Global WASH frameworks address water access, sanitation infrastructure and handwashing. Genital hygiene is not usually named as a separate category. This page sets out why we think the question deserves attention. It is an opinion piece, not a finding.
A 2018 systematic review of non-antibiotic measures to prevent urinary tract infections (UTIs) in pregnancy (Ghouri, Hollywood and Ryan, BMC Pregnancy and Childbirth) found limited evidence overall and concluded that only hygiene measures were supported by evidence to be recommended. UTIs in pregnancy are associated with adverse outcomes, and in low-resource settings they often go untreated.
We have not found genital hygiene as a named category in the conceptual framework for WASH in maternal and reproductive health by Campbell and colleagues. We have not systematically reviewed all WASH programming, so this observation is limited to that framework.
Evidence on genital hygiene and UTIs in pregnancy is limited. We think it deserves more research, not that it is proven.
Observational studies have examined the association between hygiene practices, sexual activity and UTI during pregnancy. Observational data cannot show that hygiene changes cause fewer infections.
Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy
The Ghouri et al. (2018) review summarised eight studies of non-antibiotic measures and found the evidence limited.
A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy
This conceptual framework maps how water, sanitation and hygiene relate to maternal and reproductive health across the birth pathway.
Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework
If genital hygiene is not a recognised domain within WASH, interventions in this area are harder to evaluate, fund or scale, whatever their merit.
We raise the question because our own research touches the male genital microbiome. We do not claim that any product or device addresses it.
If you work in WASH, maternal health or public health and have a view on this question, we would like to hear from you.
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