Tampons and douches as a source of phthalate exposure: Assessing the association with bacterial vaginitis and phthalate exposure among Black women living with HIV in Atlanta, GA Restricted; Files Only
Chery, Lyzberthe (Spring 2023)
Published
Abstract
The extent to which tampons and douches contribute to phthalate exposure and the association between phthalate exposure and bacterial vaginitis remains unclear. To address this gap in knowledge, a study was conducted to identify phthalate exposure from douches and tampons in Black women living with HIV in Atlanta, GA, and to assess the association between phthalate exposure and bacterial vaginitis in this population. The study involved Black women living with HIV in Atlanta, GA, who were part of the MWCCS cohort. Information was collected on the participants' tampon and douche usage, and urine and cervicovaginal lavage (CVL) samples were collected and analyzed for phthalate metabolites. Bacterial vaginitis was diagnosed through the collection of vaginal swabs. Data collected was analyzed using descriptive statistics, univariate analysis, and regression models to identify differences and associations. The study found a significant increase in MCMHP urinary phthalate metabolites among women who douched (ꞵ: 0.65, 95% CI [0.02, 1.28], p = 0.04) in the unadjusted linear regression. The study also found a significant decrease in CVL MEHP metabolite among women who douched, both in the unadjusted (ꞵ:-0.19, 95% CI [(-0.29, -0.09], p = 0.001) and adjusted models (ꞵ: -0.17, 95% CI [- 0.28, -0.07], p = 0.001). Additionally, the study found a significant association between MBP exposure and bacterial vaginitis, with almost a 5-fold increase in the odds (p = 0.03), which remained significant after adjusting for age and education level (p = 0.02). For urinary MBZP exposure and bacterial vaginitis in the adjusted model, there was almost a 3-fold significant increase in the odds (p = 0.04). Despite its limitations, this study provides valuable information on the association between tampon and douche use with phthalate exposure and bacterial vaginitis in Black women living with HIV. Further research is necessary to examine the potential effects on the vaginal microbiome and the risk of sexually transmitted infections and other reproductive health complications using mediation analysis. Understanding the impact of phthalate exposure on bacterial vaginitis is critical to reducing the burden of disease in this population, given the high prevalence of both bacterial vaginitis and HIV among Black women.
Table of Contents
Introduction ................................................................................................................................... 1
Phthalates .................................................................................................................................... 1
Biological Pathway of Phthalates ........................................................................................... 1
Phthalates’ Effects on Health .................................................................................................. 2
Feminine Hygiene Products and Vaginal Cleansing Products ................................................... 4
VCPs, FHPs, and the Vaginal Microbiome ............................................................................ 6
Factors Contributing to Changes in Vaginal Microbiome .................................................. 6
Vaginal Microbiome and Infections ................................................................................. 11
Feminine Hygiene Products and Vaginal Cleansing Products as Possible Phthalate Exposure 12
Phthalate Exposure and Bacterial Vaginitis .............................................................................. 13
Methods ........................................................................................................................................ 14
Introduction ............................................................................................................................... 14
Population and Sample ............................................................................................................. 15
Data Collection ......................................................................................................................... 16
Vaginal Hygiene Measures ................................................................................................... 16
Phthalate Measurement ......................................................................................................... 16
Vaginitis Measure ................................................................................................................. 18
Candida ............................................................................................................................. 18
Trichomonas ..................................................................................................................... 18
Bacterial Vaginosis ........................................................................................................... 18
Data Analysis ............................................................................................................................ 19
Descriptive Statistics and Univariate Analysis ..................................................................... 19
Regression Analysis .............................................................................................................. 20
Ethical Considerations .............................................................................................................. 21
Results .......................................................................................................................................... 21
Demographics, Feminine Hygiene and Vaginal Cleansing Products, and Bacterial Vaginitis 21
Associations between Feminine Hygiene and Vaginal Cleansing Products with Phthalate
Exposure ................................................................................................................................... 23
Urinary Phthalates ................................................................................................................. 23
CVL Phthalates ..................................................................................................................... 23
Associations between Bacterial Vaginitis with Phthalate Exposure ......................................... 24
Urinary Phthalates ................................................................................................................. 24
CVL Phthalates ..................................................................................................................... 25
Discussion..................................................................................................................................... 25
Conclusion ................................................................................................................................... 32
Public Health Implications and Recommendations ................................................................. 32
References .................................................................................................................................... 34
Tables and Figures ...................................................................................................................... 43
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File download under embargo until 18 May 2025 | 2023-04-21 17:56:12 -0400 | File download under embargo until 18 May 2025 |
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