Women & Health

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Female university students’ menstrual-hygiene

management and factors associated with
genitourinary-tract infections in Korea

Kyung Mi Kim & Jeong Sil Choi

To cite this article: Kyung Mi Kim & Jeong Sil Choi (2019): Female university students’ menstrual-
hygiene management and factors associated with genitourinary-tract infections in Korea, Women &
Health, DOI: 10.1080/03630242.2019.1680482

To link to this article: https://doi.org/10.1080/03630242.2019.1680482

Published online: 20 Oct 2019.

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WOMEN & HEALTH
https://doi.org/10.1080/03630242.2019.1680482

Female university students’ menstrual-hygiene management

and factors associated with genitourinary-tract infections in
Korea
Kyung Mi Kima and Jeong Sil Choib
a
Department of Nursing Science, Chungbuk National University, Cheongju, Korea (the Republic of); bCollege
of Nursing, Gachon University, Incheon, Korea (the Republic of)

ABSTRACT ARTICLE HISTORY

This study examined female university students’ menstrual-hygiene Received 9 January 2019
management and identified factors associated with genitourinary Revised 7 October 2019
tract infections in this sample. This study was conducted as Accepted 8 October 2019
a descriptive survey. Participants were 383 female students from six KEYWORDS
universities in South Korea. Data were collected between April and Genitourinary infection;
June, 2017. Multiple logistic regression analysis was used to access hygiene; menstruation
the factors associated with genitourinary-tract infections. Multiple
logistic regression revealed that genitourinary tract infections were
significantly associated with low socioeconomic level, history of sex-
ual intercourse, and vaginal douching during menstruation. We eval-
uated menstrual hygiene practices and their relation to genitourinary
tract infections. Korean college students were relatively good at
managing menstrual hygiene. However, some menstrual hygiene
behaviors were improper. Therefore, school and community health
agencies should provide education to maintain adequate menstrual
hygiene and correct erroneous hygiene practices to prevent geni-
tourinary tract infections.

Introduction
Menstruation is a physiological phenomenon that occurs naturally each month in healthy
women, from puberty to menopause (Jones et al. 2009; Sumpter and Torondel 2013).
Menstrual hygiene management differs by country and even within a country, based on
personal preference, available resources, socioeconomic status, region, cultural belief, and
knowledge and education (Sumpter and Torondel 2013). Menstrual hygiene management
is defined as a series of behaviors related to the cleansing or drying of the genital area and
the use of pads, tampons, and panties to absorb menstrual blood (Ahn and Cho 2014).
Previous studies have reported that poor menstrual hygiene management is a cause of
reproductive tract infections worldwide, especially bacterial vaginosis or vulvovaginal
candidiasis (Klebanoff et al. 2010; Sumpter and Torondel 2013).
During the menstrual period, menstrual discharge causes the acidity of the vagina to
change from acid to alkaline, thereby destroying the balance of normal flora, weakening
the immune response, and making it vulnerable to infection (Bahram, Hamid, and Zohre
2009). If the period between sanitary pad replacements is too long or poor menstrual

CONTACT Jeong Sil Choi jschoi408@empas.com College of Nursing, Gachon University, Medical Campus, Incheon,
21936 Korea (the Republic of)
© 2019 Taylor & Francis Group, LLC
2 K. M. KIM AND J. S. CHOI

hygiene management is practiced, such as delayed bathing or vaginal douching during

menstruation, the chance increases of genitourinary tract infections occurring that may
damage the skin of the vulva (Klebanoff et al. 2010; Sumpter and Torondel 2013). Thus,
personal hygiene practices, such as genital washing, sanitary-napkin care, and hand
washing during the menstrual period are the most basic and essential health behaviors
to maintain health and prevent the spread of disease (Ahn and Cho 2014). In contrast,
although menstrual hygiene management was associated with genitourinary tract infection
in seven studies, a meta-analysis showed no relation (odds ratio [OR]: 1.07, 95% con-
fidence interval [CI]: 0.52–2.24), suggesting the need for research to investigate and verify
the causes of genitourinary tract infections (Sumpter and Torondel 2013).
Searches for studies of menstrual hygiene management among 10–19-year-old female
students in low- and middle-income countries, published between 2000 and 2015 in the
Google Scholar, PubMed, and EBSCO’s Global Health electronic databases, revealed 81
studies in 25 countries, mainly in Africa and Asia (Chandra-Mouli and Patel 2017).
However, no studies were conducted in Korea, which has a strong Confucian influence
and is a conservative society regarding sex (Ahn and Cho 2014). Female college students
are fertile women who perform menstrual hygiene management themselves and are
important nursing clients in preserving the genital structure and functions necessary for
future pregnancy (Ameade and Garti 2016). A study of menstrual hygiene in Korea
showed that the incidence of vaginitis was low in adolescence at 1.0% (Ahn and Cho
2014) and that rates among middle-aged women were 26.7% and 11.9% among those who
did and did not practice vaginal douching, respectively, showing a significant relationship
between vaginal douching and vaginitis (Ahn 2013).
The purpose of the present study was to investigate the current state of menstrual-
hygiene management in Korean female college students in East Asia and to identify the
menstrual hygiene management factors related to genitourinary tract infections. The
purpose of this study was to provide basic data on menstrual hygiene management
among Korean female college students that will contribute to the preparation of guidelines
and educational materials for safe and proper menstrual hygiene management.

Methods
Study design and sample
This quantitative research study was conducted as a descriptive survey using a self-
reported questionnaire. The data collection period was from April to June 2017. Study
participants were 383 female college students from six different four-year universities in
Seoul and Incheon, Korea, recruited by convenience sampling. However, quota sampling
was used to recruit equal numbers of participants at each university and grade.
Participants’ majors were nursing, medicine, clinical laboratory, or health administration.
Married and pregnant students were excluded. Researchers visited classrooms of each
school to inform participants of the purpose of the research and the time required to
complete the questionnaires. Participants understood the purpose of the study and the
methods of participation and volunteered to provide consent to participate.
To protect personal information, participants submitted the questionnaires to us in
individual envelopes. The number of participants needed was calculated using G-Power
 WOMEN & HEALTH 3

3.1 (Faul et al. 2007). The number of the women required to complete the questionnaires
was at least 95 for a detectable odds ratio [OR] of 2.70, selected on the basis of previous
studies on the relationship between vaginitis and vaginal douching in Korean middle-aged
women (Ahn 2013), a significance level of 0.05, and a power of 0.95 for the logistic
regression. A total of 400 students were recruited to participate in the survey, considering
that the rate of vaginitis among college students is lower than that of middle-aged women
and to prepare for potential dropouts. A total of 398 respondents (response rate 99.5%)
responded to the survey, and 383 questionnaires (96.2%) were used in the analysis, after
excluding 15 questionnaires that were not completed.

Measurements
The variables used to explore the risk factors for genital infection were revised and
supplemented, based on those identified in previous studies (Ahn and Cho 2014;
Ameade and Garti 2016; Klebanoff et al. 2010; Sumpter and Torondel 2013). Tools
consisted of personal characteristics and characteristics of menstrual hygiene management
behavior. Personal characteristics included age, grade, socioeconomic level, and mother’s
educational level. Family socioeconomic status level was selected subjectively as low,
medium, and high, based on previous study (Yoon 2016) by participants, depending on
parental education, monthly income, and employment status (permanent position, tem-
porary position, and unemployed).
Reproductive health history included age at menarche, menstrual hygiene education
and source of education, history of sexual intercourse, and sexually transmitted disease
experience. The menstrual hygiene management practice was structured to indicate the
tools used and the risk factors for vaginitis (Klebanoff et al. 2010) based on a study of 31
items developed by Czerwinski (2000) and translated into Korean (Ahn 2013; Ahn and
Cho 2014).Menstrual hygiene management is defined as a series of behaviors related to the
cleansing or drying of the genital area and the use of pads, tampons, and underwear to
absorb menstrual blood (Ahn and Cho 2014; Czerwinski 2000). The questionnaire was
constructed to select the differentiated and multiple-choice items of “Yes” and “No”, and
two nursing professors verified the content validity. The categories of items consisted of
body-cleansing practices, feminine hygiene products usage and personal hygienic prac-
tices, sanitary protection methods and personal hygienic practices. Other items included
the use of waterproof underwear during menstruation, frequency of changing underwear,
methods of cleansing panties stained with blood, and swimming during menstruation.
Genitourinary tract infections were self-reported to indicate if participants had been
diagnosed with vaginitis or urethritis within the last six months or had symptoms of pain
or difficult urination, unusual vaginal discharge, vaginal itching, or foul vaginal smell.

Data analysis
The collected data were analyzed using IBM SPSS Statistics for Windows, version 23.0
(IBM Corp., Armonk, NY, USA). The participants’ general characteristics and character-
istics regarding menstrual hygiene management were analyzed using frequencies, percen-
tages, means, and standard deviations. Kolmogorov–Smirnov tests were used to
investigate if the variables followed a normal distribution and, thus, could determine the
4 K. M. KIM AND J. S. CHOI

ability to use parametric statistical tests. Chi-square and independent t-tests were used to
assess the bivariate relationships between the study variables and genitourinary tract
infections. After completing these tests, multiple logistic regressions were conducted to
assess the factors associated with genitourinary-tract infections, generating adjusted odds
ratios (aOR) and 95% confidence intervals (CI). The significant variables (p < .05) result-
ing from the chi-square and independent t-tests were included in the multiple regression
models using the Enter method (including socioeconomic status of family, reference
≧Middle; history of sexual intercourse, reference = No; history of sexual transmitted
infection, reference = No; vaginal douche during menstruation, reference = No; bidet
use during menstruation, reference = No). No interactions were examined. The fit of the
data to the logistic model was evaluated by the Hosmer-Lemeshow test. Regression
analysis satisfied the basic assumptions of the model. Autocorrelation and multi-
collinearity were not observed. In the logistic regression analysis, the level of significance
used was 0.05.

Ethical considerations
All study procedures were approved by the Gachon University Institutional Review Board
(No. 2017–072). All participants provided written, signed informed consents.

Results
Sample characteristics
Among the 383 female college students, 12.8% reported genitourinary tract infections
(Table 1). Their average age was 21 years, and 80.9% were majoring in some type of
medical science. Most responders had socioeconomic status “above the middle level”
(91.30%), and 61.4% reported their mothers had university graduate degrees or greater
education. Among genital health-related characteristics, the beginning age of menstrua-
tion was 12.53 years; 65.5% of participants had experience in menstrual hygiene education,
and 76.1% of them had received such education from their school. A history of sexual
intercourse was reported by 27.9% of participants, and 1.3% reported having a history of
sexually transmitted diseases.

Menstrual-hygiene management during menstruation

Regarding feminine hygiene product usage and personal hygienic practices, 96.6% of
participants reported performing genital washing during their menstrual period, with
a mean of 2.90 washings per day. Hand washing before washing their genitals was
reported by 84.3% of participants, and 69.5% answered they wiped from front to back.
Among participants who answered they washed their genitals during their menstrual
period, 25.7% reported performing vaginal washing. The use of vaginal deodorants during
their menstruation period was reported by 6% of participants.
Regarding sanitary protection methods and personal hygiene practices, 97.7% of parti-
cipants used mainly disposable sanitary pads, and 76.2% replaced the sanitary pad every
 WOMEN & HEALTH 5

Table 1. Bivariate relationships between genitourinary tract infections and descriptive characteristics
(N = 383).
Genitourinary tract
infections
No Yes
Total (87.2%) (12.8%)
n (%) or n (%) or n (%) or χ2
Categorical variables (range) M ± SD M ± SD M ± SD or t p
General characteristics
Age in years (17–32) 20.99 ± 1.97 20.92 ± 1.88 21.47 ± 2.48 2.07 .040
Grade Freshman 75 (19.6) 66 (19.8) 9 (18.4) 2.186b .535
Sophomore 74 (19.3) 68 (20.4) 6 (12.2)
Junior 106 (27.7) 90 (26.9) 16 (32.7)
Senior 128 (33.4) 110 (32.9) 18 (36.7)
Family socioeconomic status Low 38 (9.9) 29 (8.7) 9 (18.4) 4.484b .042*
≧Middle 345 (90.1) 305 (91.3) 40 (81.6)
Mother’s level of education ≦High school 149 (38.6) 126 (37.7) 22 (44.9) 0.927 .349
≧College 235 (61.4) 208 (62.3) 27 (55.1)
Reproductive health history
Menarche in years (9–18) 12.53 ± 1.32 12.54 ± 1.28 12.47 ± 1.57 0.346 .730
Education regarding MHM No 132 (34.5) 119 (35.6) 13 (26.5) 1.566b .260
Yes 251 (65.5) 215 (64.4) 36 (73.5)
Education source for MHMa Mother 53 (21.1) 46(21.5) 7 (19.8) 1.946 .746
Health education in high 93 (37.1) 79 (36.9) 14 (37.8)
school
University health 98(39.0) 84(39.3) 14(37.8)
education
Pamphlet or internet 7(2.8) 5(2.4) 2(5.4)
History of sexual intercourse No 276 (72.1) 261 (78.1) 15 (30.6) 47.952 <.001*
Yes 107 (27.9) 73 (21.9) 34 (9.4)
History of sexually transmitted No 378 (98.7) 333 (99.7) 45 (91.8) 20.509b .001*
infection Yes 5 (1.3) 1 (0.3) 4 (8.2)
MHM = menstrual hygiene management, aCase of “yes”; bFisher’s exact test, *p < .05.

two hours or less. Hand washing before replacement of the sanitary pad was reported by
26.6% of participants, and 97.7% performed hand washing after replacement.
Regarding the Other category, 49.1% responded they wore waterproof underwears
during menstruation, and 91.9% exchanged their underwear more than once per day
during menstruation (Table 2). Hand washing of blood-stained underwears was reported
by 70.2% of participants, and 14.6% responded they went swimming during menstruation.

Factors associated with genitourinary tract infection

Socioeconomic level (p = .042) showed significantly negative associations with genitour-
inary tract infections, and history of sexual intercourse (p < .001), sexually transmitted
disease experience (p = .001), vaginal douching during menstruation (p = .002), and bidet
use during menstruation (p = .015) showed significantly positive associations with geni-
tourinary tract infections.
Multivariate analysis of these five variables to adjust for confounding variables revealed
that those with a low socioeconomic status had a 2.66-fold increased odds of genitourinary
tract infections compared to those in the middle or upper socioeconomic levels (95% CI:
1.04–6.76). Those who reported having had sexual intercourse had a 7.37-fold increased
odds of genitourinary tract infections (95% CI: 3.63–14.98), and those who performed
6 K. M. KIM AND J. S. CHOI

Table 2. Bivariate relationships between genitourinary tract infections and menstrual hygiene manage-
ment during menstruation (N = 383).
Genitourinary tract
infections
No Yes
Total (87.2.%) (12.8%)
n (%) or n (%) or n (%) or χ2
Categorical variables (range) M ± SD M ± SD M ± SD or t p
Menstrual hygiene management during menstruation
I. Body-cleansing practice
Shower during menstruation No 14 (3.7) 10 (3.0) 4 (8.2) 3.242b .090
Yes 369 (96.3) 324 (97.0) 45 (91.8)
Bathtub during menstruation No 367 (95.8) 321 (96.1) 46 (93.9) 0.531 .443
Yes 16 (4.2) 13 (3.9) 3 (6.1)
Bidet during menstruation No 303 (79.1) 271 (81.1) 32 (65.3) 6.481 .015*
Yes 80 (20.9) 63 (18.9) 17 (34.7)
II. Feminine hygienic products usage and personal hygienic practice
Washing of reproductive tract during No 13 (3.4) 11 (3.3) 5 (4.1) 0.081b .676
menstruation Yes 370 (96.6) 323 (96.7) 47 (95.9)
Number of reproductive tract washing 2.90 ± 1.26 2.88 ± 1.23 3.02 ± 1.49 −0.740 .460
(1–7,/1 day)a
Washing solution of reproductive tract Only water 211 (57.0) 181 (56.0) 30 (63.8) 1.465 .528
during menstruationa Water with 97 (26.2) 88 (27.2) 9 (19.1)
soap
Water with 62 (16.8) 54 (16.7) 8 (17.0)
detergent
Washing hands before washing of the No 58 (15.7) 48 (14.9) 10 (21.3) 1.278 .282
reproductive tracta Yes 312 (84.3) 275 (85.1) 37 (78.7)
a
Wipe front to back No 113 (30.5) 100 (31.0) 13 (27.7) 0.211 .736
Yes 257 (69.5) 223 (69.0) 34 (72.3)
Vaginal douche during menstruationa No 275 (74.3) 249 (77.1) 26 (55.3) 10.190 .002*
Yes 95 (25.7) 74 (22.9) 21 (44.7)
Use of vaginal deodorant during No 360 (94.0) 317 (94.9) 43 (87.8) 3.876b .097
menstruation Yes 23 (6.0) 17 (5.1) 6 (12.2)
III. Sanitary protection methods and personal hygiene practice
Type of sanitary protection Single-use pads 374 (97.7) 325 (97.3) 49 (100.0) 0.611b .288
Others 9(2.3) 9(2.7) 0(0.0)
Frequency of changing sanitary pads ≧Every 2 hours 292 (76.2) 255(76.3) 37(75.5) 4.902b .179
Every 3–5 hours 51 (13.3) 41(12.3) 10(20.4)
Every 6–8 hours 16 (4.2) 16(4.8) 0(0.0)
≧Every 9 hours 24 (6.3) 22(6.6) 2(4.1)
Wash hands before changing sanitary pads No 281 (73.4) 242(72.5) 39(79.6) 1.114 .387
Yes 102 (26.6) 92(27.5) 10(20.4)
Wash hands after changing sanitary pads No 9 (2.3) 7(2.1) 2(4.1) 0.734 .323
Yes 374 (97.7) 327(97.9) 47(95.9)
IV.Other
Wear waterproof underwear during No 195 (50.9) 169(50.6) 26(53.1) 0.104 .762
menstruation Yes 188 (49.1) 165(49.4) 23(46.9)
Change of underwear during menstruation ≧1/1day 349 (91.1) 302(90.4) 47(95.9) 1.597 b
.285
1/2–3 days 34 (8.9) 32(9.6) 2(4.1)
How to wash blood-stained underwear Washing 91 (23.8) 79(23.7) 12(24.5) 0.020 .990
machine
Wash by hand 262 (70.2) 235(70.4) 34(69.4)
Use of boiling 23 (6.0) 20(6.0) 3(6.1)
water
Swimming during menstruation No 327 (85.4) 289(86.5) 38(77.6) 2.758 .127
Yes 56 (14.6) 45(13.5) 11(22.4)
a
Case of “yes”; bFisher’s exact test, *p < .05.
 WOMEN & HEALTH 7

Table 3. Multiple logistic regression analysis of factors associated with genitourinary tract infections
(N = 383).
Variables B SE Wald OR 95% CI p
Socioeconomic status of family (reference ≧ Middle) 0.977 0.476 4.216 2.657 1.04–6.76 .040*
History of sexual intercourse (reference = No) 1.997 0.362 30.460 7.370 3.63–14.98 <.001*
History of sexual transmitted infection (reference = No) 2.110 1.183 3.181 8.252 0.81–83.90 .074
Vaginal douche during menstruation (reference = No) 1.596 0.684 5.448 4.933 1.29–18.84 .020*
Bidet use during menstruation (reference = No) −0.586 0.715 0.672 0.557 0.137–2.26 .412
OR = odds ratio; CI = confidence interval, *p < .05.

vaginal douching during menstruation showed a 4.93-fold increased odds of genitourinary

tract infections (95% CI: 1.29–18.84; Table 3). The genitourinary tract infection rate was
23.7% and 11.6% for “low” and “middle or upper” socioeconomic levels, respectively,
37.1% and 5.4% for “have had sexual experience” and “have never had before,” respec-
tively, and 22.1% and 9.5% for “those who performed vaginal douching during menstrua-
tion” and “those who do not perform vaginal douche during menstruation,” respectively
(Tables 1 and 2).

Discussion
Menstruation is a physiological phenomenon and natural experience in mature women;
religious and cultural influences have been related to perceptions of menstruation and the
management of attitudes (Chandra-Mouli and Patel 2017; Sumpter and Torondel 2013).
Most female university students are fertile women; thus, correct menstrual knowledge and
practices are important for their health. The results of this study are meaningful in
focusing on the behavior of female Korean university students in their menstrual hygiene
practices and factors related to these practices.
In the present study, Korean female college students reported having received men-
strual hygiene education mainly at school, consistent with the results of a previous study
of menstruation among university students (Ameade and Garti 2016). However, partici-
pants in the present study reported that mothers had provided most information about
menstruation, including the use of sanitary pads and consultation when menstruation
started. According to Chandra-Mouli and Patel (2017) analysis of 81 previous studies,
adolescents first receive primary information from their mother or other female family
members, but this information is often insufficient, late, or incorrect. This finding was
considered to be due to socioeconomic and cultural factors, as the included studies were
mostly conducted in South Asia, East Africa, and West Africa. The results of these studies
indicated the importance of mothers as an educational resource for girls who are men-
struating and the need for proper menstrual hygiene knowledge. Increased knowledge of
menstrual care leads to more effective menstrual-hygiene practice (Ameade and Garti
2016; Javalkar and Akshaya 2017). Ameade and Garti (2016) found that only 3.1% of
participants consulted with their father about menstruation. In a society with a high
divorce rate such as Korea, it is difficult for girls living with their fathers to receive
menstrual hygiene education. Therefore, it is important to provide girls adequate men-
strual hygiene education in schools before they begin menstruating.
8 K. M. KIM AND J. S. CHOI

Bathing during menstruation should be recommended because it leads to maintenance

of body cleanliness, relief of menstrual pain and ballottement, and emotional relief (Ahn
and Cho 2014). Previous studies (Ameade and Garti 2016; Ahn 2013; Pal and Mullick
2017) have reported that the number baths decrease as menstruation starts; however, in
the present study, students often practiced body cleansing during menstruation. Most
(96.3%) of the university students reported taking showers, and 79.1% reported using
bidets. In this study, genitourinary tract infections were reported significantly more often
in the group that used a bidet and performed vaginal douching during menstruation. It is
necessary to educate habitual users regarding the appropriate use of bidets. Opportunistic
infections may occur during menstruation due to decreased normal flora in the vagina and
increased pathogens (Ahn and Cho 2014).
Vaginal douching has been associated with bacterial vaginitis (Choi 2018; Klebanoff
et al. 2010). In this study, vaginal douching during menstruation was also identified as
a factor associated with the reporting of genitourinary tract infections. In the present
study, 25.7% of participants reported vaginal douching during menstruation, similar to
results reported in Korean adolescents by others (Ahn and Cho 2014). However, in a study
of 2,602 women in the United States (Grimley et al. 2006), the douching prevalence rate of
women 18 to 24 years old was only 11.0%.
In the present study, we did not investigate the reasons for vaginal douching, but those
reported in previous studies included post-menstruation and sexual intercourse, cleansing
vaginal discharge, removing unpleasant odor, and before a pelvic examination (Ahn and
Cho 2014; Grimley et al. 2006). Grimley et al. (2006) reported that the higher the level of
education, the lower the douching-prevalence rate, with 3.7% university graduates or
above reporting douching. Ahn and Cho (2014) reported that Korean adolescents have
a false perception of the need for vaginal douching and have never received education on
this topic. Moreover, the 56% vaginal douching rate of middle-aged women in Korea (Ahn
2013) indicates not only the presence of misinformation from mothers but also the lack of
sufficient hygiene education in school. Therefore, it is necessary to provide correct knowl-
edge and information on hygiene management for mothers and adolescents, to encourage
discontinuation of poor washing practices (Ann and Cho, 2014).
The improper use of sanitary pads can cause skin rashes, urinary infections, and
vaginitis (Nayak et al. 2016); thus, the material of sanitary pads and the frequency of
exchanging pads are important. Most study participants used single-use pads, and most
reported exchanging pads at least every two hours, showing good hygiene practice. Hand
hygiene is the most basic act of hygiene. In the present study, most participants washed
their hands after exchanging menstrual pads, but only 26.6% washed their hands before
exchanging the pads. Previous studies also reported a lower prevalence of hand washing
before exchanging tampons or sanitary pads than hand washing after replacement.
Because hand washing is the most important method to prevent infection, it is necessary
to educate people to correct the incorrect belief that they do not have to wash their hands
before using sanitary pads.
Recently, menstrual cups have been introduced in Korea, and interest in them is
increasing. The menstrual cup is a product that receives menstrual blood by inserting
a bell-shaped silicone cup into the vagina. This technology may offer a sustainable,
practical, and cost-effective alternative (Kaiser 2013). However, it is important to be
hygienic when inserting, removing, and cleaning a menstrual cup during use.
 WOMEN & HEALTH 9

Most participants changed their panties more than once during menstruation and the
average frequency of genital washing was about three times a day; thus, their hygiene
management in this regard was acceptable overall. However, the performance of washing
from front to back during genital washing was only 69.5%. The hygienic practices of
wiping from front to back to clean the genitourinary system may prevent vaginal or
urethral infection from germs from the anus (Ahn and Cho 2014); however, this practice
was not performed properly by a large proportion of participants compared to other
sanitary methods.
In the present study, multiple logistic regression analysis showed that the final factors
independently associated with genitourinary tract infections were low socioeconomic
level, sexual experience, and vaginal douching during menstruation. Previous studies
mainly examined menstrual hygiene or analyzed the relationship between menstrual
hygiene and genitourinary tract infections by bivariate analysis. Therefore, it was difficult
to find studies to compare to our results on causal factors for genitourinary tract infec-
tions. A low socioeconomic level may make it difficult to maintain menstrual hygiene
because of limitations regarding sanitary pad use, lack of privacy, and difficulty in using
water.
Korean society tends to be conservative about sex, due to the influence of tradi-
tional Confucianism. Therefore, participants had relatively limited sexual experience
and few cases of genitourinary-tract infections or history of sexually transmitted
diseases. However, sexual experience has been to be related to the development of
genitourinary tract infections. Therefore, education on safe sexual practices and
cleansing of the genitalia after sexual intercourse is necessary. In addition, basic
education should be offered to prevent inappropriate vaginal douching, with emphasis
on the notion that vaginal douching during menstruation can cause genitourinary tract
infections.
This study evaluated the status of menstrual hygiene and its effect on genitourinary
tract infections. Korean college students in this study were relatively good at managing
menstrual hygiene, but need correction in performing vaginal douches or wiping from
front to back when cleansing the genitalia. To perform menstrual hygiene properly,
schools and community-health institutions should provide health education before
menstruation starts. In addition, it is important for mothers to have knowledge about
menstrual hygiene because it is important for the proper management of menstrual
hygiene for their daughters; therefore, community health services should provide educa-
tion and public relations programs. If the socioeconomic level is low, we suggest
purchasing sanitary pads cheaply or finding a way to support the purchase through
community-health services.
The limitations of this study included the difficulties in generalizing the results
because participants were gathered through convenience sampling, and most were
studying the health fields and were from the upper middle class or higher, leading to
potential selection and participant biases. The prevalence of genitourinary tract
infections could be biased or inaccurate because it was self-reported, based on
symptoms and physicians’ diagnoses. However, one study suggested community-
10 K. M. KIM AND J. S. CHOI

based studies are an important source in estimating the prevalence of genitourinary

tract infections, although reporting bias may lead to the underestimation of their
prevalence (Anand, Singh, and Unisa 2015).

Conclusion
The purpose of this study was to investigate the menstrual-hygiene status and factors
associated with genitourinary tract infections in Korean female college students. Although
college students generally performed menstrual hygiene care well, the direction of genital
wiping and the practice of vaginal douching were often performed erroneously during genital
cleansing. In this study, multiple logistic regression analysis showed that the final factors
independently associated with genitourinary tract infections were low socioeconomic level,
experience with sexual intercourse, and vaginal douching during menstruation. School and
community health agencies should provide education on safe sexual practices and inappropri-
ate vaginal douching during menstruation. Especially considering targeting the low socio-
economic portion of the population, we propose an intervention program that evaluates the
development and effectiveness of education about menstrual hygiene management and
public-relations programs in preventing genitourinary infections.

Disclosure statement
No potential conflict of interest was reported by the authors.

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