A review of opioid-induced itching after cesarean birth.

Currently, about one-third of all women giving birth have a cesarean surgical birth, and the majority are given an epidural or spinal anesthetic containing an opioid for surgery. An unpleasant side effect experienced by many of these women is itching. This article reviews the literature on itching after spinal and epidural administration of opioids and how nurses can best manage this side effect.

An updated review of of evidence to discourage douching.

PURPOSE: To review current studies on vaginal douching. DATA SOURCES: MEDLINE PubMed, CINAHL, and Cochrane databases from 2002 to 2008 using MeSh terms "vaginal AND irrigation or vaginal and douching" from 2002 to 2003 and "vaginal douching" and "vaginal douching and adverse effects" from 2004 to 2008. STUDY SELECTION: MEDLINE PubMed included 156 records, CINAHL 15, and Cochrane 10. Articles in English were reviewed, and those pertaining to vaginal douching and reproductive and gynecologic outcomes were included. References from these articles were reviewed and included when appropriate. 2008 Web sites of the Centers for Disease Control and Prevention were also included. DATA EXTRACTION: Articles were reviewed and summarized. RESULTS: Vaginal douching is a common practice for almost one-third of women in the United States. Douching is associated with adverse pregnancy outcomes including ectopic pregnancy, low birth weight, preterm labor, preterm birth, and chorioamnionitis. Douching is more prevalent among non-Hispanic black women than among white women or Hispanic women. Douching alters the vaginal flora and predisposes women to develop bacterial vaginosis (BV), which is also more prevalent among women who douche and among black women. Douching is also associated with serious gynecologic outcomes, including increased risk of cervical cancer, pelvic imflammatory disease, endometritis, and increased risk for sexually transmitted infections, including HIV. Many factors influence women's douching behaviors, including social, cultural, and educational factors. Healthcare providers can influence women to stop douching. CLINICAL IMPLICATIONS: Healthcare providers may not be aware of the mounting evidence of negative health outcomes associated with the practice of douching. At every opportunity, healthcare providers should ask women whether they douche and inquire about vaginal douching practices and beliefs associated with the practice. Douching should be discouraged because it places women at risk for multiple health problems.

Vaginal douching among university women in the southeastern United States.

OBJECTIVE: The authors assessed the knowledge, beliefs about, and practices of vaginal douching among women attending 2 universities in the southeastern United States. PARTICIPANTS: There were 416 participants in this study; 46.9% were black and 44.5% were white. METHODS: The authors administered a 30-item questionnaire to women enrolled in health-related and social science courses at 2 southeastern universities. RESULTS: Approximately 38% of participants reported vaginal douching, mostly for hygienic reasons (70.7%). Most women first learned about douching from their mother. Douching was more common and more frequent among black women (48%) than among white women (27%). Age of first douche correlated positively with age of first sexual intercourse and age of first period. CONCLUSION: Women who had been informed not to douche by a healthcare professional were less likely to have douched within the past 6 months than were women who were not given this information. Misconceptions about douching are common and should be addressed by healthcare professionals.

Vaginal douching practices of women in eight Florida panhandle counties.

OBJECTIVE: To document knowledge, beliefs, douching practices, prevalence of bacterial vaginosis, and preterm births in women who douche. DESIGN: Descriptive, cross-sectional nonexperimental design. SETTING: Six private midwifery/nurse practitioner offices and eight county health departments in the Florida panhandle. PARTICIPANTS: Four hundred eighty-three English- or Spanish-speaking women aged 14 to 45 years. METHODS: Self-administered questionnaire about douching; medical record review. MAIN OUTCOME MEASURES: Prevalence of douching, history of preterm labor, preterm births, and prevalence of bacterial vaginosis. RESULTS: Of 483 women, 76% had douched, 43% douched at least once per month, and 36% were unaware they should not douche. As determined by odds ratio, women who douched monthly were 2.5 times more likely to have a history of bacterial vaginosis than women who did not douche (p < .001), and women who douched weekly were 2.75 times more likely to have bacterial vaginosis (p = .004). Of 409 clients with medical records available, 32 had preterm births of which 69% had a history of bacterial vaginosis (x2 = 4.5, df = 1, p = .034). Among women with preterm births who douched regularly prior to pregnancy (n = 14), 87% had a history of bacterial vaginosis (x2 = 7.14, df = 1, p = .008). CONCLUSIONS: Associations of douching with bacterial vaginosis and bacterial vaginosis with preterm labor were significant. Health care professionals should initiate discussions to discourage douching.

Maternal bacterial vaginosis and fetal/infant mortality in eight Florida counties, 1999 to 2000.

This study determined the prevalence of maternal bacterial vaginosis (BV) in fetal/infant mortality cases and factors associated with BV. A retrospective descriptive study was utilized. Data were obtained from review of vital statistics and medical records of 176 women experiencing fetal/infant deaths in eight Florida counties, 1999 to 2000. Non-White mothers accounted for 68.96% of deaths (chi square = 10.119, df = 4, p = 0.038), although the population of the eight counties was 64% White. Of 121 non-White mothers (68.8%) with infections, 37 (30.6%) had BV. Most fetal/infant deaths (39.7%) occurred 20-23 weeks' gestation and at birthweights <500 g, as did most cases of BV (46%). Women with BV were more likely to be non-White (OR 2.756, 95% CI 1.075, 7.066), single (OR 2.090, 95% CI 1.081, 7.246), <24 years old (t = 3.172, p = 0.002), and have <12 years of education (t = 2.56, p = 0.011). Findings support early screening and treatment for BV in women with these risk factors or a history of prior fetal/infant loss or preterm/low-birthweight infant. Factors contributing to racial disparity in BV and fetal/infant mortality need further exploration.

Vaginal douching.

OBJECTIVE: To review current literature on vaginal douching. DATA SOURCES: MEDLINE, CINAHL, and Cochrane databases from 1997 to 2001, using keywords douche or douching; 2001 Web sites of the Centers for Disease Control and Prevention; and Internet search engines for information about current retail sales of douches. STUDY SELECTION: MEDUNE included 67 records, CINAHL 18, and Cochrane 2. Abstracts of articles in English were reviewed, and those pertaining to vaginal douching practices were included. MEDLINE had 44 pertinent articles, CINAHL 11, and Cochrane 1. References from these articles were reviewed and included when appropriate. DATA EXTRACTION: Articles were reviewed and summarized. DATA SYNTHESIS: Vaginal douching is a common practice for women in the United States. Douching is associated with adverse reproductive and gynecologic outcomes including bacterial vaginosis, preterm birth, low-birth-weight infants, pelvic inflammatory disease, chlamydial infection, tubal pregnancy, higher rates of HIV transmission, and cervical cancer. Cultural beliefs and educational factors strongly influence douching practices. CONCLUSIONS: Nursing assessment of women should include information on vaginal douching practices and beliefs. Nurses should use culturally appropriate educational strategies to discourage women of all ages from using vaginal douches as part of routine feminine hygiene because of the associated risks. Further research is needed on factors that influence women's beliefs and douching practices.