Why Rectal Douches May Be Acceptable Rectal-Microbicide Delivery Vehicles for Men Who Have Sex With Men

The authors undertook the current study to explore the age of onset of rectal douching among men who have sex with men (MSM) and the reasons for continuing to douche, as well as to consider whether rectal douches containing microbial agents would be acceptable for men at risk of HIV infection.

In stage one of the research, the team used qualitative methods to assess douching behavior in a sample of 20 MSM. The researchers then developed a structured questionnaire that was administered to 105 MSM in stage two.

Despite being advised not to do so, more than half of the participants who completed stage one douched during the trial. Of the 105 HIV-negative MSM in stage two, 51 percent reported rectal douching in the previous six months; 47 percent reported douching before anal intercourse; and 25 percent reporting doing so after anal sex. Most participants reported douching frequently or always. Men reported douching on average about two hours before anal intercourse or one hour after. Average age of beginning to douche was late 20s. Most respondents said they douched because they wanted to be clean, or because their partners encouraged them to do so. In addition, some men thought post-intercourse douching could prevent STDs.

"Rectal douching appears to be a popular behavior among men who have receptive anal intercourse," the authors concluded. "It is necessary to identify harmless douches. If [HIV] or [STD] preventive douches can be developed, rectal douching before or following sexual intercourse could become an important additional prevention tool. To reshape an existing behavior to which some men strongly adhere, like douching, by suggesting use of one type douche over another may be more successful than trying to convince MSM to engage in behaviors they never practiced before or those they resist (e.g., condom use)."