Vaginal-Stimulating Product Use and Cervicovaginal Health Among Adolescent Girls and Young Women in Rural South Africa: A Cross-Sectional Baseline Study

Background Vagina-stimulating products (VSPs) are widely used in sub-Saharan Africa for perceived sexual enhancement, hygiene, or cultural practices, yet their biological implications for cervical health remain poorly understood, particularly among adolescent girls and young women (AGYW). These practices occur within largely unregulated informal markets and intersect with gender norms, sexual negotiation, and reproductive health vulnerability among AGYW. We present baseline findings from a prospective cohort examining associations between VSP use, cervicovaginal abnormalities, and sexually transmitted infections (STIs). Methods Cross-sectional baseline data were analysed from 252 sexually active, HIV-negative participants enrolled in rural KwaZulu-Natal, including adolescents (n=188, 14-19 years) and adults (n=64, 25-35 years). Participants completed structured questionnaires and underwent clinical examination, STI testing, human papillomavirus (HPV) genotyping, vaginal pH assessment, and colposcopy. VSP use was categorised as intravaginal, ingested, or none. Age-stratified multivariable logistic regression models estimated statistical associations, adjusting a priori for age, hormonal contraceptive use, condom use, vaginal pH and lifetime number of sexual partners. Results VSP use was common among adolescents (68.1%) and adults (69.8%), with adolescents more likely to report intravaginal use and adults more likely to report ingested products. Among adolescents, VSP use was not statistically associated with cervicovaginal abnormalities after adjustment. However, exploratory analyses showed higher prevalence of Trichomonas vaginalis infection (p=0.021) and HPV-16 (p=0.007) among VSP users. Alum use was statistically associated with lower odds of visible cervicovaginal injury (OR 0.14; 95% CI 0.04-0.48), though this finding should be interpreted cautiously. Among adults, both intravaginal (aOR 3.7; 95% CI 1.2-11.8) and ingested (aOR 2.9; 95% CI 1.1-8.5) VSP use were statistically associated with cervical ectopy, while product-specific associations with individual products did not persist after adjustment. Conclusion VSP use is highly prevalent among AGYW, with distinct age-specific patterns. In this cross-sectional baseline analysis, VSP use was statistically associated with cervical ectopy among adults, while exploratory findings suggested associations with STI and HPV patterns among adolescents. These hypothesis-generating findings underscore the need for longitudinal and mechanistic studies to clarify biological pathways linking VSP use with infection risk, and highlight the potential importance of culturally responsive sexual health interventions and regulatory attention to informal vaginal product markets.