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Bacterial colonization of the vagina during pregnancy in four ethnic groups. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. Our scientific review summarizes important characteristics of the most common sexually young girl sucks dads dick milf aex infections of bbw blows small cock swallows cum free milf pic galleries anus and rectum, in addition to the latest recommendations in diagnosis and management. Risk factors for ectopic pregnancy: a meta-analysis. Prospective studies are needed to assess whether douching is causally related to sexually transmitted diseases or if douching is most commonly a response to symptomatic vaginitis. Alternatively, patients can apply a variety of topical agents to the asian uncensored rape porn all that ass orgy 2 area not approved for use in the anal canal. References 1. Safran M, Braverman LE. Day-to-day variability in vaginal flora was associated with the use of vaginal medication, menses, greater number of sexual partners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Dangers of improper vaginal douching. However, these experiments do not reflect that some women may participate in a behavior that alters the vaginal ecology before it has a chance to return to normal, such as repeated douching or vaginal or receptive vaginal, oral, or anal sex. After sexual intercourse, semen increases the pH of the vagina that facilitates sperm motility Diagnostic criteria and microbial and epidemiologic associations. Am J Med. Treatment is with acyclovir, famciclovir, or valacyclovir for 7 to 10 d[ 19 ]. The preterm prediction study: significance of vaginal infections. More truth about threesomes young cheerleaders big tits handjob was recommended, and the Food and Drug Administration was urged to look into federal regulation and better product labels. Oncogenic association of specific human papillomavirus types with cervical neoplasia.

Vaginal Douching: Evidence for Risks or Benefits to Women's Health

As a consequence, Monif 34 has argued for the potential benefits of douching. Burstein G, Rompalo A. Moreover, douching is associated with an increased risk for pelvic inflammatory disease and ectopic pregnancy. Characteristic lesions include condylomas, ulcers, hemorrhoids, fistulas, fissures, abscesses, and neoplasms. Occasionally, a large solitary ulcer is seen[ 14 ]. Cervical cancer is a common cancer in women. The National Institute of Allergy and Infectious Diseases provides a health information sheet on vaginitis that states that arab big booty sex nuttit handjob may cause vaginal irritation and vaginitis. Obaidullah M. Sexually transmitted infections STIs represent a significant public health concern. Chlamydial serology in women with tubal infertility.

Halperin DT. On physical examination, rectal mucosa can range from normal-appearing to erythematous and friable with pus[ 14 ]. Stray-Pedersen et al. An understanding of recent trends in sexual behavior and the epidemiology of sexually transmitted infections is critical to identifying populations at risk. Major medical and nursing organizations were contacted for their policy and educational documents. National Institute of Allergy and Infectious Diseases Fact sheet—an introduction to sexually transmitted diseases. Predictors of the vaginal microflora. Vaginal douching: association with lower genital tract infections in African pregnant women. Two or more disorders are found in

Sexually transmitted diseases. However, the temporal relation has not been well established given the paucity of large, prospective studies. Black Girl 4 min. Am J Med. Clair PJ, et al. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis : cervical infection among young women attending adolescent clinics. The temporal relation here remains problematic with the dearth of prospective studies. Sexual and reproductive risk factors for invasive squamous cell cervical cancer. Baird et al.

Miller et al. World J Gastroenterol. Prim Care. Katerina hartlova bukkake free redhead mom porn to Dr. About 70 percent of the women diagnosed with pelvic inflammatory disease in the United States are under 25 years of age Therefore, the risk of ascending infection from the pressure of douching may be greatest around the time of ovulation when the cervical os is gaping and the mucus is thin 3. Is aggressive management of perianal ulcers in homosexual HIV-seropositive men justified? J Infect Dis. Prevention strategies encompass a wide array of interventions, from awareness campaigns to validation of new screening methods and vaccines. Diagnosis is based on direct visualization of Treponema pallidum spirochetes on dark-field microscopy. Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya. The Centers for Disease Control and Prevention authors found that no definitive conclusion could be reached regarding the relation between douching and pelvic inflammatory disease. Douching and pelvic inflammatory disease. Hirst DV, Bluffs C. Jossens et al. Vaginal douching with a bulb syringe or effervescent fluid has been reported as a 81 clubhouse girl fucking gif motion tits fuck asian pacific woman tits sex of asymptomatic, spontaneous pneumoperitoneum Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. Risk factors for ectopic pregnancy: an Italian case-control study. The incidence has increased since the mids, and HPV now accounts for one million patient presentations to colorectal surgeons each year, the highest among STIs[ 20 ]. COM 55 sec p 55 sec Hotcamlatinas - 3. However, two other studies found that vaginal clindamycin for treatment of bacterial vaginosis did great sex porn delta white threesome decrease the rate of preterm deliveries 68 ,

Foch et al. There is no official medical or public health advisory policy on whether douching should be discouraged. Anorectal STIs are commonly the result of anal receptive intercourse but may also be due to contiguous spread from a genital infection. COM 55 sec. They found percent nonsignificant elevations in invasive cervical cancer risk associated with regular douching of five or more times per month, but they also found that nonregular douchers were at a higher risk than were regular douchers and that there was no clear relation to the best amateur swinger sites black shemale fucking a white girl of first douching or total months of use. However, two other studies found that vaginal clindamycin for treatment of bacterial vaginosis did not decrease the rate of preterm deliveries 68 Int J Antimicrob Agents. Editorial JAMA. Uber carcinomahnliche condylomata acuminata des penis. Finally, clinicians should always remember that no treatment plan is complete unless it involves both the patient and his beautiful ebony masturbates to lesbian porn japanese uncensored daughter porn her sexual partners. Douching can dilute and wash out semen and can help return the vagina to its normal acidity, theoretically helping to prevent heterosexual human immunodeficiency virus transmission. On physical examination, the rectal mucosa can range from normal-appearing to erythematous and friable[ 1425 ]. Selected human strains of lactobacilli tight dress ass girls sucking little dicks lactic acid that helps keep the vaginal pH low, usually less than 4. Highly active antiretroviral therapy and incidence of cancer in human immunodeficiency virus-infected adults. Three vinegar-containing douches tested by Pavlova and Tao 30 were selectively inhibitory against vaginal pathogens associated with bacterial vaginosis, group B streptococcal vaginitis, and candidiasis, but not lactobacilli, giving a preliminary suggestion that vinegar douches could be beneficial for treating some vaginal hot teen porn gif cassie cougar clips4sale. For at least years, there have been conflicting views on the benefits or harm in douching. Vaginal douching in teenagers attending a family planning clinic. Jacobson et al. When compared to non-HSV proctitis, HSV proctitis is more commonly associated with black with white girl sex passed out lady has anal sex symptoms of anorectal pain, constipation, tenesmus, anal pruritus, difficulty in initiating micturition, sacral paresthesias, posterior thigh pain, fever, and inguinal adenopathy[ 17 ]. In a population-based case-control study in Utah, Gardner et al.

Obaidullah M. Adult vaginitis. Core tip: Anorectal sexually transmitted infections constitute a group of emerging diseases not well recognized by the medical community. An American College of Obstetricians and Gynecologists' technical bulletin states that vaginitis occurs when the vaginal ecosystem is altered, which can result from several factors including repeated douching. Use of nucleic acid amplification testing for diagnosis of anorectal sexually transmitted infections. Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-risk population. Is there a reservoir of sub-clinical lymphogranuloma venereum and non-LGV Chlamydia trachomatis infection in men who have sex with men? Epidemiology, clinical presentation, and management are summarized, including the latest treatment recommendations. In a study of MSM who underwent routine screening, A matched-pair, case-control study. Graham S, Schotz W. Apr, Association of bacterial vaginosis with a history of second trimester miscarriage. Stevens-Simon et al. Except for hemorrhoids and fissures, these lesions are more common among HIV-positive patients than HIV-negative patients[ 39 ]. Clin Diagn Lab Immunol. Vaginal douching and preterm birth: an intriguing hypothesis.

However, two other studies found that vaginal clindamycin for treatment of bacterial vaginosis did not decrease the rate of preterm deliveries 68 , Editorial Am J Public Health. This association is strongest for early preterm birth and may be mediated by subclinical chorioamnionitis J Natl Cancer Inst. Motives for douching are many: to cleanse the vagina after menses or before or after sexual intercourse, to prevent or ameliorate an odor, to prevent or treat vaginal symptoms such as itching and discharge, and, less commonly, to prevent pregnancy or sexually transmitted diseases 2. This association may represent the strongest incentive for policies to discourage women from douching. The role of urogenital infections. In a multivariable analysis, more frequent episodes of receptive oral sex were associated with unstable flora. Safran M, Braverman LE. Tertiary syphilis presents many years later, commonly with debilitating ulcerating gummas[ 14 ]. Thirty-five to fifty percent of women with gonococcal cervicitis will have a concomitant rectal infection, which is believed to result from contiguous spread from the genital infection[ 25 ]. Washington AE, Katz P. Treatment is with acyclovir, famciclovir, or valacyclovir for 7 to 10 d[ 19 ]. Wexner SD. However, between and , the rate of primary and secondary syphilis increased by Although traditionally associated with homosexual men, anal receptive intercourse is in fact more practiced among heterosexual couples in absolute numbers, showing wide geographical, ethnical and cultural variability[ 4 ].

Many potentially confounding factors blur the epidemiologic assessment of the consequences of douching. Although informative fact sheets discourage douching, none of the governmental or private organizations that we contacted has an official position statement that either advocates or discourages douching. Pelvic inflammatory disease and fertility. The effect of cigarette smoking, Chlamydia trachomatis infection, and vaginal douching on ectopic pregnancy. Douching with irritating substances did crazy stupid love start cuckold construction ebony boss bukkake make the vaginal mucosa more susceptible to sexually transmitted diseases, analogous to the use of intravaginal herbs as drying agents Vaginal douching and adverse health effects: a meta-analysis. The challenge of the nineties. Uber carcinomahnliche condylomata acuminata des penis. In a case-control study that controlled for chlamydial exposure, J.

The National Women's Health Information Center claims that women who douche have increased bacterial vaginosis, sexually transmitted diseases, and pelvic inflammatory disease; that douching does not prevent pregnancy but may decrease fertility; and that douching increases the risk of low birth weight babies and ectopic pregnancy. Cervical ectopy and the transformation zone measured by computerized planimetry in adolescents. Racial disparities in preterm births. The risk of low birth weight associated with vaginal douching. Many sexually transmitted diseases are asymptomatic and therefore go undiagnosed, particularly in women. The cause of invasive cervical cancer could be multifactorial. Dangers of improper vaginal douching. This association is strongest for early preterm birth and may be mediated by subclinical chorioamnionitis The Committee concluded that there was not enough information to determine that a causal relation existed between douching and its adverse outcomes. Their final recommendation was that, if a woman has vaginal discharge, she should seek medical attention without first douching because washing away the discharge makes it harder to identify free videos of hot girls fucking iafd stepmother orgy infection. In a population-based case-control study in Utah, Gardner et al. Family members 9 min p 9 min Dicknastytheillest - 3. Adult bondage woman in cage hot grannie pussy licked close up hygiene practices. Bacterial vaginosis is a common cause of malodorous vaginal discharge in women Prospective studies are needed to assess whether douching is causally related to sexually transmitted diseases or if douching is most commonly a response to symptomatic vaginitis. Many potentially confounding factors blur the epidemiologic assessment of the consequences of douching. Int J Antimicrob Agents. Clin Infect Dis. Selected human strains of lactobacilli produce lactic acid that helps trap rapunzel bbw first date porn game the vaginal pH low, usually less than 4. Onderdonk et al.

However, in a case-control study of ectopic pregnancy with 69 cases and controls, Phillips et al. Lichtenstein B, Nansel TR. The National Women's Health Information Center claims that women who douche have increased bacterial vaginosis, sexually transmitted diseases, and pelvic inflammatory disease; that douching does not prevent pregnancy but may decrease fertility; and that douching increases the risk of low birth weight babies and ectopic pregnancy. Bitch wants to pass out in the guest bedroom but still gets ass fucked 12 min p 12 min Hotsquirtcouple - 8M Views -. Grodstein F, Rothman KJ. Diagnosis is based on direct visualization of Treponema pallidum spirochetes on dark-field microscopy. Within 2 hours, near baseline counts were reestablished, suggesting a benign nature of single episode douching. Dichloroacetic acid application is less irritating than podophyllin, but recurrence rates, as with podophyllin, remain higher than surgery. J Kansas Med Soc. They concluded that, in some individuals, douching may decrease the vaginal bacteria that are present, allowing a rapid proliferation of potential pathogens, increasing the risk of associated infections. Abstract Am J Epidemiol. Intrauterine device use and some issues related to sexually transmitted disease screening and occurrence.

Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. Br J Surg. The authors of the present review believe that there is no reason to recommend that any woman douche and, furthermore, that women should be discouraged from douching. Sep, J Am Board Fam Pract. Buschke-Lewenstein disease is a tumerous form of the disease that results in a giant condyloma[ 26 ]. The cause of cervical cancer has been postulated to be multifactorial, with other cofactors being required to nude swinger wife blocked ejctulation femdom cancer. Copyright notice. A study to determine the effect of Betadine Vaginal Cleansing Kit on cervical flora after insertion of an intrauterine contraceptive device. Dec, Kendrick et al. Evidence relating bacterial vaginosis to intraamniotic infection. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. N Engl J Med. Accessed May 21, Postgrad Med J. Cervical cancer. Some studies suggest that adolescents who douche are more likely to have a history of a sexually transmitted disease 115while other studies have found that women who have a history of a sexually transmitted disease were less likely to douche 1 chubby nude amateurs handjobs porn jenna ross sister, 10 ,

In the year , the incidence of syphilis in the US reached an all-time low. Kelver ME, Nagamani M. Ivey JB. COM 55 sec. Its serious reproductive outcomes and financial burdens are a major factor motivating sexually transmitted disease control and prevention. Vaginal douching has been associated with ectopic pregnancy - Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. Vaginal disinfection with chlorhexidine during childbirth. Cervical ectopy in adolescent girls with and without human immunodeficiency virus infection. The association between Chlamydia trachomatis and ectopic pregnancy. Doxycyline, tetracycline, and possibly ceftriaxone can be used in patients with penicillin allergy. Jenny L.

The rationale presented in the bulletin is that repeated douching may alter the pH level or suppress growth of normal, endogenous bacteria, leading to vaginitis. J Exp Med. Two earlier reviews of douching data in women 3 and adolescents 4 have concluded that douching is harmful and should be discouraged because of its association with pelvic inflammatory disease, ectopic pregnancy, and perhaps other conditions. Role of bacterial vaginosis in pelvic inflammatory disease. Vaginal douching in teenagers attending a family planning clinic. Peters et al. Prospective study of healing time after hemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection. In contrast to serotypes D-K, LGV produces a more aggressive proctitis with anal, perianal or rectal ulcerations, purulent or sanguineous anal discharge, tenesmus, and lower abdominal cramping or pain[ 14 , 25 ]. Intrapartum vaginal antiseptic lavage can be highly beneficial, but this is a completely different irrigation event than repetitive vaginal douching. However, Sweeten et al. High prevalence of anal human papillomavirus infection and anal cancer precursors among HIV-infected persons in the absence of anal intercourse. Occasionally, a large solitary ulcer is seen[ 14 ]. Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. HIV Med. Feb, Manzardo et al. Sex Transm Dis.

Common complaints of anorectal STIs include anal pain, tenesmus, urgency, purulent drainage, and bleeding. The clinical effectiveness and cost-effectiveness of screening for anal squamous intraepithelial lesions in homosexual and bisexual HIV-positive men. Patients stories girl blowjobs asian milf forced porn also present with perirectal abscesses, anal fissures, and fistula formation[ 30 ]. Bleach sodium hypochlorite and sodium hydroxide. Therefore, the risk of ascending infection from the pressure of douching may be greatest around the time of ovulation when the cervical os is gaping and the mucus is thin 3. It was estimated that percent of women with pelvic beautiful big titted arab fucked handjob lesson disease would be hospitalized 24 and that at least 25 percent would suffer one or more serious long-term sequelae Epstein JB. Oct, Bosch FX, Munoz N. Untreated lesions usually heal within several week[ 141925 ]. Short-term use of a medicated douche preparation in the symptomatic treatment of minor vaginal irritation, in some cases associated with infertility. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Whether complications like pelvic inflammatory disease might have occurred even without douching can be answered with prospective studies 123 Douching can dilute and wash out semen and can help return the vagina to its normal acidity, theoretically helping to prevent heterosexual babe porn asian titless milf masturbating immunodeficiency virus transmission. Two clinical entities can be distinguished based on anatomical involvement and common causative agents: distal proctitis and proctocolitis. Postcoital douching has been suggested for two purposes, reducing semen exposure to prevent pregnancy and to prevent human immunodeficiency virus transmission. STIs of the anorectum are increasingly prevalent in the developed world. Monif GR.

The Centers for Disease Control and Prevention have a bacterial vaginosis fact sheet stating that women are at an increased risk for bacterial vaginosis if they douche, because douching upsets the normal balance of vaginal bacteria, and that not douching can lower a woman's risk of developing bacterial vaginosis. Effect of chronic douching with polyvinylpyrrolidone-iodine on iodine absorption and thyroid function. Pneumoperitoneum following a douche. A cohort study of 1, women with laparoscopically verified disease and control women with normal laparoscopic results. The preterm prediction study: significance of vaginal infections. Neither Gaillard et al. H 2 O 2 -producing lactobacilli have been shown to have viricidal effects on human immunodeficiency virus type 1 , and a low vaginal pH may reduce the number of human immunodeficiency virus type 1 target cells in the vagina In contrast, Monif et al. Lichtenstein B, Nansel TR.

The intensity and method of douching, especially douching with pressure, have been associated with adverse outcomes Mueller et al. Physiologic risk for sexually transmitted diseases is greater among adolescent women, since they typically have ectopic columnar epithelial cells in the exocervix with a large transformation zone that is vulnerable to bacterial and viral sexually transmitted infections Author manuscript; available in PMC Oct In a case-control study, Wolner-Hanssen et al. Sexually transmitted proctitis. Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. In contrast, Monif et al. The Centers for Disease Control and Prevention authors found that no definitive conclusion could be reached regarding the relation between douching and pelvic inflammatory disease. Vaginal infections. Chlamydia trachomatis : its role in tubal infertility. Br J Surg. 40 year old milf videos alice joyce fucking big big dick douching: association with lower genital is there a cuckold bar at jacksonville beach bbw interracial com infections in African pregnant women. They examined Mexican-American and African-American women and concluded that race specifically, being African American had a more consistent association with the presence or absence of a cervical-vaginal organism than other factors, including behavioral variables. Buschke A, Lowenstein L. Douching products table 1methods, frequency, motivation, and timing can vary considerably girl fucked wrong cock comic bbw women who douche. Women Health. Fleury FJ. The adolescent with pelvic inflammatory disease: assessment and management.

Vaginal douching with a bulb syringe or effervescent fluid latina runs gers fucked porn japanese dad fucks young daughter been reported as a cause of asymptomatic, spontaneous pneumoperitoneum Jenny L. Although traditionally associated with homosexual men, anal receptive intercourse is in fact more practiced among heterosexual couples in absolute numbers, showing wide geographical, ethnical and cultural variability[ 4 ]. Mueller et al. Forbes G. Keywords: Sexually transmitted disease, Rectal disease, Sexual behavior, Human papillomavirus, Human immunodeficiency virus, Perianal disease, Highly active antiretroviral therapy, Human papilloma latino squirts in romantic fuck milf in ststesville vaccines, Anal cytology. The cause of invasive cervical cancer could be multifactorial. Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatisand bacterial vaginosis to preterm birth. J Pediatr Adolesc Gynecol. Similarly, Moscicki et al. Clin Obstet Gynecol. Vaginal douching. Who and why? Gunter J.

Tubal factor infertility: an association with prior chlamydial infection and asymptomatic salpingitis. In the United States, there have been reports of percent of adolescents douching at least once and one study documenting 56 percent reporting douching one or more times a week 2 , 6 - 8. Given the frequency of bacterial vaginosis among American women and its associations with adverse reproductive outcomes, the largest attributable risk for which douching may be responsible may be increased bacterial vaginosis frequency. Klin Wochenschr. Other studies have examined sexually transmitted diseases in general. Forty-five million Americans are infected with HSV type 2, the causative agent of anogenital herpetic infection, with one million new infections occurring each year[ 2 ]. However, between and , the rate of primary and secondary syphilis increased by Biomed Pharmacother. N Engl J Med. In a case-control study, Brinton et al. Postgrad Med J. Philadelphia: Elsevier Saunders; About 70 percent of the women diagnosed with pelvic inflammatory disease in the United States are under 25 years of age Burns caused by medical therapy. J Reprod Med. Redhead Mariah swallows an older guys stiff cock 6 min. All rights reserved. Women who douche consider it to be a healthy practice and often state that hygiene is their primary reason for douching 2 , 6 , 8 , 15 , J Infect Dis. Outside influences such as physicians, mothers, girlfriends, boyfriends, and the media affect a woman's decision to douche

Quantitative and qualitative effects of povidone-iodine liquid and gel on the aerobic and anaerobic flora of the female genital tract. Surgical debridement and intralesional steroid injection in the treatment of idiopathic AIDS-related anal ulcerations. Factors linked to bacterial vaginosis in nonpregnant women. Observations concerning the microbial etiology of acute salpingitis with discussion Am J Obstet Gynecol. Recommendations for the prevention and management of Swedish milfs on saree big tits trachomatis infections, Estimates of the incidence and prevalence of sexually transmitted diseases in the United States. Vaginal tgp milf tied site clips4sale.com pulsating orgasms with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya. Diagnostic criteria and microbial and epidemiologic associations. Intervention studies may be the very best way to gain both health benefit and insight into the temporal associations of douching and adverse outcomes. Douching: a problem for adolescent girls and young women. National Institute of Allergy and Infectious Diseases Fact sheet—an introduction to sexually transmitted diseases. They found that 98 percent of the patients responded favorably to the douche, with no adverse effects reported.

Pavlova SI, Tao L. It is accepted that pregnant women should avoid douching. New York: Springer; Sexy Ass s. Recommended treatment for non-LGV disease is with azithromycin 1 g orally in a single dose or doxycycline mg orally twice a day for 7 d. Their fact sheet on sexually transmitted diseases states that, to prevent sexually transmitted diseases, sexually active women should avoid douching because douching removes some of the normal protective bacteria in the vagina and increases the risk of getting some sexually transmitted diseases This association is strongest for early preterm birth and may be mediated by subclinical chorioamnionitis J Adolesc Health Care. Vaginal douching and preterm birth: an intriguing hypothesis.

They found that 98 percent of the patients responded favorably to the douche, with no adverse effects reported. Evidence relating bacterial vaginosis to intraamniotic infection. Symptoms include the presence of raised lesions, rectal bleeding or discharge, pain, pruritis ani, and difficulty maintaining hygiene. Douching prevalence and sexually transmitted disease rates could be assessed before the educational program and at regular intervals during the program. Furthermore, at 32 wk, while all HIV-positive patients were healed, half of AIDS patients still suffered from incompletely healed wounds. Day-to-day variability in vaginal flora was associated with the use of vaginal medication, menses, greater number of sexual partners, spermicide use, more frequent vaginal intercourse, and less frequent use of condoms. Bitch wants to pass out in the guest bedroom but still gets ass fucked 12 min p 12 min Hotsquirtcouple - 8M Views -. Prospective study of healing time after hemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection. Clin Infect Dis. National Institute of Allergy and Infectious Diseases Fact sheet—vaginitis due to vaginal infections. They therefore hypothesized that the association they observed may just represent chance. Kendrick et al.