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Claudia Holzman, DVM, MPH, PhD, Judith M. Leventhal, PhD, Hong Qiu, MD, Nicole M. Jones, BS, Jenny Wang, MS and the BV Study Group

The authors are with the Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing. Members of the BV Study Group are listed in the Acknowledgments section.

Correspondence: Requests for reprints should be sent to Claudia Holzman, DVM, MPH, PhD, Department of Epidemiology, College of Human Medicine, Michigan State University, 4660 S Hagadorn, Suite 600, East Lansing, MI 48823 (e-mail: holzman{at}pilot.msu.edu).

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.

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