Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota

C. van der Veer, S. M. Bruisten, R. van Houdt, A. A. Matser, G. Tachedjian, J. H. H. M. van de Wijgert, H. J. C. de Vries, J. J. van der Helm

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos®) on the vaginal microbiota (VM) in a prospective study. Results: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014-413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88%), and 60% used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84%) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16%) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95% CI: 0.9-2.1) and OR = 1.7 (95% CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95% CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95% CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95% CI: 1.2-7.2); p = 0.017]. Conclusion: The Etos® douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.
Original languageEnglish
Article number168
JournalBMC Microbiology
Volume19
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

van der Veer, C., Bruisten, S. M., van Houdt, R., Matser, A. A., Tachedjian, G., van de Wijgert, J. H. H. M., ... van der Helm, J. J. (2019). Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota. BMC Microbiology, 19(1), [168]. https://doi.org/10.1186/s12866-019-1545-0
van der Veer, C. ; Bruisten, S. M. ; van Houdt, R. ; Matser, A. A. ; Tachedjian, G. ; van de Wijgert, J. H. H. M. ; de Vries, H. J. C. ; van der Helm, J. J. / Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota. In: BMC Microbiology. 2019 ; Vol. 19, No. 1.
@article{632720737dfa4616ac9bb6eb3e3acc6f,
title = "Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota",
abstract = "Background: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos{\circledR}) on the vaginal microbiota (VM) in a prospective study. Results: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014-413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88{\%}), and 60{\%} used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84{\%}) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16{\%}) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95{\%} CI: 0.9-2.1) and OR = 1.7 (95{\%} CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95{\%} CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95{\%} CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95{\%} CI: 1.2-7.2); p = 0.017]. Conclusion: The Etos{\circledR} douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.",
author = "{van der Veer}, C. and Bruisten, {S. M.} and {van Houdt}, R. and Matser, {A. A.} and G. Tachedjian and {van de Wijgert}, {J. H. H. M.} and {de Vries}, {H. J. C.} and {van der Helm}, {J. J.}",
year = "2019",
doi = "10.1186/s12866-019-1545-0",
language = "English",
volume = "19",
journal = "BMC Microbiology",
issn = "1471-2180",
publisher = "BioMed Central",
number = "1",

}

Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota. / van der Veer, C.; Bruisten, S. M.; van Houdt, R.; Matser, A. A.; Tachedjian, G.; van de Wijgert, J. H. H. M.; de Vries, H. J. C.; van der Helm, J. J.

In: BMC Microbiology, Vol. 19, No. 1, 168, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Effects of an over-the-counter lactic-acid containing intra-vaginal douching product on the vaginal microbiota

AU - van der Veer, C.

AU - Bruisten, S. M.

AU - van Houdt, R.

AU - Matser, A. A.

AU - Tachedjian, G.

AU - van de Wijgert, J. H. H. M.

AU - de Vries, H. J. C.

AU - van der Helm, J. J.

PY - 2019

Y1 - 2019

N2 - Background: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos®) on the vaginal microbiota (VM) in a prospective study. Results: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014-413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88%), and 60% used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84%) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16%) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95% CI: 0.9-2.1) and OR = 1.7 (95% CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95% CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95% CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95% CI: 1.2-7.2); p = 0.017]. Conclusion: The Etos® douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.

AB - Background: Over-the-counter intra-vaginal lactic-acid containing douches are marketed as vaginal hygiene products that support optimal vaginal pH balance. We report the effect of a commercially available douche (Etos®) on the vaginal microbiota (VM) in a prospective study. Results: Twenty-five healthy women were recruited through advertisements in 2015-2017 (ethical approval: METC-2014-413) and followed over three menstrual cycles. The participants had a median age of 24 years [IQR: 22-29], were mostly Dutch-Caucasian (88%), and 60% used combined oral contraceptives. All participants douched three times a week during the second cycle, starting on the first day of that cycle. Participants completed a questionnaire at baseline, kept a daily diary to report douching, menses, and sexual activity, self-collected vaginal swabs every other day during the first and third cycle and daily during the second cycle, and measured vaginal pH mid-cycle. A median of 44 vaginal swabs [inter-quartile range (IQR): 41-50] were assessed per participant by 16S rRNA gene (V3-V4 region) sequencing and a Candida albicans PCR was done at four time-points. At baseline, 21 participants (84%) had Lactobacillus-dominated VM (Lactobacillus crispatus (n = 14), L. iners (n = 6), or diverse Lactobacillus species (n = 1) and 4 participants (16%) had VM consisting of diverse anaerobes. In multinomial logistic regression models, a trend towards increased odds were observed for having diverse anaerobic VM in the second and third cycle, compared to the first cycle, after adjusting for menses [odds ratio (OR) = 1.4 (95% CI: 0.9-2.1) and OR = 1.7 (95% CI: 0.9-3.1), respectively] (p = 0.376). Douching did not affect vaginal pH. Menses increased the odds for having VM consisting of diverse anaerobes almost two-fold (OR = 1.7; 95% CI: 1.0-2.8), while douching during menses increased the odds 2.6 fold (OR = 2.6; 95% CI: 1.0-6.5), compared to not menstruating (p = 0.099). Participants were more likely to test positive for C. albicans after cycle 2, compared to cycle 1 [OR = 3.0 (95% CI: 1.2-7.2); p = 0.017]. Conclusion: The Etos® douche did not significantly affect the vaginal pH or VM composition, although increased odds for having diverse anaerobic VM was observed, especially when douching during menses. Furthermore, douching may promote C. albicans infections.

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