Preference for dry sex, condom use and risk of STI among HIV-negative black women in the Western Cape province, South Africa

The practice of wiping, douching or inserting substances into the vagina is reportedly common in sub-Saharan Africa. Intercourse following such vaginal treatment is referred to as ‘dry sex’. The most common reasons offered by women for these practices include the enhancement of sexual experience through sensations of vaginal dryness, tightness or warming; cleansing of the vagina before or after intercourse; treatment or prevention of STI; restoration and tightening of the vagina after delivery; or the satisfaction of a partner. Although the evidence in the literature is inconclusive, it has been suggested that ‘dry sex’ may increase the risk of HIV infection among women through the sloughing of the vaginal wall during sex, or possible inflammation, ulceration or epithelial damage caused by the insertion of substances in the vagina. In a study conducted among Zimbabwean women, participants indicated that condoms frequently burst when used in conjunction with drying agents or ‘because the vagina was so tight’, and condoms may block the effect of some ‘love agents’ such as lovedrops (a commercial agent imported from South Africa) or mutundo wegudo (a traditional powder believed to have been made from baboon’s urine, which when rubbed on incisions on the body is believed to magically cause a man to remain faithful to one woman). In South Africa, where the HIV prevalence among pregnant women attending public health services in 2006 was 29.1%, there is increasing concern over the high prevalence of the practice of ‘dry sex’. It has been reported that 60% of men and 46% of interviewed women indicated preferring dry sex over lubricated sex. The most common materials used included tissues, towels or toilet paper; very few of the women reported using traditional herbs to dry the vagina. The specific materials or substances may vary widely across population groups. Many studies have focused on elucidating the mechanism through which substances inserted into the vagina, or dry sex practices, may directly increase the risk of HIV in women. A preference for the practice of dry sex among women could, however, reduce their desire to use condoms. Research into the implications of the preference for dry sex among women on their uptake of condoms use is therefore important. The objectives of this study were to describe dry sex behaviour among Xhosa women in South Africa, and to evaluate the association of the preference for dry sex with the rate of condom use and the prevalence of sexually transmitted infections (STIs) involving Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV).