Vaginal microbiome knowledge and hygiene practices among women in Saudi Arabia: a cross-sectional study
Only 20.67% of participants correctly identified Lactobacillus as the dominant genus in a healthy vaginal ecosystem, and use of internal vaginal washes was significantly associated with lower vaginal microbiome knowledge scores (β = −0.30; 95% CI: −0.58 to −0.01).
| Population | Women aged ≥18 years residing in Saudi Arabia (n = 1,040), recruited by convenience and snowball sampling via social media |
|---|---|
| Exposure | Online questionnaire assessing knowledge of the human and vaginal microbiome and intimate hygiene practices |
| Comparator | Internal comparisons by educational level, healthcare employment, and type of hygiene product used |
| Outcome | Correct identification of Lactobacillus as dominant genus; Vaginal knowledge score and internal vaginal wash use; Knowledge score and higher education level; Knowledge score among healthcare workers; Other feminine product use and knowledge score |
Summary of findings
| Outcome | Effect | 95% CI | Certainty | Clinical relevance | Notes |
|---|---|---|---|---|---|
| Correct identification of Lactobacillus as dominant genus | prevalence 20.67% (215/1040) | — | Low | — | 1 studies |
| Vaginal knowledge score and internal vaginal wash use | beta -0.30, 95% CI -0.58 to -0.01, p=0.0403 | — | Low | — | 1 studies |
| Knowledge score and higher education level | direction positive (exact beta not reported in excerpt) | — | Low | — | 1 studies |
| Knowledge score among healthcare workers | direction positive (exact beta not reported in excerpt) | — | Low | — | 1 studies |
| Other feminine product use and knowledge score | no statistically significant association (p not reported) | — | Low | — | 1 studies |
Context
The Lactobacillus-dominated vaginal microbiome maintains acidic pH and suppresses pathogens, and is disrupted by hygiene practices such as internal douching. Data on vaginal microbiome awareness in Middle Eastern populations are scarce. This study is among the first to map this knowledge gap in Saudi Arabia.
What the study showed
Only 215 of 1,040 women (20.67%) correctly identified Lactobacillus. Knowledge scores were higher among women with higher education and healthcare workers. Use of internal vaginal washes was associated with lower knowledge scores (β = −0.30; 95% CI: −0.58 to −0.01; p = 0.0403). No other feminine product showed a statistically significant association with knowledge scores.
How it was done
Cross-sectional online survey conducted between November 2024 and February 2025 among 1,040 women ≥18 years residing in Saudi Arabia, recruited via convenience and snowball sampling through social media platforms. Multivariable linear regression examined associations between sociodemographic characteristics, hygiene practices, and knowledge scores.
Effect magnitude
The association between internal vaginal wash use and lower knowledge was statistically significant but small in magnitude (β = −0.30; 95% CI: −0.58 to −0.01). The CI approaches zero, indicating a borderline effect.
Risk of bias
Convenience and snowball sampling via social media introduces substantial selection bias, over-representing young, educated, digitally connected women and limiting generalizability. The cross-sectional design precludes causal inference between hygiene practices and knowledge level. No formal risk-of-bias tool was applied (the AXIS checklist would be appropriate for cross-sectional surveys). The temporal direction of the knowledge–practice association remains undetermined.
What this study does NOT prove
This study does not prove that hygiene practices cause vaginal microbiome alterations or that educational interventions improve reproductive outcomes. Findings are not generalizable beyond Saudi Arabia or to women without social media access.
In clinical practice
Healthcare providers should incorporate vaginal microbiome education into routine gynecological consultations, particularly for patients who report internal douching. Approaches should be culturally adapted for Middle Eastern populations. This study provides no basis for recommending any specific clinical intervention beyond health education.
Limitations
Convenience and snowball sampling via social media introduces substantial selection bias, over-representing young, educated, digitally connected women and limiting generalizability. The cross-sectional design precludes causal inference between hygiene practices and knowledge level. No formal risk-of-bias tool was applied (the AXIS checklist would be appropriate for cross-sectional surveys). The temporal direction of the knowledge–practice association remains undetermined.
What is still missing
Longitudinal or educational intervention studies are needed to determine whether improving vaginal microbiome knowledge effectively reduces disruptive hygiene practices and clinical outcomes such as bacterial vaginosis.
Technical appendix
Version history
- 1.0 · 2026-06-21 — Auto-generated under Evidence Standard v1.0