Global WASH frameworks address water access, sanitation infrastructure, and handwashing. Genital hygiene does not appear. Yet a systematic review of non-antibiotic interventions for UTI prevention in pregnancy found genital cleansing to be the most effective measure available. This page is about the gap between that evidence and the frameworks meant to act on it.
A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy identified genital cleansing as the single most effective intervention — outperforming hydration, probiotics, and other behavioural hygiene practices. UTIs in pregnancy are among the most common drivers of preterm birth and low birth weight globally, and in low-resource settings they frequently go untreated.
Despite this evidence, no genital wash concept exists within established WASH frameworks. The seminal framework paper "Getting the basic rights — the role of water, sanitation and hygiene in maternal and reproductive health" maps WASH interventions across the reproductive health pathway but does not include genital hygiene as a category. The gap is structural, not incidental — and it has persisted while the evidence has continued to accumulate.
Genital cleansing was identified as the most effective non-antibiotic intervention for UTI prevention in pregnancy. It has no place in WASH programming.
Prospective studies have demonstrated a direct association between genital hygiene practices and urinary tract infection risk during pregnancy. Sexual activity and inadequate periurethral hygiene are among the strongest modifiable risk factors identified, pointing to both male and female genital hygiene as clinically relevant variables.
Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy
A systematic review of non-antibiotic measures for UTI prevention in pregnancy ranked genital cleansing as the most effective intervention across all categories examined. This finding has not been translated into any WASH programme, clinical guideline, or public health campaign at scale.
A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy
The most widely cited conceptual framework for WASH in maternal and reproductive health maps the role of water, sanitation, and hygiene across the birth pathway — from pre-conception through the postnatal period. Genital hygiene does not appear as a category. The framework is comprehensive in its scope; its omission of this domain reflects a field-wide blind spot.
Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework
The Circunaro device — a medical-grade silicone ring designed to maintain aeration of the subpreputial space — is one concrete example of what a genital hygiene intervention could look like in practice. It is water-independent, non-antibiotic, reversible, and manufacturable at low cost. It holds CE marking and has a six-year commercial safety record.
But the broader point is not about this device. It is about the absence of a category. Without genital hygiene as a recognized domain within WASH, no such intervention — however evidence-grounded — can be systematically evaluated, funded, or scaled. The Circunaro device is an example of an unexploited opportunity that exists precisely because the conceptual framework does not.
We are seeking researchers, public health practitioners, and WASH programme designers willing to explore what a genital hygiene component within WASH frameworks could look like. Addressing this conceptual gap is, we believe, essential for improving maternal and reproductive health outcomes globally. If your work touches these areas, we want to hear from you.
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