
324
Never corelated urination with intercourse
35
840
Cleaning perineum after
intercourse
Washing
1.5
36
Wiping
98
2352
Nil
0.5
12
Lubrication during
intercourse
No
83.04
1992
Yes
Medicated cream
6.4
154
Jelly
10.4
250
Saliva
0.16
4
Table 3. Variables for Perineal Hygiene during Menstruation & Sexual
Activity
Out of 2400 women 42.5 were using sanitary napkins
from market as absorbent material during their menstrual
cycle, while 35.5 % were using cloth, 4.46 % used tampons
whereas one foreigner (German women) used menstrual
cups. It was found that only 5 % of women washed perineum
while changing of pad. It was seen that 98.7 % of women
avoided sexual intercourse during menstruation.
On inquiring about practices of urination in relation to
intercourse, it was found that 51.5 % women practiced
urination before sexual intercourse while only 13.5 %
immediately after sexual intercourse and 35 % did not
corelate urination with sexual intercourse. Ninety eight
percent women practised cleaning of perineum by wiping
with cloth after intercourse whereas 1.5 % had habit of
washing the perineum with water. However, it was strange to
find that 0.5 % did not cleaned perineum at all after
intercourse.
Variables
%
No.
Past History of Perineal
rashes
Yes
58.6
1406
No
41.4
994
Past history of Itching in
perineal region
Yes
65.58
1574
No
34.42
826
How did they came to know
about rash in perineal region
During routine examination by a doctor
51
1224
Seen by partner
40.5
972
Self - examination using mirror
8.5
204
Long mirror available in
privacy
Yes
9.5
228
No
90.5
2172
Table 4. Variables in Relation to Perineal Itching / Rashes
On enquiring about past history 58.61 % women gave
history of perineal rash and 65.58 % gave history of itching in
perineal region at some point of time in past. The diagnosis of
perineal rash in majority of women (51 %) was made during
routine examination by a doctor or paramedic, some women
came to know when they developed itching and was seen by
partner or she examined in mirror. It was very interesting to
find that only 9.5 % of females had a long mirror (example in
bathroom, bedroom, in assigned area) for self - examination.
DI S CU SS IO N
This study examined the perineal hygiene practices among
women of Himalayan foothills. This study helps to add to the
limited data available on this subject. While there are some
studies available on the perineal hygiene practices but
majority of these are limited to western world. Strength of
present study includes the large sample size and inclusion of
extensive array of behaviours in the different age group.
Regarding perineal hygiene, attention is being drawn to
the fact that only 15 % of the subjects cleaned the genital area
with water after urination, 5 % while changing pads during
menstruation, only 1.5 % washed the genitalia immediately
after sexual intercourse. It is known that accumulation of
residues of urine, sperm, faeces, menstrual blood and scrapes
of paper promotes irritation and itching, so that they may
predispose to the formation of cracks and cause perineal
infection. These hygienic practices are almost similar in all
strata of education. In a similar descriptive study by Ruiz et al
on daily genital cares of female gynaecologists, only 25.9 %
practiced washing of genitalia with running water after
urination and 52.7 % sanitized themselves after sexual
relation.5 Similar results were seen in a study by Giraldo et al
in their survey on 341 university students of a large Brazilian
university.6
Pubic hair grooming practices are currently considered as
social norm however, very little data on the topic exists.
There are many reasons for removal of pubic hair like
hygiene and cosmetic however the main reason for perineal
hair grooming were for comfort and preventing odour.7 In
present study the commonest method was shaving (38.4 %).
Similarly, in a study by Rouzi et al the most common single
method of removal of pubic hair was razor blade (33.5 %).8 It
was observed in present study that 77 % of the population
removed pubic hair monthly similar to a study by AlGhamdi
KM et al in which removal of pubic hair was practiced once in
Jemds.com Original Research Article
J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 41 / Oct. 11, 2021 Page 6811
40 days.9 The results of the study are consistent with
previous studies in different study population.
While analysing menstrual hygiene, in present study, 42.5
% of study population was using sanitary pads from market
and 35 % used homemade cloth pads. Women who used cloth
for menstrual protection, majority discarded the cloth after
every use however very few reused the cloth after washing.
Similarly habit of reusing the cloth was found in a study done
by Santra S. on reproductive age women of slum area of
Kolkata, west Bengal, India.10 It was found that only 5 % of
women were doing perineal washing while changing of pad.
Privacy for washing, changing of pads or cleaning purpose is
something very important for proper menstrual hygiene but
in it was seen that, lack of privacy was an important problem,
both at home or at school / work place. The results of present
study are consistent with previous reports in different study
populations. Similar results were seen in a community -
based study on menstrual hygiene among adolescent girls in
a study done by Jogdand K.11
Ninety eight point seven percent of women avoided
sexual intercourse during menstruation in present study.
Which match the results seen in a study by Mazokopakis E et
al. According to the Old Testament (Provisions for clean and
unclean of the Mosaic Law), a woman during menstruation or
a man who has sexual relations with a menstruating woman
are perceived as "unclean". When seven days pass after the
first day of menstruation, the woman is regarded as "clean"
and sexual contact is permitted.12 Modern medical science
also discourages practice of sexual intercourse during
menstruation as it has been reported that there are higher
risk of infection and endometriosis to the female partner.
Menstruation should not be treated as a dirty phenomenon
and it should not be a hindrance to daily activities. Sanitary
pads should be made available free or at affordable price and
it should be easily accessible. Clean toilet, water and facilities
to dispose sanitary pads should be made available at schools
and at work place. Discussion about intimate hygiene should
be a routine at home and at schools. This topic should not be
considered a taboo. As a frontline health care worker, it’s our
duty to promote healthy perineal hygienic practices.
CO N CL US IO NS
Female genital hygiene is a vital topic. Awareness should be
increased regarding maintenance of hygienic practices
through health education programmes. More studies need to
be performed in order to provide directions for proper
female genital hygiene, as well as guidelines.
Data sharing statement provided by the authors is available with the
full text of this article at jemds.com.
Financial or other competing interests: None.
Disclosure forms provided by the authors are available with the full
text of this article at jemds.com.
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married women at urban field practice area, Dharwad.
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[2] Attieh E, Maalouf S, Roumieh D, et al. Feminine hygiene
practices among female patients and nurses in Lebanon.
Reprod Health 2016;13(1):59.
[3] Pete PNM, Mabvouna Biguioh RM, Izacar AGB, et al.
Genital hygiene behaviors and practices: a cross-
sectional descriptive study among antenatal care
attendees. J Public Health Afr 2019;10(1):746.
[4] Shah SK, Shrestha S, Maharjan PL, et al. Knowledge and
practice of genital health and hygiene among adolescent
girls of Lalitpur Metropolitan City, Nepal. American
Journal of Public Health Research 2019;7(4):151-6.
[5] Ruiz C, Giraldo PC, Sanches JM, et al. Daily genital cares of
female gynecologists: a descriptive study. Rev Assoc Med
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[6] Giraldo PC, Polo RC, Amaral RLG, et al. Hábitose
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roupas íntimas, adornos genitais, depilação e práticas
sexuais. Rev Bras Ginecol Obstet 2013;35(9):401-6.
[7] Muallaaziz D, Yayci E, Ataçağ T, et al. Pubic hair removal
practices in Muslim women. Basic Clin Sci 2014;3:39–44.
[8] Rouzi AA, Berg RC, Turkistani J, et al. Practices and
complications of pubic hair removal among Saudi
women. BMC Women's Health 2018;18(1):172.
[9] AlGhamdi KM, AlHomoudi FA, Khurram H. Skin care:
historical and contemporary views. Saudi Pharm J
2014;22(3):171–8.
[10] Santra S. Assessment of knowledge regarding
menstruation and practices related to maintenance of
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[11] Jogdand K, Yerpude P. A community based study on
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