{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T11:13:29Z","timestamp":1784978009777,"version":"3.55.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:00:00Z","timestamp":1616630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Expertise France","award":["16SANIN210"],"award-info":[{"award-number":["16SANIN210"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Intravaginal practices (IVPs), methods used by women most often to manage vaginal hygiene and address perceived disruptions to vaginal health, may increase the risk of contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). This qualitative study explores the social, professional, and peer context surrounding IVPs, the experiences of self-cleaning or getting cleaned from a health professional, and the perceived impacts of IVPs among female entertainment workers (FEWs) in Cambodia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In 2017, we conducted 27 focus group discussions from four provinces, and 16 follow-up semi-structured in-depth interviews with purposively selected participants in two provinces. Data collection occurred over three weeks, with concurrent data transcription and translation. The data from the transcripts were analyzed using Dedoose, an online, open-access qualitative analysis software. Two researchers independently labeled sections of transcripts associated with broader categories and subcategories based on the initial content analysis matrix and created codes. This process continued iteratively until a final coding schema and conceptual model was created.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We found that IVPs are widely practiced among FEWs in Cambodia and are associated with internalized and enacted stigma. Stigma was an overarching theme that impacted the sub-themes of (1) messages about cleaning, (2) the cleaning process, and (3) the impact of cleaning. Experiences of enacted stigma and internalized stigma permeated conversations about IVP, including feeling pressured by peers to keep themselves clean, practicing internal cleaning after transactional sex, and being called dirty by health providers.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>FEWs who practice IVP talk about it in the context of their lived experiences stigma and discrimination. Highly stigmatized practices such as IVP among FEWs may benefit from a harm reduction approach that emphasizes positive changes without judgment, coercion, or discrimination.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-021-01271-y","type":"journal-article","created":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T14:03:04Z","timestamp":1616680984000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["\u201cFeeling clean\u201d: stigma and intravaginal practices among female entertainment workers in Cambodia"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9376-5528","authenticated-orcid":false,"given":"Carinne","family":"Brody","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel L.","family":"Berkowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pheak","family":"Chhoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn C.","family":"Kaplan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sovannary","family":"Tuot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyan","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,25]]},"reference":[{"issue":"2","key":"1271_CR1","doi-asserted-by":"publisher","first-page":"e9119","DOI":"10.1371\/journal.pone.0009119","volume":"5","author":"AM Hilber","year":"2010","unstructured":"Hilber AM, Francis SC, Chersich M, Scott P, Redmond H, Bender N, et al. Intravaginal practices, vaginal infections and HIV acquisition: systematic review and meta-analysis. PLoS ONE. 2010;5(2):e9119. https:\/\/doi.org\/10.1371\/journal.pone.0009119.","journal-title":"PLoS ONE"},{"issue":"10","key":"1271_CR2","first-page":"753","volume":"36","author":"MJ Rosenberg","year":"1991","unstructured":"Rosenberg MJ, Phillips RS, Holmes MD. Vaginal douching. Who and why? J Reprod Med. 1991;36(10):753\u20138.","journal-title":"J Reprod Med."},{"key":"1271_CR3","doi-asserted-by":"crossref","unstructured":"Bui TC, Tran LT-H, Hor LB, Scheurer ME, Vidrine DJ, Markham CM. Intravaginal practices in female sex workers in Cambodia: a qualitative study. Arch Sex Behav. 2016;45(4):935\u2013943.","DOI":"10.1007\/s10508-015-0675-1"},{"issue":"7","key":"1271_CR4","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1136\/sti.2007.028597","volume":"83","author":"AM Hilber","year":"2007","unstructured":"Hilber AM, Chersich MF, van de Wijgert JHHM, Rees H, Temmerman M. 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The Touro College Institutional Review Board (No. PH-0117) The informed consent process was such that the data collector read the informed consent to the participant, asked for their verbal consent, signed as a witness and gave a copy of the consent form to the participant. Participants were told that their participation was voluntary, and they could withdraw from the study at any time. Participants were informed of the special issues of confidentiality that come with the focus group study design. In addition, participants were offered escorted referrals to counselors and health services including to a local women\u2019s center.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"127"}}