Evaluation of the Genital Hygiene Behavior and Related Factors of Women Aged 15-49

Abstract

Aim: Approximately one million people in the world are exposed to urogenital tract infections every year and at least 75% of women have a history of genital infection. The frequency of vaginal infections in women aged 15-49 in Turkey is known to be 35-68%. Genital infections can be asymptomatic and can cause negativity in sexual and family life. Therefore, it is important to take preventive measures. Mentioning correct genital hygiene behaviors in the training and consultancy services provided by healthcare professionals helps people to increase their awareness. In our study, we aimed to evaluate women's genital hygiene behaviors and related factors.
Methods: Our study was carried out with 457 women between the ages of 15-49 in the Gynecology Outpatient Clinic of Nisa Hospital. The socio-demographic characteristics and gynecological characteristics of the subjects were collected by face-to-face interviews using the questionnaire form that consisted of 20 questions and the “Genital Hygiene Behavior Inventory”. The IBM SPSS version 22 program was used for statistical analysis.
Results: This study was conducted with 457 women. A significant negative correlation was found between the Genital Hygiene Behavior Inventory score and the number of pregnancies and number of children (p=0.028, r=-0.128, p=0.037, r=-0.128, respectively), and a significant positive correlation was found between education status, income status, and having children (p=0.010, p=0.000, p=0.007, respectively). Participants who stated that they had the knowledge and received this information from doctors and/or nurses had higher Genital Hygiene Behavior Inventory scores.
Conclusion: Questioning genital complaints of women by all healthcare professionals, determining hygiene behaviors, and correcting erroneous practices will positively affect urogenital health.

Full text

Euras J Fam Med 2022;11(1):35-42. doi:10.33880/ejfm.2022110105
35
Original Research
Evaluation of the Genital Hygiene Behavior and
Related Factors of Women Aged 15-49
Asiye Uzun1, Guzin Zeren Ozturk2, Saliha Busra Aksu3
1Department of Obstetrics and Gynecology Medipol Teaching and Research Hospital, Istanbul, Turkey. ORCID iD: 0000-
0001-8322-6643
2Department of Family Medicine, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital,
Istanbul, Turkey. ORCID iD: 0000-0001-7730-2929
3Department of Family Medicine, Aslanapa District State Hospital, Kutahya, Turkey. ORCID iD: 0000-0003-0432-6801.
drsalihabusra@gmail.com (Corresponding Author)
ABSTRACT
Aim: Approximately one million people in the world are exposed to urogenital tract infections every
year and at least 75% of women have a history of genital infection. The frequency of vaginal infections
in women aged 15-49 in Turkey is known to be 35-68%. Genital infections can be asymptomatic and
can cause negativity in sexual and family life. Therefore, it is important to take preventive measures.
Mentioning correct genital hygiene behaviors in the training and consultancy services provided by
healthcare professionals helps people to increase their awareness. In our study, we aimed to evaluate
women's genital hygiene behaviors and related factors.
Methods: Our study was carried out with 457 women between the ages of 15-49 in the Gynecology
Outpatient Clinic of Nisa Hospital. The socio-demographic characteristics and gynecological
characteristics of the subjects were collected by face-to-face interviews using the questionnaire form that
consisted of 20 questions and the “Genital Hygiene Behavior Inventory”. The IBM SPSS version 22
program was used for statistical analysis.
Results: This study was conducted with 457 women. A significant negative correlation was found
between the Genital Hygiene Behavior Inventory score and the number of pregnancies and number of
children (p=0.028, r=-0.128, p=0.037, r=-0.128, respectively), and a significant positive correlation was
found between education status, income status, and having children (p=0.010, p=0.000, p=0.007,
respectively). Participants who stated that they had the knowledge and received this information from
doctors and/or nurses had higher Genital Hygiene Behavior Inventory scores.
Conclusion: Questioning genital complaints of women by all healthcare professionals, determining
hygiene behaviors, and correcting erroneous practices will positively affect urogenital health.
Keywords: hygiene, education, genital infection, reproductive health, family practice
Date of submission: 18.10.2021 / Date of acceptance: 17.03.2022
How to cite: Uzun A, Ozturk GZ, Aksu SB. Evaluation of the genital hygiene behavior and related factors of women
aged 15-49. Euras J Fam Med 2022;11(1):35-42. doi:10.33880/ejfm.2022110105.
Conflict of interest: No conflict of interest was declared by the authors.
Financial disclosure: No financial disclosure was declared by the authors.

Uzun A et al. Evaluation of the genital hygiene behavior and related factors of women aged 15-49. Euras J Fam Med 2022;11(1):35-42
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Introduction
Approximately one million people in the world
are exposed to urogenital tract infections every year
and at least 75% of women have a history of a genital
infection (1). The frequency of vaginal infections in
women aged 15-49 in Turkey is known to be 35-68%
(2). In a study conducted in our country in 2020, this
rate was found to be 78.6% (3).
Genital infections disrupt the quality of life by
negatively affecting family and sexual life, and
predispose to the development of complications such
as infertility, pregnancy problems, and cervical cancer
(4,5). However, most genital infections can be
asymptomatic. Therefore, screening should be done
especially in risky individuals to prevent
complications (6).
The most common genital infections in women
are vulvovaginitis; it is known that correction of faulty
genital hygiene habits has a place in prevention (7).
Mentioning correct genital hygiene behaviors in the
training and consultancy services provided by
healthcare professionals helps people to increase their
awareness.
In our study, we aimed to evaluate women's
genital hygiene behavior and related factors.
Methods
The type of our study was descriptive and we
included non-pregnant, non-menopausal, and married
women aged 15-49 in our study. It was carried out in
the Gynecology Outpatient Clinic of Nisa Hospital
between 7th August -30th October 2020. Our clinic is
affiliated with a private hospital in Istanbul which is
the most populous and advanced city in Turkey and
generally serves patients with middle-upper income
and education levels.
Ethical committee approval was obtained from
the Medipol University Ethics Committee protocol
dated 06.08.2020 and numbered 625.
A questionnaire consisting of an information form
and an inventory of genital hygiene behaviors was
used to collect data.
The number of outpatient clinic applications per
month is around 1000 and the sample size has been
calculated to be 341 with 95% confidence interval and
aimed to reach this minimum number.
The questionnaire form was filled in by face-to-
face interviews with the researchers, and the Genital
Hygiene Behavior Inventories (GHBI) were filled in
by the women themselves in a private room in the
outpatient clinic. Following the completion of the
questionnaire, the researcher informed the participants
about the subjects they wanted to learn and felt
insufficient about genital hygiene behaviors.
The socio-demographic characteristics and
gynecological characteristics of the subjects were
collected by face-to-face interviews using the
questionnaire form that consisted of 20 questions and
the “Genital Hygiene Behavior Inventory’’.
Genital Hygiene Behavior Inventory consisted of
a total of 23 items were developed by Ege and
Eryılmaz (8) to evaluate the genital hygiene behaviors
of women aged 15–49 years. Inventory items ranged
from "totally agree" to "totally disagree" by giving
numerical values from 5 to 1. 5 items in the inventory
were scored inversely. The lowest total score was 23,
while the highest total score was 115. A high-level
total score from the inventory indicates that the genital
hygiene behavior is at the desired level. Apart from the
total score, there are three subgroups: "general hygiene
behaviors", "menstrual hygiene" and "abnormal
finding awareness".
The IBM SPSS version 22 (Statistical Package for
the Social Sciences) program was used for statistical
analysis. The socio-demographic data obtained were
evaluated with their number and percentage
dispersions. Chi-square and t-test were used in the
statistical analysis. The results were evaluated within
the 95% confidence interval, and significance was
evaluated at p<0.05.
Results
This study was conducted with 457 women and
the mean age of the participants was 30.49±6.56. The
sociodemographic and chronic disease histories of 457
participants are shown in Table 1.

Uzun A et al. Evaluation of the genital hygiene behavior and related factors of women aged 15-49. Euras J Fam Med 2022;11(1):35-42
37
Table 1. Sociodemographic features and chronic disease
history of participants
n
%
Education
Level
Low (Educated under
high school)
89
19.5
High (Educated High
school or higher)
368
80.5
Income
status (per
month)
Low (<2000 TL)
73
16.0
Middle (2000–5000 TL)
248
54.3
High (≥5000 TL)
136
29.7
Employment
status
Employed
273
59.7
Unemployed
184
40.3
Marital
status
Married
334
73.1
Not married
(Single/Divorced/Widow)
123
26.9
Status of
having
children
Yes
267
58.4
No
190
41.6
Chronic
Disease
History
None
395
86.4
Hypertension
22
4.8
Diabetes Mellitus
8
1.8
Asthma/
Chronic Obstructive
Pulmonary Disease
7
1.5
Others
25
5.5
(TL: Turkish lira)
There were 267 (58.4%) patients who had no
vaginitis history and 181 (39.6%) patients who had no
urinary tract infections history. 334 participants were
married and 264 of them had children. The mean
marriage year was 7.18±6.39 years. The mean number
of pregnancies and births was 1.36±1.49 and
1.04±1.14, respectively.
The mean height of the participants was
163.10±5.85; the mean weight was 65.73±12.03 and
the mean body mass index was 24.75±4.56. The
distribution of the participants according to their body
mass index is shown in Figure 1.
Figure 1. BMI groups of participants
The knowledge and behaviors of the participants
about sexual life and genital hygiene are given in Table
2.
Table 2. Evaluation of sexual life and genital hygiene
knowledge and attitudes
n
%
Having knowledge
about genital hygiene
Yes
338
74.0
No
51
11.1
No idea
68
14.9
Where did she get
information about
genital hygiene?
No information
75
16.4
Social media/
online
139
30.4
Family/friend
49
10.7
Doctor/nurse
142
31.1
Newspaper/book
12
2.5
Other
40
8.9
Is it important to pay
attention to genital
hygiene?
Yes
441
96.5
No
16
3.5
Sexually Active
Yes
361
79.0
No
96
21.0
Performing vaginal
douche
Yes
233
51.0
No
224
49.0
Using genital
products during
genital cleansing
Yes
392
85.0
No
65
15.0
History of urinary
tract infections
Yes
276
60.4
No
181
39.6
History of vaginitis
Yes
190
41.6
No
267
58.4
One hundred and ten (24%) of the participants
who declared to be sexually active did not use any
contraception method. Water and soap were the most
commonly used materials for genital cleaning, the
distribution of the products used were given in Figure
2.
Figure 2. Genital cleaning methods of participants

Uzun A et al. Evaluation of the genital hygiene behavior and related factors of women aged 15-49. Euras J Fam Med 2022;11(1):35-42
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Participants' mean score from the Genital Hygiene
Behavior Inventory was 97.70±10.36, of the
subgroups; menstrual hygiene mean score was
33.71±4.81, abnormal findings awareness mean score
was 12.26±2.81 and genital hygiene awareness mean
score was 59±5.34. The comparison of Genital
Hygiene Behaviors Inventory and socio-demographic
data is shown in Table 3 and 4. A significant negative
correlation was found between the GHBI and the
number of pregnancies and children (p=0.028, r=-
0.128, p=0.037, r=-0.128, respectively), and a
significant positive correlation was found between
education status, income status and having children
(p=0.010, p=0.000, p=0.007, respectively).
Table 3. Comparison of genital hygiene behavior inventory and sociodemographic data
Genital Hygiene
Awareness Score
Menstrual Hygiene
Score
Abnormal Findings
Awareness Score
Total score
r
p
r
p
r
p
r
p
Age*
0.047
0.312
-0.071
0.128
-0.039
0.405
-0.007
0.882
Height*
0.002
0.972
0.055
0.237
0.142
0.002
0.52
0.270
Weight (kg)*
0.073
0.119
-0.001
0.979
0.007
0.881
0.050
0.288
Years of marriage*
-0.024
0.662
-0.121
0.027
-0.30
0.583
-0.065
0.237
Number of total pregnancies*
-0.84
0.147
-0.193
0.001
-0.15
0.794
-0.128
0.028
Number of children*
-0.089
0.145
-0.208
0.001
0.003
0.967
-0.128
0.037
Number of total abortions *
0.095
0.361
0.099
0.340
0.158
0.127
0.161
0.159
*Pearson Correlation
Table 4. Comparison of genital hygiene behavior inventory and sociodemographic data
Genital Hygiene
Awareness Score
Menstrual Hygiene
Score
Abnormal Findings
Awareness Score
Total score
Mean
Rank±SD
p değeri
Mean
Rank±SD
p value
Mean
Rank±SD
p
value
Mean
Rank±SD
p
value
Education
statusx
Low
50.61±6,24
0.216
31.62±4,88
0.000
11,65±3,87
0.045
94,11±12,20
0.003
High
51.83±5.08
34.21±4.66
12.40±2.73
98.57±9.69
Income statusx
Low
50.36±5.92
0.016
30.80±5.37
0.000
11.53±3.40
0.279
92.71±11.65
0.000
Middle
52.15±5.39
34.32±4.56
12.35±2.75
98.99±10.54
High
51.23±4.79
34.16±4.38
12.47±2.53
98.02±8.40
BMI groupsx
Underweight
48.73±5.20
0.012
32.33±3.42
0.029
11.33±2.68
0.053
92.40±7.64
0.006
Normal weight
51.63±5.16
34.29±4.56
12.49±2.81
98.62±9.39
Overweight
52.09±5.43
33.22±5.10
12.24±2.75
97.61±11.22
Obese
51.59±5.54
33.24±5.41
11.89±2.94
97.03±12.25
Employment
status*
Employed
51.67±4.88
0.637
34.43±4.56
0.000
12.28±2.86
0.790
98.47±9.63
0.132
Unemployed
51.48±5.97
32.64±4.98
12.21±2.75
96.56±11.29
Marital status*
Married
51.91±5.39
0.015
33.68±4.93
0.947
12.28±2.67
0.991
98.08±10.77
0.066
Not married
50.74±5.11
33.78±4.48
12.18±2.67
96.65±9.13
Status of having
children*
Yes
52.08±5.39
0.005
33.81±5.15
0.180
12.31±2.70
0.721
98.44±11.12
0.007
No
50.91±5.20
33.57±4.29
12.18±12.26
96.66±9.11
*Pearson Correlation; xChi-square; SD: Standard deviation
A significant relationship was found between
body mass index and the Genital Hygiene Behavior
Scale, and the highest mean was found in individuals
with normal body mass index (p=0.005).
In Table 5, the relationship between sexual life,
genital hygiene knowledge and attitudes, and GHBI
scores were given, and a significant relationship was
found between the GHBI total score of those who said
they knew about genital hygiene, those who thought it
was important to pay attention to genital hygiene, and
those who received information from doctors and/or
nurses (p=0.000; p=0.000; p=0.000 respectively). In
addition, awareness of menstrual hygiene was found to
be significantly higher in those without a history of
vaginitis (p=0.015), while awareness of abnormal
findings was significantly higher in those who did not
do vaginal douching (p=0.031).

Uzun A et al. Evaluation of the genital hygiene behavior and related factors of women aged 15-49. Euras J Fam Med 2022;11(1):35-42
39
Table 5. Comparison of genital hygiene knowledge and attitude characteristics and genital hygiene behavior inventory scores
Genital Hygiene
Awareness Score
Menstrual Hygiene
Score
Abnormal Findings
Awareness Score
Total score
Mean Rank±
SD
p
Mean
Rank±SD
p
Mean Rank
±SD
p
Mean
Rank±SD
p
Having
knowledge about
genital hygiene?1
Yes
52.22±4.93
0.000
34.45±4.38
0.000
12.76±2.48
0.000
99.56±9.12
0.000
No
49.27±6.31
32.39±4.94
11.50±2.75
93.37±11.60
No idea
50.20±5.84
31.02±5.57
10.29±3.41
91.70±10.36
Where did she get
information about
genital hygiene?1
No
information
49.81±5.72
0.008
31.17±5.57
0.000
10.64±3.22
0.000
91.52±11.75
0.000
Social media/
online
51.53±5.35
34.05±4.15
12.24±2.84
97.88±9.27
Family / friend
51.32±4.69
34.59±3.81
13.08±2.27
99.14±7.97
Doctor /nurse
52.09±5.30
34.03±4.98
12.74±2.65
99.27±10.55
Newspaper/
book
54.41±2.99
33.08±4.54
12.50±2.02
100.00±7.01
Other
52.85±5.21
35.25±4.51
12.55±2.20
100.65±9.94
Is it important to
pay attention to
genital hygiene?1
Yes
51.79±5.19
0.002
33.90±4.72
0.000
12.38±2.77
0.000
98.22±10.02
0.000
No
48.33±1.15
26.66±1.15
9.33±0.57
84.33±0.57
Other
45.53±7.10
28.76±4.69
8.84±2.03
83.15±10.72
Sexually active2
Yes
51.20±5.16
0.315
33.39±4.49
0.298
12.25±3.04
0.934
95.93±9.23
0.219
No
51.70±5.39
33.79±4.89
12.26±2.76
97.90±10.65
Performing
vaginal douche2
Yes
51.32±5.68
0.597
33.49±5.00
0.484
11.99±2.85
0.031
97.11±11.02
0.496
No
51.86±4.98
33.93±4.61
12.52±2.76
98.29±9.65
Using genital
products during
genital cleansing2
Yes
51.63±5.29
0.868
33.70±4.87
0.859
12.31±2.87
0.159
97.83±10.43
0.450
No
51.37±5.64
33.75±4.46
11.95±2.46
96.93±9.96
History of urinary
tract infections2
Yes
51.98±5.24
0.231
33.79±4.88
0.707
12.31±2.81
0.819
98.26±10.37
0.481
No
51.00±5.44
33.58±4.71
12.17±2.84
96.84±10.32
History of
vaginitis2
Yes
51.26±5.45
0,241
33.09±4.98
0.015
12.48±2.62
0.215
97.04±10.48
0.205
No
51.83±5.6
34.15±4.64
12.09±2.94
98.17±10.27
1Kruskal-Wallis H; 2Mann-Whitney U; SD: Standard deviation
Discussion
Vulvovaginitis is one of the most common
reasons for hospital admissions among reproductive
health problems (9,10). It has been shown that 75% of
women experience vulvovaginitis at least twice in their
life, studies conducted in our country have shown that
this rate is 35-50% (11,12). In our study, the rate was
41.6%, which is consistent with the literature.
Studies have found that those with a high level of
education have better genital hygiene practices
(13,14). Consistent with this, in our study, the GHBI
score was found to be significantly higher in women
with a high level of education. The reason for this may
be that as the education level increases, health literacy
increases (15). In our study, as the number of
pregnancies and children had increased, the GHBI
scores of the individuals decreased and this was found
to be statistically significant. However, in the
literature, no significant difference was found between
pregnant and non-pregnant women in terms of genital
hygiene behaviors (16). The reason for this difference
may be related to the characteristics of the population,
or it may be the result of the decreasing in self-care as
the number of children increases. A similar result was
obtained in a study conducted in our country (17).
In our study, the GHBI score was found to be high
in normal-weight individuals. A study on the
relationship between body mass index (BMI) and
Genital Hygiene behavior has found an inverse
relationship between BMI and genital hygiene
behavior (18).
In our study participants thought that genital
hygiene is important; those who stated that they had
the knowledge and received this information from
doctors and/or nurses had higher GHBI scores. This is
a finding showing that getting education on genital
hygiene, positively affects women's genital hygiene
behaviors. Health education and counseling constitute
an important part of the protection of women's and

Uzun A et al. Evaluation of the genital hygiene behavior and related factors of women aged 15-49. Euras J Fam Med 2022;11(1):35-42
40
reproductive health (19,20).
Vaginal douching is frequently used by Turkish
women as a part of feminine hygiene (21,22). 233
(51%) participants in our study stated that they
perform vaginal douching. In our country, women use
vaginal douching not only as a part of general hygiene
but also as a religious practice of ghusl and cleansing
after menstruation (22). While there was no
relationship between vaginal douching and GHBI
scores, the scale score of those who did vaginal
douching was lower, also, awareness of abnormal
findings was significantly lower in those who had
vaginal douching.
The rate of the participants who cleaned the
genital area was 85%, and the two most commonly
used methods were water and water plus soap together.
In similar studies, it was found that the most frequently
used material for this purpose was water at the rate of
63.9% and water plus soap at the rate of 25.5% (23).
Compared to other studies, it is stated that in Muslim
countries water and soap are used more whereas
special products are used in western countries (24,25).
Questioning genital complaints of women by all
healthcare professionals, determining hygiene
behaviors, and correcting erroneous practices will
positively affect urogenital health (26).
The present findings have provided an
informative sample of beliefs and attitudes regarding
genital hygiene only in the Istanbul region of Turkey.
Future studies should investigate if there are additional
motivations for women and their genital hygiene
practices. Different populations (i.e. urban vs rural),
different socioeconomic groups, and regions of
Turkey should be evaluated according to their genital
hygiene behaviors.
It should be ensured that information brochures
prepared specifically for women on correct genital
hygiene practices and protection from genital
infections are available and women's awareness should
be increased with audio-visual tools. It is
recommended that women be supported on issues they
are conscious of and informed by training on issues
they are inadequate.
We believe that it is important to organize training
programs to be given to women on reproductive health
and hygiene. We think that our nurses, who are
especially intertwined with the public and who provide
training, can investigate and evaluate the knowledge
of this group of women on genital hygiene and how
they behave, and than they can ensure that women
have the right genital hygiene behaviors.
Conclusion
Genital infections are common in women and
proper practice of genital hygiene behaviors has an
important place in their prevention. Genital hygiene
behavior increases with the education level of
individuals, giving importance to this subject, getting
information, and getting this information from the
doctor/nurse.
We believe that it is important to organize training
programs to be given to women on reproductive health
and hygiene.
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