Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.

Orientadores: Paulo Cesar Giraldo, Ana Katherine S. Gonçalves / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-08T15:31:40Z (GMT). No. of bitstreams: 1 Amaral_RoseLuceGomesdo_M.pdf: 734908 bytes, checksum: 93d7f5663377e139f755920fc4edece2 (MD5) Previous issue date: 2007 / Resumo: Objetivo: Verificar se o uso de duchas higiênicas íntimas (DHI) pode interferir na microbiota vaginal de mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal realizado durante seis meses verificou o risco de 155 mulheres profissionais do sexo (PS), usuárias e não usuárias de DHI, apresentarem flora vaginal alterada e/ou vaginose bacteriana. As PS foram atendidas em centro de saúde (CS) localizado em zona de prostituição no município de Campinas, São Paulo, e agrupadas em usuárias e não usuárias de duchas higiênicas íntimas para análise da microbiota vaginal. A anamnese determinou os perfis sociodemográfico e sexual destas mulheres que procuraram o CS por diferentes motivos. O conteúdo vaginal foi coletado com swab estéril de Dacron e disposto em duas lâminas de vidro que foram coradas por técnica de Gram. A caracterização da microbiota vaginal pelos critérios de AMSEL adaptado foi realizada por microscopia óptica com lente de imersão. Análises univariável, bivariável com testes de qui-quadrado e exato de Fisher, além de regressão múltipla variável (stepwise) demonstraram o poder de associação entre as variáveis. Resultados: A média de idade, a etnia branca, a escolaridade básica e hábito de fumar encontrados respectivamente nas 94 usuárias e nas 61 não usuárias de DHI foram de 25,5 (± 6,2) vs. 26,0 (± 6,8)anos (p=ns), 48,9% vs. 47,5% (p=ns), 60,6% vs. 45% (p=ns) e 41,5% vs. 49,2% (p=ns) dos casos. Não houve diferença no uso regular de condom com seus parceiros sexuais fixos. Apenas o uso de lubrificantes vaginais foi significativamente maior nas usuárias de DHI (63,8%) que nas não usuárias (36,1%), p=0,0007. As prevalências de flora vaginal alterada, vaginose bacteriana, candidíase, tricomoníase e vaginose citolítica foram de 75,48%; 50,96%; 5,1%; 0,64% e 1,9%, respectivamente. Não houve diferenças significativas destas prevalências quando foram analisados estes achados entre as usuárias e não usuárias de DHI (78,7% vs. 70,5%, ns), (47,9% vs. 55,7%, ns), (5,3% vs. 4,9%, ns), (0 vs. 1,6%, ns) e (1,1% vs. 3,3%, ns). A análise de regressão múltipla tipo stepwise não identificou qualquer risco aumentado de ter flora vaginal alterada ou de vaginose bacteriana em mulheres usuárias de DHI. Conclusão: O uso de DHI não aumentou o risco de flora vaginal alterada e/ou de vaginose bacteriana em mulheres PS. Palavras-chave: profissionais do sexo, duchas higiênicas íntimas, microbiota vaginal, vaginose bacteriana, candidíase vaginal / Abstract: Aims: Verify if vaginal douching (VD) can cause vaginal flora imbalance in Female Sex Workers (FSW). Patients and Methods: A cross sectional study, carried out for six months, analysed the risk of vaginal flora imbalance and/or vaginal bacteriosis due to vaginal douching in 155 FSW. The FSW were seen at a public outpatient in a prostitution area in the city of Campinas, the state of São Paulo, Brazil. The vaginal douching (VD) users and non-users made up the two groups for vaginal microbiological analysis. The social-demographic and sexual profile of these women, who were seen for different reasons, was checked by anamnesis. Vaginal content was collected using a sterile Dacron Swab and placed on two glass slides that were stained using Gram technique. Adapted AMSEL criteria characterized the vaginal flora using optic microscope with immersion lens. Univariate, bivariate statistical analyses with X2 and exact Fisher tests apart from multiple variate regression (Stepwise) analysis determined the association between variables. Results: Mean age, white ethnicity, level of schooling and the habit of smoking analysed in the 94 users and 61 non-users of VD respectively were 25.5 (± 6.2) vs. 26.0 (± 6.8) years (p=ns), 48.9% vs. 47.5% (p=ns), 60.6% vs. 45% (p=ns) and 41.5% vs. 49.2% (p=ns) of the cases. There was no difference in the regular use of condoms with their steady sexual partners. Only the use of vaginal lubricant was significantly higher in the VD users (63.8%) than in the non-users (36.1%); p=0.0007. General prevalence of abnormal flora, bacterial vaginosis, candidiasis, trichomoniasis and cytolitic vaginosis was 75.48%, 50.96%, 5.1%, 0.64% and 1.9% respectively. There were no significant differences when analysing the findings between users and non-users of VD (78.7% vs. 70.5%; ns); (47.9% vs. 55.7%; ns); (5.3% vs. 4.9%; ns); (0 vs. 1.6% ns) and (1.1% vs. 3.3%; ns). Stepwise multiple regression analysis did not identify any increased risk of altered vaginal flora or bacterial vaginosis in VD users. Conclusion: The use of VD did not increase the risk of vaginal flora imbalance and/or bacterial vaginosis in FSW / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia