Prevalence and self-reported health consequences of vaginal practices in KwaZulu-Natal, South Africa: findings from a household survey

Objectives To investigate population‐level prevalence of vaginal practices, their frequency and self‐reported health consequences in KwaZulu‐Natal, South Africa. Methods A household survey using multi‐stage cluster sampling was conducted in 2007. Women aged 18–60 (n = 867) were interviewed on demographics, sexual behaviours and vaginal practices, focusing on intravaginal practices. Design‐based analysis used multivariate logistic regression to identify factors associated with intravaginal or any practice. Results Most women currently perform vaginal practices (90.2%), with 34.8% reporting two and 16.3%≥3 practices. Internal cleansing, the commonest practice (63.3% of women), is undertaken frequently (61.6% cleansing twice daily; 20.0% using ≥2 products). Fewer report application (10.1%), insertion (11.6%) or ingestion (14.3%) practices. Hygiene is a common motivation, even for the 23.2% of women reporting intravaginal practices around the time of sex. Prevalence of any practice was lower among women with tertiary education than those without primary education (AOR = 0.26, 95% CI = 0.08–0.85), nearly twice as common in sexually active women (95% CI = 1.05–3.56) and increased as overall health status declined. Adjusted odds of intravaginal practices were 1.8‐fold higher in women reporting unprotected sex (95% CI = 1.11–2.90). Few reported health problems with current practices (0.6%); though, 12.6% had ever‐experienced adverse effects. Conclusions Vaginal practices are common in KwaZulu‐Natal. Although self‐reported health problems with current practices are rare, high lifetime risk of adverse events and potential for asymptomatic but clinically important damage make continued research important.