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Journal Club: Intravaginal practices and risk of bacterial vaginosis and candidiasis infection

Article reviewed

Brown JM, Hess KL, Brown S, Murphy C, Waldman AL, Hezareh M. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol. 2013 Apr;121(4):773-80.

Purpose of study

A normal vaginal environment is a concept that has eluded an ultimate definition for decades, both in terms of the vaginal symptoms that one should or should not find in a healthy woman, as well as in terms of the normal microscopic inhabitants and chemical balance that should predominate in a healthy vagina. As a matter of fact, in recent years these notions have been the subject of considerable debate and novel research, and the perceptions regarding them are changing.

With this much challenge in describing the normal, the definition of abnormal becomes especially elusive, as are the factors that lead from deviation from the normal and tip the vaginal environment towards a disease state. These problems continue to be current to the concept of bacterial vaginosis, a condition in which the normal vaginal microbial ecosystem is perturbed, leading to such unpleasant manifestations as fishy odor and abnormal discharge. Some other disturbances of the vaginal ecosystem (e.g. yeast infections or vaginal candidiasis) are better delineated both in terms of salient clinical features and the microbiological features accompanying the condition.


In a recent study published in Obstetrics and Gynecology by Brown and colleagues, an attempt was made to draw correlations between different intra-vaginal practices (e.g. douching, lubricant use) and the risk of bacterial vaginosis and yeast infection.

The study included 99 sexually active women between 18 to 65 years of age of varying ethnic backgrounds (white, African-American and Latin American) who completed 2 questionnaires, a year apart, regarding their intra-vaginal practices, as well as sexual practices, demographic background and any vaginal symptoms they experienced within a month of questionnaire completion. With each questionnaire, the participants also provided a urine sample, a blood sample and a self-collected vaginal swab, which were used for laboratory diagnosis of a variety of sexually transmitted infections, bacterial vaginosis and vaginal candidiasis.


The authors compiled an impressive dataset regarding the variety of intra-vaginal practices in their sample population, of which only the insertion of petroleum jelly appeared to increase the risk of bacterial vaginosis, while the use of baby oil was associated with a higher chance of vaginal yeast colonization.

The major drawback of the study was the lack of correlation between the laboratory diagnosis of both bacterial vaginosis and vaginal candidiasis, and the vaginal symptoms reported by participants. Consequently, the jury still remains out on what intra-vaginal practices increase the risk of clinically significant disturbances in the vaginal microbial ecosystem.

Further Information

  1. Favel et al. Vaginal microbiome of reproductive-age women. PNAS 2011; 108 (Suppl.1):4680-4687.
  2. Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol. 2012; 66:371-89.


Dr. Richard Lester, Medical Head, STI/HIV Control, Clinical Prevention Services, BCCDC
Avril Spencer, Clinical Nurse Educator, STI/HIV Control, Clinical Prevention Services, BCCDC