Vulnerability of women who have sex exclusively with women and women who have sex with women and men to bacterial vaginosis.

Author(s)

Mariana Alice de Oliveira Ignacio

• Document type: Doctoral Thesis
• Press: Botucatu. 2022-04-20.
• Institution: Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu
• Defense date: 2022-04-12
• Advisor: Marli Teresinha Cassamassimo Duarte

Abstract

Bacterial vaginosis (BV) is the most common alteration in the vaginal microbiota which can cause negative repercussions on women's sexual and reproductive health. Literature shows high prevalence of BV among women who have sexual relationships with other women, but no studies were found with the theoretical framework of vulnerability to analyze this relationship. Thus, the aim of this study was to analyze the vulnerability of women who have sex with women and women who have sex with women and men to BV. Method: A cross-sectional study comprising a broader research called "Vulnerability of women who have sex with women to health problems related to mental, sexual and reproductive health and situations of violence", developed in Botucatu-SP. The sample consisted intentionally of 453 women classified into three groups, according to the type of sexual partnership in the past 12 months of the data collection: Group 1 - 149 women who reported having sex exclusively with women (WSW), Group 2 - 80 women who reported having sex with women and men (WSWM) and Group 3 - 224 women who reported having sex exclusively with men (WSM). The sample and data collections were carried out in two periods: from January 2015 to April 2017 and from January 2019 to January 2020. Data were obtained through the application of a questionnaire, with the interest variables and gynecological examination. The diagnosis of BV was performed by microscopic examination according to Gram stain and classified according to Nugent et al. The diagnosis of human papilloma virus and Chlamydia trachomatis was performed by polymerase chain reaction. The classification of vulnerability variables was based on the vulnerability framework proposed by Ayres et al. in 2012. The vulnerability analysis of the groups to BV was performed by comparing the variables and the mean of the vulnerability scores using the Chi-square or Fisher's exact and Mann-Whitney tests. Comparison of BV prevalence among groups was performed using the chi-square test. Cox regressions were performed to verify whether the type of sexual partnership was associated with the prevalence of BV and to identify the vulnerability variables associated with BV in each of the three groups studied. Differences were considered statistically significant if p < 0.05. This research was approved by the ethics committee, reports 3.320.951 and 820.717. Results: The mean age of participants was 26 years old (18-55), most were white (74.8%), had more than 12 years of education (76.1%), did not live with a partner (79.2%) and had a paid job (65.1%). The WSW and WSWM had a higher profile of vulnerability to BV than WSM, and WSWM was more vulnerable to BV than WSW. The prevalences of BV among WSW and WSWM were significantly similar and higher than that of WSM (35.6%a X 36.3%a X 23.2%b; p=0.013). The type of sexual partnership was not associated with BV – WSW [1.13 (CI 95%: 0.71-1.78); p= 0.613] and WSWM [0.94 (CI95%: 0.56-1.56); p=0.802] and the vulnerability variables associated with this outcome was different in each of the groups studied. Among the WSW, education was a protective factor against BV [0.91 (CI 95%: 0.82-0.99); p= 0.048], among WSWM, non-white skin color was associated with an increased prevalence of BV [2.34 (CI 95%: 1.05-5.19); p= 0.037] and among WSM change of sexual partner in past three months [2.09 (CI 95%: 1.14- 3.82); p= 0.017], inconsistent condom use [2.61 (CI 95%: 1.10-6.20); p= 0.030] and positive diagnosis of C. trachomatis [2.40 (CI 95%: 1.01-5.73); p= 0.048] were the vulnerability variables independently associated with BV. Conclusion: WSW and WSWM are more vulnerable to BV than WSM, and the WSWM are the most vulnerable group. Although the prevalence of BV was significantly higher than WSW, the type of sexual partnership was not independently associated with BV in the present investigation. The vulnerability variables associated with BV among the groups were different showing the necessity of taking into consideration the history of women's sexual partnership in order to develop effective strategies to reduce such vulnerability. (AU)

• FAPESP's process: 18/14770-6 - Vulnerability of women who have sex with women to Bacterial Vaginosis
• Grantee: Mariana Alice de Oliveira Ignacio
• Support Opportunities: Scholarships in Brazil - Doctorate