Genital Powder Use and Risk of Epithelial Ovarian Cancer in the Ovarian Cancer in Women of African Ancestry Consortium.

BACKGROUND: Genital powder use is more common among African-American women; however, studies of genital powder use and ovarian cancer risk have been conducted predominantly in White populations, and histotype-specific analyses among African-American populations are limited. METHODS: We used data from five studies in the Ovarian Cancer in Women of African Ancestry consortium. Participants included 620 African-American cases, 1,146 African-American controls, 2,800 White cases, and 6,735 White controls who answered questions on genital powder use prior to 2014. The association between genital powder use and ovarian cancer risk by race was estimated using logistic regression. RESULTS: The prevalence of ever genital powder use for cases was 35.8% among African-American women and 29.5% among White women. Ever use of genital powder was associated with higher odds of ovarian cancer among African-American women [OR = 1.22; 95% confidence interval (CI) = 0.97-1.53] and White women (OR = 1.36; 95% CI = 1.19-1.57). In African-American women, the positive association with risk was more pronounced among high-grade serous tumors (OR = 1.31; 95% CI = 1.01-1.71) than with all other histotypes (OR = 1.05; 95% CI = 0.75-1.47). In White women, a significant association was observed irrespective of histotype (OR = 1.33; 95% CI = 1.12-1.56 and OR = 1.38; 95% CI = 1.15-1.66, respectively). CONCLUSIONS: While genital powder use was more prevalent among African-American women, the associations between genital powder use and ovarian cancer risk were similar across race and did not materially vary by histotype. IMPACT: This is one of the largest studies to date to compare the associations between genital powder use and ovarian cancer risk, overall and by histotype, between African-American and White women.

Volatile organic compounds in feminine hygiene products sold in the US market: A survey of products and health risks.

Feminine hygiene products (FHPs) are used on highly permeable and sensitive vaginal and vulvar tissues by many women. These products contain a variety of chemicals, and few regulations require disclosure of their ingredients. The objectives of this study are to identify volatile organic compounds (VOCs) that may be present in these products and to evaluate the potential for exposure and health risk associated with product use. We collected 79 commercially available FHPs, including washes, tampons, menstrual pads, wipes, sprays, powders and moisturizers, and analyzed their composition using purge and trap sampling, thermal desorption, gas chromatography and mass spectroscopy. Exposures and risks were modeled using reasonable upper bound exposure scenarios. The highest VOC concentrations (as total target VOCs) were found in washes, sprays and powders, with median concentrations from 25,000 to 34,000 ng/g. Benzene (maximum: 3,604 ng/g) was detected in 83% of the collected products, and 1,4-dioxane (maximum: 24,354 ng/g) in 50% of the products. VOC composition depended on the FHP type, manufacturer and brand. Products labeled as "organic," "natural," or "for sensitive skin" did not necessarily have lower VOC concentrations. For most FHPs, calculated risks were low; however, menstrual pads had hazard ratios of up to 11, sprays and powders had hazard ratios of up to 2.2 and excess cancer risks of up to 2.1 × 10-6, and washes had excess cancer risks of up to 3.3 × 10-6. Our data suggest that all tested FHPs contained some toxic VOCs, and that risks of using some products should be addressed. We recommend the elimination of toxic ingredients and the disclosure of all chemicals that are used in these products.

Superabsorbent sodium carboxymethyl cellulose membranes based on a new cross-linker combination for female sanitary napkin applications.

The main intent of this investigation was to retain the strength and superabsorbency of natural and non-toxic biodegradable polymers using an innovative combination of cross-linkers for application as the absorbent core of sanitary napkins. For this, sodium carboxymethyl cellulose (NaCMC) and starch were blend to form membranes by phase inversion and lyophilisation, using an optimized cross-linker combination of sodium trimetaphosphate (STMP) and aluminium sulphate (AlS). Optimal cross-linking of NaCMC and starch hampered membrane dissolution and disintegration, yielding a microtextured surface morphology. The membranes were biodegradable and yet possessed the requisite flexibility and mechanical strength for the proposed application, without compromise of superabsorbency. Lyophilised membranes possessed higher immediate water and blood sorption with ∼50% water retention capabilities when compared to the phase inversion technology. The results suggest that the developed membranes can be a cost-effective degradable alternative to the commercial polyacrylate-based nonbiodegradable sanitary products.

Acceptability and safety of the menstrual cup: A systematic review of the literature / Aceptabilidad y seguridad de la copa menstrual: revisión sistemática de la literatura

RESUMEN Objetivo: realizar una búsqueda sistemática de la literatura para evaluar la aceptabilidad y seguridad de la copa menstrual como producto de higiene genital femenina. Materiales y métodos: se realizó búsqueda en las bases de datos PubMed, Cochrane Library, Scopus, PopLine y Google Scholar, desde 1966 hasta julio de 2019. Se utilizaron los términos: "Menstrual" AND "Cup" OR "Copa" AND "Menstrual". Se incluyeron estudios cuantitativos, cualitativos y mixtos, series y reportes de caso publicados en inglés y español que hubieran evaluado la copa menstrual en mujeres en edad reproductiva. Los estudios fueron selecciona- dos y los datos fueron extraídos por dos evaluadores de manera independiente. Como resultado primario se evaluó la aceptabilidad y seguridad. La síntesis de información se presenta de manera narrativa. Resultados: se encontraron 737 títulos para revisión inicial. Finalmente, se incluyeron 38 estudios. La copa menstrual tiene una aceptabilidad que varía entre el 35 y el 90 %. Del 10 al 45 % la encontraron difícil de usar. Fue descrita como más cómoda comparada con el tampón y la toalla higiénica de fabricación industrial. La continuidad de su uso está entre el 48 y el 94 %. En cuanto a la seguridad se presentó un caso de síndrome de choque tóxico, uno de atrapamiento mecánico, uno de alergia al producto y mayor riesgo de expulsión en usuarias del dispositivo intrauterino. Conclusión: la copa menstrual es una alternativa cómoda, segura y eficiente para la higiene mens- trual. Se requieren más estudios controlados alea- torizados y cohortes prospectivas a largo plazo para determinar el riesgo de complicaciones por una exagerada colonización bacteriana o menstruación retrógrada.

ABSTRACT Objective: To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods: A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results: Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion: The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.

El ciclo menstrual en el siglo XXI. Entre el mercado, la ecología y el poder femenino / O ciclo menstrual no século XXI. Entre o mercado, a ecologia e o poder feminino / Menstrual Cycle in the XXI Century. Between the marketplace, ecology and women's power

Resumen: Este artículo analiza las concepciones relativas al género, la sexualidad, la salud, la espiritualidad/religiosidad, la política, el medio ambiente y el empoderamiento femenino, presentes en el mercado de productos "alternativos" que atienden y celebran el ciclo menstrual en la Argentina contemporánea. Se trata de un estudio cualitativo basado en el análisis de páginas web, blogs y perfiles de Facebook de mujeres que fabrican, comercializan y/o difunden toallas de tela y copas de silicona; la observación participante en talleres sobre el ciclo y entrevistas personales con sus organizadoras. El estudio visibiliza la emergencia y difusión de visiones que celebran el ciclo menstrual, considerándolo una fuente de identidad y empoderamiento femenino, y las tensiones que se dan con otros enfoques que cuestionan estas premisas.

Resumo: Este artigo analisa as concepções relativas ao gênero, à sexualidade, à saúde, à espiritualidade/religiosidade, à política, ao meio ambiente e ao empoderamento feminino, presentes no mercado de produtos "alternativos" que atendem e celebram o ciclo menstrual na Argentina contemporânea. Trata-se de um estudo qualitativo baseado na análise de páginas, blogs e perfis do Facebook pertencentes a mulheres que fabricam, comercializam e/ou difundem toalhas de pano e copos de silicone, observação participante em oficinas sobre o ciclo e entrevistas pessoais com suas organizadoras. O estudo visibiliza a emergência e difusão de visões que celebram o ciclo menstrual, considerando-o uma fonte de identidade e empoderamento feminino, e as tensões que se dão com outro enfoques que questionam estas premissas.

Summary: This article explores meanings related to gender, body care and women's health, spirituality/religiosity, politics, environment, and women's empowerment, present in the marketing of "alternative" menstrual products (cloth towels, menstrual cup, books which celebrate menstrual cycle) and workshops and virtual networks about the menstrual cycle in contemporary Argentina. This is a qualitative study based on the analysis of publicity, blogs and Facebook groups of female entrepreneurs who manufacture, sell and/or promote these products, as well as participant observation in workshops and interviews with their organizers. It focuses in the tension between visions which privilege hygiene and perceive menstruation as a bad time for women and those which celebrate the menstrual cycle and consider it a source for women empowerment.

Avaliação da Rotulagem e Parâmetros deQualidade de Sabonetes Íntimos / Analysis of Labelling and Quality Parameters of Intimate Soaps

Considerando que os sabonetes íntimos devemproteger a região genital feminina, permitindo a manutençãoda microbiota natural, propôs-se nesse estudo, a verificar osparâmetros de qualidade de sabonetes íntimos disponíveiscomercialmente, tais como características gerais, físicoquímicase microbiológicas, levando em consideração asexigências para um produto com essa finalidade. Material eMétodos: Foram analisadas cinco marcas de sabonetes íntimos.Quanto aos aspectos físico-químicos foram realizados testesde pH, viscosidade, densidade, teste de centrífuga e índice deespuma. Também foi verificada a eficácia contra Candidaalbicans obtida de isolado clínico, com densidade aproximadade 0,5 x 108 UFC/mL pelo método de diluição em tubos.Resultados: Verificou-se que apenas um produto, marca A, foiaprovado em todos os testes, desde a rotulagem até o testemicrobiológico. Todas as marcas foram capazes de inibir ocrescimento microbiológico de Candida albicans. No entanto,deve-se atentar para as variações de pH encontradas nesteestudo (3,93 a 11,66), embora não haja consenso a respeitoda faixa de pH ideal para as formulações de sabonete íntimo,deve-se respeitar o pH fisiológico, levemente ácido (4,0 –4,5). Os dados de viscosidade, densidade e índice de espumaapresentaram ampla variação, refletindo no padrão deaceitabilidade comercial. Frente ao teste de centrífuga todasas amostras demonstraram estabilidade física nas formulações.Quanto a rotulagem, apenas a marca C foi reprovada, nãoatendendo à legislação pertinente, tendo também apresentadoo maior desvio de pH (11,66) em relação ao pH fisiológico.Conclusão: Fica evidente a importância do controle daqualidade, bem como a observação dos rótulos de produtosde uso íntimo, considerado como um aliado na manutençãoda saúde feminina...

Intimate soaps should protect the female genitalarea and thus allow for the maintenance of the naturalmicrobiota therein. Here, we verified quality parameters ofintimate soaps commercially available, including generalphysicochemical and microbiological characteristics based onspecific requirements for this type of product. Material andMethods: A total of five brands of intimate soaps were analyzed.With regard to physicochemical aspects, tests measuring pH,viscosity and density, the centrifuge test and the lather indextest were performed. The soups were also tested for their efficacyagainst Candida albicans clinical isolate with standardizeddensity of approximately 0.5x108 CFU/mL using the dilutionmethod. Results: We found that only one product (brand A)passed all tests from labeling to microbiological testing, andthat all brands inhibited microbiological growth of Candidaalbicans. However, attention should be drawn to the pHvariations found in this study (3.93 to 11.66). Although there isno consensus on the ideal pH range for intimate soapformulations, it should take into account the physiological pHwhich is slightly acidic (4.0 to 4.5). The viscosity, density andlather index data exhibited a wide variation impacting thepattern of commercial acceptance. As for labeling, only thebrand C was rejected as it did not meet the regulatory criteriaand presented the highest deviation of pH (11.66) as comparedto the physiological pH. Conclusion: It is evident the importanceof quality control as well as observation of labels in intimateproducts which should be considered as an ally in maintainingwomen’s health...

Hábitos higiénicos vulvo-vaginales de consultantes ambulatorias en gineco-obstetricia / Vulvo-vaginal hygienic habits of outpatient consultants in gynecology-obstetrics

OBJETIVO: Determinar la frecuencia y tipos de hábitos higiénicos vulvo-vaginales en mujeres chilenas. MÉTODOS: Estudio de corte transversal en 271 usuarias adultas que asistieron a centros ginecológicos primarios del sistema público y privado. Médico aplicó una encuesta de 7 preguntas con alternativas de respuestas cerradas para pesquisar la frecuencia y tipo de hábitos higiénicos íntimos. Se realizó estadística descriptiva utilizando modelos univariados y multivariados, expresando la magnitud de asociación como Odds Ratio. Se seleccionaron los modelos multivariados con mayor varianza mediante selección por pasos. RESULTADOS: Un 25% lava sus genitales una vez/día, 32% dos veces/día, 28% tres veces/día y 13% cuatro o más veces/día. Las mujeres del sistema público tienden a un aseo genital con frecuencias de dos a tres veces al día, mientras que las del sistema privado mayormente una y dos veces al día. El 56% de las mujeres, especialmente aquellas atendidas en consultas privadas, utiliza algún otro elemento adicional al agua, preferentemente jabones especiales. Las mujeres mayores y postmenopáusicas se asociaron a lavados genitales con elementos adicionales al agua. Las diabéticas presentaron una probabilidad 3 veces mayor de usar un jabón especial que las no diabéticas. CONCLUSIONES: Mujeres chilenas de ambos sistemas de atención, realizan aseo íntimo con una frecuencia entre una y tres veces al día en el 85% de las encuestadas. El 56% de ellas y el 75,6% de las que consultan en el sistema privado utilizan para el aseo genital algún otro elemento adicional al agua, preferentemente jabones especiales.

OBJECTIVE: To determine frequency and types of vulvovaginal hygienic habits that Chilean women have. METHODS: Cross-sectional study in 271 adult women who attended primary gynecological centers of public and private systems. A survey of 7 questions with closed-answer alternatives was undertaken by a physician in order to determine frequency and type of intimate hygiene. Descriptive statistics were performed by using univariate and multivariate models, expressing the magnitude of association as Odds Ratio. Multivariate models with higher variance were selected by stepwise selection. RESULTS: 25% washed their genitals once a day, 32% twice a day, 28% three times a day and 13% four or more times a day. Women attending public centers tend to wash their genitals two or three times a day, while the ones attending private centers do this mostly once or twice a day. 56% of women - especially those treated in private centers - use additional elements apart from water, preferably special soaps. Older and postmenopausal women were associated with the use of additional elements other than water. Diabetics were 3 times more likely to use a special soap than non-diabetics. CONCLUSIONS: 85% of chilean women of both health-care systems perform intimate hygiene between one and three times a day; 56% of them and 75.6% of those attending private centers use elements other than water, preferably special soaps.

Avaliação comparativa de segurança e eficácia para produtos de higiene íntima em mulheres na menopausa / Comparative evaluation of safety and efficacy for hygiene products in menopausal women

Justificativa e objetivo: A menopausa é a última menstruação, um marco no período do climatério, momento de grandes modificações na vida da mulher. O objetivo deste estudo foi avaliar a segurança e eficácia hidratante e restauradora da mucosa, de um produto de higiene íntima em pacientes menopausadas. Métodos: Estudo envolvendo 70 voluntárias, sexo feminino, com idade entre 45 e 65 anos, randomizadas em dois grupos com 35 integrantes. Cada grupo utilizou uma fragrância do produto investigacional por 15 dias e, posteriormente, foi acrescentado ao produto investigacional uma loção hidratante por mais 15 dias. Após um intervalo de 7 dias as voluntárias utilizaram o produto-controle por mais 30 dias. A avaliação da eficácia foi realizada através da corneometria (avaliação da hidratação) e da evaporimetria (medida de perda de água transepidérmica - TEWL). Foram realizadas avaliações subjetivas, com a aplicação de questionários realizados no início e fim do tratamento para cada produto. Resultados: O produto-controle demonstrou resultado significativamente superior quanto à melhora da sensação de elasticidade da mucosa genital e da sensação de firmeza da mucosa genital, em comparação ao produto investigacional fragrância Silver Frutal. A associação de loção hidratante ao produto investigacional fragrâncias Silver Frutal e Silver Floral demonstrou resultados positivos nos parâmetros avaliados, exceto para viscosidade. Quanto à segurança, nenhuma das voluntárias apresentou reação alérgica ou outra reação adversa. Conclusão: Os produtos de higiene íntima feminina devem auxiliar a manutenção das condições genitais fisiológicas e possuir uma alta margem de segurança que possibilite o uso em mulheres menopausadas saudáveis.

Intravaginal practices and microbicide acceptability in Papua New Guinea: implications for HIV prevention in a moderate-prevalence setting.

BACKGROUND: The acceptability of female-controlled biomedical prevention technologies has not been established in Papua New Guinea, the only country in the Pacific region experiencing a generalised, moderate-prevalence HIV epidemic. Socio-cultural factors likely to impact on future product uptake and effectiveness, such as women's ability to negotiate safer sexual choices, and intravaginal hygiene and menstrual practices (IVP), remain unclear in this setting. METHODS: A mixed-method qualitative study was conducted among women and men attending a sexual health clinic in Port Moresby. During in-depth interviews, participants used copies of a hand-drawn template to indicate how they wash/clean the vulva and/or vagina. Interviewers pre-filled commercially available vaginal applicators with 2-3mL KY Jelly® to create a surrogate vaginal microbicide product, which was demonstrated to study participants. RESULTS: A total of 28 IDIs were conducted (women=16; men=12). A diverse range of IVP were reported. The majority of women described washing the vulva only with soap and water as part of their daily routine; in preparation for sex; and following sexual intercourse. Several women described cleaning inside the vagina using fingers and soap at these same times. Others reported cleaning inside the vagina using a hose connected to a tap; using vaginal inserts, such as crushed garlic; customary menstrual 'steaming' practices; and the use of material fragments, cloth and newspaper to absorb menstrual blood. Unprotected sex during menstruation was common. The majority of both women and men said that they would use a vaginal microbicide gel for HIV/STI protection, should a safe and effective product become available. Microbicide use was considered most appropriate in 'high-risk' situations, such as sex with non-regular, transactional or commercial partners. Most women felt confident that they would be able to negotiate vaginal microbicide use with male sexual partners but if necessary would be prepared to use product covertly. CONCLUSIONS: Notional acceptability of a vaginal microbicide gel for HIV/STI prevention was high among both women and men. IVP were diverse in nature, socio-cultural dimensions and motivators. These factors are likely to impact on the future acceptability and uptake of vaginal microbicides and other biomedical HIV prevention technologies in this setting.

Use of a lactic acid plus lactoserum intimate liquid soap for external hygiene in the prevention of bacterial vaginosis recurrence after metronidazole oral treatment / Uso do ácido láctico com lactoserum em sabonete líquido íntimo para higiene externa na prevenção da recorrência de vaginose bacteriana após tratamento oral com metronidazol

OBJECTIVE: To determine the recurrence of bacterial vaginosis (BV) after the use of a lactic acid plus lactoserum liquid soap starting immediately after the treatment with oral metronidazole and the quality of life of the participants. METHODS: A total of 123 women with diagnosis of BV with at least three of the following criteria: 1) homogeneous vaginal discharge without inflammation of the vagina or vulva; 2) vaginal pH ≥ 4.5; 3) positive Whiff test; and 4) "clue cells" in more than 20 percent of the epithelial cells in the vagina. A Nugent score ≥ 4 in the vaginal bacterioscopy was also used. After BV diagnosis, metronidazole 500 mg was administered orally bid during 7 days. Patients cured of BV were then instructed to use 7.5 to 10 mL of a lactic acid plus lactoserum liquid soap once-a-day for hygiene of the external genital region. Three subsequent control visits after starting the hygiene treatment (30, 60, and 90 days; ± 5 days) were scheduled. A questionnaire was applied in the form of visual analogue scale (VAS) in all the visits regarding: 1) level of comfort at the genital region; 2) malodorous external genitalia; 3) comfort in sexual intercourse; 4) satisfaction with intimate hygiene; and 5) self-esteem. RESULTS: Ninety two (74.8 percent) women initiated the use of a lactic acid plus lactoserum liquid soap at visit 1. At visit 2, 3, and 4 there were 84, 62 and 42 women available for evaluation, respectively. The rate of recurrence of BV was 19.0 percent, 24.2 percent and 7.1 percent, respectively in the three visits and vaginal candidiasis was observed in five treated women. Quality of life was evaluated in the 42 women who completed the four visits schedule and there were significant improvement in the five domains assessed. CONCLUSION: A lactic acid plus lactoserum liquid soap for external intimate hygiene may be an option for the prevention of BV recurrence after treatment and cure with oral metronidazole.

OBJETIVO: Determinar a ocorrência de vaginose bacteriana (VB) após o uso de acido láctico com lactoserum em sabonete líquido iniciado imediatamente após o tratamento com metronidazol oral e qualidade de vida das participantes. MÉTODOS: Um total de 123 mulheres com dianóstico de VB com ao menos três dos seguintes critérios: 1) leucorreia vaginal homogênea sem inflamação de vagina ou vulva; 2) pH vaginal ≥ 4,5; 3) teste positivo de Whiff; e 4) "clue cells" em mais de 20 por cento das células epiteliais na vagina. O escore de Nugent ≥ 4 na bacterioscopia vaginal também foi usado. Após o diagnóstico de VB, metronidazol 500 mg oral foi ministrado durante 7 dias. Pacientes curados da VB foram instruídos a usar 7,5 a 10 mL de acido láctico com lactoserum em sabonete líquido uma vez ao dia para higiene da genitália externa. Três visitas de controle foram agendadas (30, 60 e 90 dias; ± 5 dias). Um questionário foi aplicado na forma de escala visual análoga (EVA) em todas as visitas sobre: 1) nível de conforto na região genital; 2) mau odor na genitália; 3) conforto na relação sexual; 4) satisfação com higiene íntima; e 5) autoestima. RESULTADOS: Noventa e duas (74,8 por cento) mulheres iniciaram o uso de ácido láctico com lactoserum líquido na visita 1. Na visita 2, 3 e 4 foram 84, 62 e 42 mulheres para avaliação, respectivamente. A taxa de recorrência da VB foi 19,0 por cento, 24,2 por cento e 7,1 por cento, respectivamente nas três visitas e candidíase vaginal foi observada em cinco mulheres. Qualidade de vida foi avaliada em 42 mulheres que completaram as quatro visitas agendadas e houve uma melhora significativa nos cinco domínios avaliados. CONCLUSÃO: O uso de acido láctico com lactoserum em sabonete líquido para higiene externa intima pode ser uma opção para a prevenção da recorrência de VB após tratamento e cura com metronidazol oral.

The effect of "breathable" panty liners on the female lower genital tract.

OBJECTIVE: To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation. METHODS: A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears. RESULTS: After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period. CONCLUSION: After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.

Can the behind-the-knee clinical test be used to evaluate the mechanical and chemical irritation potential for products intended for contact with mucous membranes?

BACKGROUND: The behind-the-knee (BTK) clinical test system is being used increasingly to replace in-use clinical studies in the evaluation of potential irritation effects of consumer products. The objectives of these studies were to determine if the BTK test could adequately evaluate the potential to cause irritation for feminine protection products intended for mucous membrane contact, and confirm that the BTK test would not underestimate the irritant potential that may occur when products such as tampons come into contact with mucous membranes. MATERIALS AND METHODS: Two identical tampon products were tested in in-use and BTK clinical studies. In the BTK clinical test, sites were scored daily 30-60 min after sample removal (PM scores with no recovery) and prior to application of the next sample (after 18 h of recovery). In the in-use clinical study, 6 sites (labia minora, introitus, lower and middle vaginal walls, upper vagina and cervix) were graded separately for erythema using colposcopy after use of each product for an entire menstrual cycle. RESULTS: In the in-use clinical study, the labia minora were most susceptible to irritation effects with mean erythema scores (± SE) of 0.36 (± 0.05) and 0.50 (± 0.06) for the experimental and control products, respectively. All other sites produced a mean erythema ≤0.26. In the BTK clinical test, the postbaseline averages for erythema for the experimental and control products were 0.19 (± 0.04) and 0.20 (± 0.04) for the AM scores (with recovery), and 1. 25 (± 0.05) and 1. 27 (± 0.06) for the PM scores (no recovery). CONCLUSIONS: Preliminary results showed that the BTK clinical test may be used to evaluate potential irritation effects of products that contact mucous membranes. In a first comparison of 2 tampon products in both the in-use and BTK clinical studies, the BTK protocol produced erythema reactions at the test sites that were similar to or severer than those observed on mucosal sites in the in-use study. Overall, the BTK clinical test showed a higher sensitivity, rapid turnaround time, higher flexibility and easier implementation. Thus, making the BTK clinical test a more useful tool for both safety testing and claim support.

Higiene íntima femenina y vaginosis bacteriana: Encuesta Epidemiológica Latinoamericana 2008 / Intimate hygiene and bacterial vaginosis: Epidemiological Latinoamerican Survey 2008

Objetivos: hacer una aproximación a la prevalencia de vaginosis bacteriana (VB) en mujeres en Latinoamérica y explorar la asociación entre el tipo de hábitos higiénicos y prácticas sexuales con la presencia de este diagnóstico. Metodología: estudio de corte transversal en mujeres de 10 países de Latinoamérica entre los 16 y 49 años, vida sexual activa y ciclos menstruales. Se excluyeron las mujeres que presentaban otro tipo de infección vaginal, en gestación o en puerperio, con incapacidad para responder la encuesta o con cambio de pareja sexual en el último trimestre. Igualmente, se realizó muestreo por conveniencia de 1.000 mujeres. Se presenta la prevalencia de punto de VB. Se aplicó una encuesta que contenía información sociodemográfica, información sobre actividad sexual e higiene íntima y se hizo el diagnóstico presuntivo de vaginosis bacteriana basado en criterios clínicos y de laboratorio. Se evalúa la asociación entre VB, los hábitos higiénicos y prácticas sexuales por medio del OR y su intervalos de confianza del 95%. Resultados: la prevalencia de VB fue del 40% en las pacientes encuestadas. Se encontró asociación con el uso de alcohol y tabaco. Como actores protectores se identificaron el lavarse las manos después de orinar o defecar (OR=0,32; IC95%, 0,16-0,63); utilizar una técnica “adecuada” de aseo genital (OR=0,55; IC95%, 0,41-0,74) el uso de jabón en forma líquida (OR=0,62; IC95%, 0,46-0,84) y el uso de un jabón exclusivo para el área genital (OR=0,56; IC95%, 0,42-0,75). Como factores de riesgo se encontraron el uso de tampón (OR=3,00; IC95%,1,88-4,80), tener relaciones sexuales durante el período menstrual (OR=1,46; IC95%, 1,03-2,07) y usar lubricantes durante el coito (OR=1,68; IC 95%, 1,07-2,64). Conclusión: la prevalencia de VB es similar a la previamente informada en Latinoamérica. Su frecuencia esta asociada a los hábitos higiénicos y prácticas sexuales.

Objectives: presenting an approximation to bacterial vaginosis (BV) prevalence in Latin America and exploring the association between types of hygienic habits and sexual practices presented along with such diagnosis. Methodology: this was an epidemiological survey of women aged 16 to 49 from ten Latin-American countries who had active sexual lives and menstrual cycles. Females having another type of vaginal infection, pregnant females or those in puerperium, those unable to fill in the survey or who had changed their sexual partner during the last three-month period were excluded. 1,000 females were included by convenience sampling. The survey revealed BV prevalence; it had and provided data about presumptive diagnosis of BV, sociodemographic data, information about sexual activity, physical grooming, genital hygiene, underwear, intimate and menstrual hygiene and protection related to sexual activity. A presumptive diagnosis of BV was based on clinical and laboratory criteria. The association between BV and the females’ hygienic habits and sexual practices was evaluated by means of OR and 95% confidence intervals. Results: 40% of the surveyed patients had BV. An association was found between BV and alcohol and tobacco use. Washing hands before and after urinating or defecating (OR=0.32; 0.16-0.63 95%CI), using a “suitable” genital washing technique (vulva to anus) (OR=0.55; 0.41-0.74 95%CI), using liquid soap (OR=0.62; 0.46-0.84 95%CI) and soap just for the genital area (OR=0.56; 0.42-0.75 95%CI) were found to be protection-inducing factors. Hygienic habits explored as being risk factors for BV included tampon use (OR=3.00; 1.88-4.80 95%CI), having sexual relations during the menstrual period (OR=1.46; 1.03-2.07 95%CI) and using lubricants during coitus (OR=1.68; 1.07-2.64 95%CI). Conclusion: BV prevalence was found to be similar to that previously reported for Latin-America. Such frequency was found to be associated with hygienic habits and sexual practices.

Evaluating lotion transfer from products to skin using the behind-the-knee test.

BACKGROUND/PURPOSE: Adding lotions or emollients to the surface of a variety of paper products confers a number of benefits to the skin of consumers. A modification of the 'behind-the-knee (BTK)' test model was used as a means of measuring the effectiveness of lotion transfer to the skin. METHODS: Two series of feminine protection pads were prepared: (1) identically constructed pads differing only in the amount of lotion applied to the surface and (2) pads of various compositions to compare the influence of other product characteristics. For the first series, pads were applied for 3 h using the BTK protocol, and lotion transfer was evaluated. For the second series of products, two sample pads were applied consecutively for 3 h each, and lotion transfer was evaluated a both time points (e.g., 3 and 6 h). In addition, a clinical in-use study was used to evaluate lotion transfer for the second product series. RESULTS: In the BTK model using pads of identical composition, lotion transfer was a function of the amount of lotion placed on the pad. However, results from the second product series indicated that when pads were prepared using different absorbant materials (supreabsorbent gelling material, or AGM and cellulose), pads with the AGM core transferred lotion more effectively than pads with a cellulose core. Other product characteristics, i.e., pad thickness and lotion configuration, did not detectibly influence lotion transfer. The results of an in-use clinical study conducted on the second series of test products were directionally similar to those from the BTK, but statistical significance was not reached. CONCLUSIONS: An adaptation of the BTK test method provides an effective means of evaluating the transfer of lotion formulations from feminine protection pads at a fraction of the cost of clinical in-use studies.

The sociocultural context of gynecological health among Haitian immigrant women in Florida: applying ethnographic methods to public health inquiry.

OBJECTIVE: Twalet deba, a culturally mediated feminine hygiene practice, is widespread in Little Haiti, the predominately Haitian neighborhood in Miami, Florida. This practice may have important implications for susceptibility to sexually transmitted infections, including human papillomavirus, the principal cause of cervical cancer. Previous research has not examined the full context of twalet deba in consideration of cultural beliefs and norms about women's hygiene and sexual health. DESIGN: Ethnographic methods guided two phases of exploratory research. The first phase included observation, participant observation, and semi-structured in-depth interviews, which were conducted with key consultants (n=6) and a subsequent purposive sample of 35 women regarding gynecological health beliefs, hygiene practices, and associated home remedy agents. These data informed the second research phase, which involved observation and informal interviews with owners of botanicas in Little Haiti, Miami, FL, USA, to assess the availability of various ethnomedical remedies, their preparation, and preferred uses. All data were analyzed qualitatively to discern patterns in interview responses and using grounded theory to identify key themes. RESULTS: Cultural constructions of gynecological health and illness were generally incongruent with the biomedical model and emphasized the control of self-defined non-specific vaginal infections through routine hygienic practices using ethnobotanical and commercial agents to avert illness, including cancer. Such practices also encourage vaginal tightness and dryness, characteristics desired by male sexual partners, on whom women were frequently economically dependent. Data from the second phase of research reinforced these findings and revealed a wide variety of feminine hygiene agents available for purchase in local botanicas. CONCLUSION: The results suggest that cultural beliefs about gynecological health and dependence on male partners influence women's routine feminine hygiene practices. Botanicas are culturally salient sites for health information. Ethnographic methods were critical for collecting personal sensitive data that are necessary to inform future intervention.

Visual analysis of vaginal cell binding and retention of a gynecological douche.

AIM: Gynecological douches may contain various molecules that need to cover and be retained by cutaneous and mucosal cells if they are to act efficaciously in treating local conditions. The aim of this study was to investigate the possibility of directly visualising the ability of a commercial medical gynecological douche to bind to, and be retained by human vaginal cells. METHODS: The commercial gynecological douche under study was "Saugella Attiva douche", bought at local chemist. The vaginal epithelial cells were obtained from healthy, non-pregnant, regularly menstruating women aged 24-52 years. The cells were obtained from the mucosal surface of the mid-vaginal wall by means of gentle scraping with a sterile spatula. Ferric oxide particles and Escherichia coli were used as inorganic and organic markers in order to visualize the adherence of the transparent thin film of a gynecological douche to human vaginal cells by means of Nomarski interference contrast microscopy and scanning electron microscopy. RESULTS: Both markers made it possible to clearly visualize the binding and retention of the transparent thin layer of the douche also at the dilution 1:2 and 1:4. CONCLUSIONS: The fact that the douche can be locally retained is useful because its formulation contains thymol and eugenol, which are known to have antibacterial, antifungal and antioxidant effects but need a period of contact before they act fully.

Beliefs about the causes of cervical cancer in Botswana: implications for nursing.

BACKGROUND: Cervical cancer is the most common cause of cancer mortality and morbidity for women in Botswana. Yet, little is known about what women believe to be the causes of the disease. AIM: This paper presents data on factors women in Botswana believe are responsible for the high incidence of cervical cancer in their country. Data were part of a larger study that explored knowledge and perceptions about cervical cancer and Pap smear screening from the perspectives of the clients and the healthcare providers. METHODS: The study that generated the data included 30 women of all socio-economic levels, recruited by network sampling. The women's ages ranged from 31 to 54 years. Demographic data were analysed descriptively. Individualized interview data were content-analysed. FINDINGS: The identified causes of cervical cancer were classified as cervical irritants and non-irritants. The most commonly cited cervical irritants were vaginally inserted chemical agents and traditional medicine. DISCUSSIONS: Participants identified vaginally inserted chemical substances and traditional medicines as possible explanations for the high incidence of cervical cancer in Botswana. They reported that women used these substances for sexual and hygienic purposes. Although these factors are believed to be the causes of cervical cancer and have not yet been medically acknowledged, verbal reports suggest that their use is problematic. CONCLUSION: There is a need for health education and for further research to affirm women's beliefs about the harmful effects of intravaginal agents.

Aceptabilidad e intención de uso de microbicidas entre mujeres residentes en el Conurbano Bonaerense, Argentina / Acceptability and willingness to use microbicides in Conurbano Bonaerense, Argentina

Aún cuando los microbicidas constituyen una esperanza para reducir la feminización de la epidemia de VIH/sida mediante el autocuidado de las mujeres en las relaciones sexuales, poco se conoce sobre la aceptabilidad e intención de uso de las mujeres argentinas...

Although there is great hope that microbicides will reduce the feminization of the HIV epidemic through female self-protection in sexual intercourse, little is known about the acceptability and willingness of Argentinean women to use them...

Allergic contact dermatitis from methyldibromo glutaronitrile in a sanitary pad and review of Australian clinic data.

Methyldibromo glutaronitrile (MDBGN) has rarely been reported as an allergen in adhesives but is recognized as a common allergen in skin care products in Europe. It has been banned for use in leave-on products by the European Union. In this study, we present a case with an unusual source of this common allergen and review all cases of allergy to MDBGN from our clinics over a 12-year period. A 49-year-old nurse presented with dermatitis affecting the vulva caused by MDBGN present in her sanitary pad. All other cases of allergy to MDBGN in patients attending the occupational dermatology or contact dermatitis clinics at the Skin and Cancer Foundation, Victoria, between January 1993 and December 2004, were reviewed. Patch testing was positive to her sanitary pad, the adhesive and MDBGN, which were used as a biocide in the pad adhesive. Only 20 cases of allergy to MDBGN have been diagnosed in 2837 patients tested during this period (0.7%). To conclude, this study highlights the importance of considering allergic contact dermatitis in the differential diagnosis of vulval rashes and the emergence of MDBGN as an important sensitizer. However, our review suggests that MDBGN remains an infrequent cause of allergy in Australia.