摘要：Objectives. The purposes of this study were to test the hypothesis that vaginal douching is linked to bacterial vaginosis in both symptomatic and asymptomatic women and to identify other demographic, reproductive, and lifestyle factors associated with bacterial vaginosis. Methods. In this cross-sectional study involving 3 clinic sites, 496 nonpregnant women completed a self-administered questionnaire. Their vaginal smears were assessed and cross-validated for bacterial vaginosis. Results. The prevalence of bacterial vaginosis across clinics ranged from 15% to 30%. In analyses restricted to site 1, adjusted odds ratios (ORs) for bacterial vaginosis remained significant for African American women with 13 or fewer years of education (OR = 5.5, 95% confidence interval [CI] = 2.1, 14.5), hormone use within the past 6 months (OR = 0.5, 95% CI = 0.2, 0.8), and vaginal douching within the past 2 months (OR = 2.9, 95% CI = 1.5, 5.6). Conclusions. Two lifestyle factors emerge as strongly associated with bacterial vaginosis: systemic contraceptives appear protective, whereas douching is linked to an increase in prevalence. The temporal relationship between douching and bacterial vaginosis needs further clarification. Bacterial vaginosis, in the past referred to as nonspecific vaginitis, is a condition of vaginal flora imbalance, in which the typically plentiful H2O2-producing Lactobacillus are scarce and other bacteria, such as Gardnerella vaginalis , Mycoplasma hominis , Ureaplasma urealyticum , and anaerobes (e.g., Prevotella , Mobiluncus , Bacteroides ), are overly abundant. 1, 2 Historically, the motivation for treating bacterial vaginosis was to eliminate symptoms in women troubled by the unpleasant odor and discharge that often accompany the condition. More recent studies, however, have noted that bacterial vaginosis–related organisms are associated with inflammatory processes in the upper genital tract and in fetal membranes and amniotic fluid during pregnancy. 3, 4 Bacterial vaginosis has been linked to a series of adverse health outcomes, including posthysterectomy cuff cellulitis, 5 postsurgical endometritis, 6 endometritis following vaginal delivery, 7 pelvic inflammatory disease, 8 and preterm delivery. 9– 14 There is also evidence that bacterial vaginosis may potentiate heterosexual transmission of HIV. 15, 16 Little is known about the natural history of bacterial vaginosis. The highest prevalences have been reported in women attending sexually transmitted disease clinics. 17 Multiethnic comparisons have shown that rates are higher among African American women, 18, 19 but there is no clear explanation for this finding. Studies have revealed that bacterial vaginosis can be intermittent, 20 that up to 35% of women with bacterial vaginosis lack symptoms, 17 and that the prevalence exceeds 25% in certain population subgroups. 17, 18 Clinical trials aimed at preventing preterm birth by treating asymptomatic bacterial vaginosis in pregnant women have produced mixed results. 21– 24 This study was initiated to identify the health and behavioral aspects of women's lives that are associated with bacterial vaginosis and to consider which, if any, of these factors account for variability in prevalence rates between population subgroups. Because vaginal douching is more common in subgroups of women with a higher prevalence of bacterial vaginosis, 25 we were particularly interested in assessing the link between vaginal douching and bacterial vaginosis among both symptomatic and asymptomatic women.
