Anorectal douching:
(1) may be performed before or after intercourse
(2) may involve home-made solutions (water, water and soap, etc) or a commercial enema product
People who engage in anorectal douching:
(1) are at risk for anorectal gonorrhea, chlamydia, syphilis and HPV infections
(2) are at risk for HIV transmission
(3) are at risk for anorectal trauma
(4) may engage in substance abuse
Factors impacting risk:
(1) use of a condom
(2) use of a lubricant
(3) hyperosmolar or hypo-osmolar solutions or lubricants
(4) chemical irritants in the enema solution
(5) concomitant substance abuse
(6) use of pre-exposure prophylaxis
