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    In contrast, men in this study are emphatic about the importance of cleanliness, reporting not only that it substantially influences their choice of partner, but that it even determines the type of sexual activities in which they will choose to engage. Our findings are consistent with the responses of adolescent males in a survey conducted by Markham et al They found that most men were familiar with douching and reported a preference for their partners to douche. In our sample of Latino men of mostly Caribbean descent, most perceive douching to be a necessary and highly beneficial part of a range of hygiene activities. This perception is related to deeply held beliefs about the importance of cleanliness.

    Almost unanimously, the men interviewed expressed the view that the vagina is an inherently flawed organ, that if left in its natural, untouched state, is unclean.

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    The conflation of concepts of ritual or moral purity with germ theory imbedded in our data has been described as a common theme in modern concepts of hygiene Douglas The woman who risks disease through her failure to engage in hygienic griends reveals a failure of moral character. The fact that most men did not explicitly acknowledge this moral dimension of genital hygiene is also a characteristic of health discourse in modern life. These findings have important implications for clinical practice and development of interventions to discourage douching among Latinas. Counselling messages must acknowledge that feminine hygiene practices, as with other behaviours related to sexuality, are practices grounded in social context and not simply individual behaviours.

    In deciding to douche, women may be responding to cues from their partners about the health, social and even moral significance of cleanliness and the desirability of women who are perceived to take good care of themselves. Messages about douching are unlikely to be successful among Caribbean Latinas unless this context is acknowledged and alternatives to douching are promoted that in particular address the importance of odour control. Additionally, our data suggest that intervening directly with male partners may be helpful, as some are already aware of potential negative consequences of douching.

    Some limitations should be acknowledged. Our sample is limited to Latino men of primarily Caribbean background who sought care in a community health centre at the time of the interview. Our results may not be generalizable to Latinos of other ethnic backgrounds, of other socioeconomic strata, or in non-urban areas. We suggest that additional research is needed to identify similarities or differences in other Latino subgroups. A female interviewer conducted the interviews; it is likely that this had some effect on the narrative. Culture Health and Sexuality.

    Vaginal douching and reduced fertility. American Journal of Public Health. Behavior, disease and health in the twentieth century United States: The moral valence of individual risk. Brandt A, Rozin P, editors.

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    Journal of Henefits Health. Vaginal douching among Latinas: Miller W, Crabtree BF. Research methodology in qualitative Analysis: How to begin Making Sense. A Practice Research Journal. Hispanlc York State Dept. Early onset of vaginal douching is associated with false beliefs and high-risk behavior. Douching behavior in high-risk adolescents. What do they use, when and why do they douche? The effect of interviewer's gender on the interviewing process: Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: Clinical Pediatrics Phila ; Vaginal douching as a risk factor for acute pelvic inflammatory disease.

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