More on Vaginal Inflammation in Africa

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Abstract
The conclusions drawn by Brown et al. (Aug. 20 issue)1 illustrate one of the dangers of limited investigations in Africa and the pitfalls of inadequately controlled studies. The lack of microbiologic studies of the women studied in Zaire and the absence of observations in comparable prostitutes with wet vaginas or vaginal discharge, symptomatic of acute inflammation, who enjoy sexual intercourse detract from the study. However, the use of intravaginal medicaments or traditional medicinal preparations has been reported to be common among prostitutes in some African countries2. They are used primarily for preventive purposes against sexually transmitted diseases, not to produce dryness and enhance sexual pleasure. This practice is not universal in Africa but is relatively common among rural and poor women and prostitutes. It is likely that the epithelial changes visualized on colposcopy in these women are due to sexually transmitted diseases rather than to the sole effects of the powders used intravaginally or to both factors combined. This can be verified by in vitro studies. There is a need to look into this sociocultural practice and its efficacy in relation to the prevention of sexually transmitted diseases in general and the heterosexual transmission of AIDS in particular3.