Vaginal Douching as a Possible Source of 1,4-Dichlorobenzene among Reproductive-Aged Women: National Health and Nutrition Examination Survey 2001-2004

摘要

Chronic exposure to volatile organic compounds (VOCs) contributes to adverse health effects in humans. No previous study has examined the use of feminine hygiene product as a potential source of VOCs. Several scientists and interest groups are calling for more research to fill in the gaps. Data on 2,432 women aged 20-49 years from NHANES 2001-2004 were used. We examined the associations between self-reported use of feminine products (tampons, sanitary napkins, vaginal douches, feminine spray, feminine powder, feminine wipes/towelettes, and other products) with whole blood concentrations of VOCs. Concentrations were log-transformed to ensure normality. We utilized a directed acyclic graph to identify a minimal adjustment set to account for confounding. Multivariate linear regression models with complex survey design were used to estimate percent changes in VOC concentrations and 95% confidence interval (CI). Black women had a significantly more use of vaginal douching, and significantly higher whole blood concentrations of 1,4-dichlorobenzene (P<.0001). After adjusting for age, race/ethnicity, educational attainment, income-to-poverty ratio, body mass index, pregnancy status, and menopausal status, we observed a dose-response relationship between a frequency of vaginal douching in the past 6 months and 1,4-dichlorobenzene (P-trend=0.04). Compared to never users, women with occasional use (≥1/month) of vaginal douching had 18.1% (95%CI: -12.0%, 58.7%) higher concentrations, and those with frequent use (≥ 2/month) had 81.0% (95%CI: 2.2%, 220.8%) higher concentrations of 1,4-dichlorobenzene. Use of feminine powder in the past month was also significantly associated with 35.6% (95%CI: 0.4%, 83.2%) higher concentrations of ethylbenzene. The presence of environmental chemicals contained in feminine hygiene products warrants further examination with longitudinal designs and repeatedly-collected samples.