Table 2. Summary effect estimates for studies reporting associations between intravaginal practices and HIV-1 (objective 1), and intravaginal practices and vaginal infections (objective 2).

Intravaginal practice	Outcome	Unadjusted effect estimate			Adjusted effect estimate
		(Study ref.)	Summary (95% CI)	I2	(Study ref.)	Summary (95% CI)	I2
Any vaginal practicea	HIV	[7], [14]–[16], [24]	2.65 (0.95, 7.36)	92.0%	[14], [16]	0.87 (0.67, 1.13)	0.0%
Intravaginal cleansingb	HIV	[14]–[16]	1.39 (0.76, 2.54)	76.6%	[15], [16]	1.88 (0.53, 6.69)	83.2%
Insertion of substancesc	HIV	[14], [24]	1.47 (1.03, 2.10)	0.0%	[14]	1.09 (0.71, 1.67)	..
Any vaginal practiced	BV	[14], [34], [35]	1.20 (1.09, 1.34)	0.0%	[25], [27], [35]	1.31 (0.87, 1.97)	38.8%
Intravaginal cleansing or douchinge	BV	[33]–[35]	1.20 (1.03, 1.40)	0.0%	[25], [27], [33]–[35]	1.12 (0.82, 1.54)	49.2%

Legend:

^aIncludes: ‘anything to dry or tighten your vagina for sex’ or ‘anything to clean the inside of your vagina’ [14]; intravaginal washing with water, soap or other substances including detergents and antiseptics [15]; ‘any intravaginal practice reported’ [16]; insertion of herbs [24].

^bIncludes: ‘anything to clean the inside of your vagina’ [14]; intravaginal washing with soap [15]; ‘any intravaginal practice reported’ [16].

^cIncludes: ‘anything to dry or tighten your vagina for sex’ [14]; insertion of herbs [24].

^dIncludes: ‘anything to dry or tighten your vagina for sex’ or ‘anything to clean the inside of your vagina’ [14]; ‘douching for cleanliness’ [25]; ‘douching’ [27]; ‘wiping inside the vagina with water, cloth and/or fingers and sometimes with soap or other cleaning agents as part of regular hygiene [34]; ‘vaginal douching using only soap and/or water’ [35].