A Comparison of Native and Immigrant Female Students’ Genital Hygiene Behaviors: a Descriptive Cross-sectional Study

doi:10.21203/rs.3.rs-4227353/v1

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Research Article

A Comparison of Native and Immigrant Female Students’ Genital Hygiene Behaviors: a Descriptive Cross-sectional Study

https://doi.org/10.21203/rs.3.rs-4227353/v1

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Background

Genital hygiene behaviors are the care practices that individuals have developed with their knowledge, beliefs and habits. These behaviors and care practices may vary between individuals. The World Health Organization defines the 15–24 age group as youth, which includes young women of university age. This study aimed to compare the genital hygiene behaviors of native and immigrant female students enrolled in nonhealth departments at Mardin Artuklu University.

Methods

The study population consisted of female students (n = 5970) enrolled in nonhealth departments at Mardin Artuklu University. The sample size of the study was determined using power analysis and G*Power software. Each group (the immigrant group and the native group) comprised 165 individuals, with 330 individuals in total. The data collection tool consisted of two sections. The first section included a sociodemographic characteristics questionnaire, while the second section utilized the Genital Hygiene Behaviors Scale.

Results

The mean age of the students who participated in the study was 23.02 ± 4.42 years (Min: 17, Max: 50). The mean age of the native students was 23.12 ± 4.27 years (Min: 17, Max: 48), while the mean age of the immigrant students was 23.06 ± 4.72 years (Min: 18, Max: 50). Variables such as age group, income status, marital status, family type, social security, method of genital area cleansing, materials used, frequency of bathing, method of genital cleaning, underwear fabric, washing method, color, habit of hand washing before toilet use, regular menstruation, and presence of foul-smelling discharge were identified to create differences in terms of genital hygiene behaviors.

Conclusions

The scores on the Genital Hygiene Behaviors Scale for both native and immigrant students are not at the desired level. The general idea is that some sociodemographic characteristics and habits related to genital hygiene influence genital hygiene behaviors. To prevent reproductive health problems in both native and immigrant students at later ages, they should receive regular education on this topic.

Immigrants

native

students

hygiene

behavior

Women experience varying reproductive health issues at different age periods [1–4]. Therefore, urogenital system infections rank highly among the reasons for hospital admissions [1, 2]. The most common reproductive health issue experienced by young people is urogenital infection [1, 5]. Although genital tract infections are treatable and preventable, they emerge as a significant public health issue throughout the lives of women in developing countries given their prevalence and complications [3, 6–8]. The primary cause of infection is inadequate hygiene, although various factors, such as the anatomical proximity of the urethra, vagina, and anus in women, low socioeconomic status, lack of education, inadequate perineal and menstrual hygiene, vaginal douching, prolonged use of antibiotics and steroids, diabetes mellitus, immune deficiencies, smoking and alcohol consumption, unsafe sexual life, and performing abortions and miscarriages in unhealthy conditions, contribute to the development of genital infections [3, 9–11]. Globally, 75% of women have a history of vaginal infection or urinary tract infection. In Turkey, the prevalence of vaginal infection and urinary tract infection ranges from 37–65% [9, 12].

An individual’s care practices, developed through their knowledge, beliefs, and habits, include their genital hygiene behaviors. These behaviors and care practices vary among individuals [2, 13]. According to the Migration and Health Report published by the Ministry of Health, Turkey, in 2019, due to the lack of culturally sensitive sexual health improvement efforts, there has been an increase in urinary system and genital infection risks among refugees and asylum seekers concerning sexual health and reproductive health [14]. The World Health Organization defines the 15–24 age group as youth, which includes young women of university age. Considering that genital hygiene behaviors are learned at an early age, it is crucial to identify risky behaviors in young women who do not have active sexual lives and to take necessary measures to improve genital hygiene behaviors accordingly [3].

Although studies have been conducted on women’s genital hygiene behaviors both in Turkey and worldwide [2, 6, 7, 9, 15–24], no study has compared the genital hygiene behaviors of native and immigrant female students. The present study aimed to compare the genital hygiene behaviors of native and immigrant female students enrolled in nonhealth departments at Mardin Artuklu University. In line with this objective, the following questions are answered:

Are there differences in terms of genital hygiene behaviors between native and immigrant female students?
Do native female students have higher scores for genital hygiene behaviors?
Do immigrant female students have higher genital hygiene behavior scores?
What are the factors influencing the genital hygiene behaviors of native and immigrant female students?

Type of Research

This is descriptive and cross-sectional research.

Participants and Sampling

The study population consisted of female students (n=5970) enrolled in nonhealth departments at Mardin Artuklu University. The sample size of the study was determined using power analysis and G*Power software. A total sample size of 330 individuals was equally distributed to both groups, with a significance level of p=0.05, a medium effect size, a study power of 99%, and a 1-Beta value set to 0.99 based on Cohen’s d=0.5. The study employed a convenience sampling method, consisting of immigrant and native students who met the inclusion criteria and agreed to participate. In convenience sampling, a researcher begins to form the sample by selecting the most accessible respondents until reaching the desired sample size or by working on a situation that is the most accessible and maximizes savings.

The study included female students enrolled in departments other than health-related departments. Male students, those enrolled in health-related departments, those with severe physical illnesses hindering cooperation, those with auditory, visual, or cognitive impairments hindering communication, and those who declined to participate in the interview were not included in the study.

Ethics approval and consent to participate

All necessary permission was obtained from the Non-Invasive Ethics Committee of the Rectorate of Mardin Artuklu University (date: November 9, 2022, no: 2022/13-24) and from Karahan (2020), who developed the Genital Hygiene Behaviors Scale (GHBS) and assessed its validity and reliability. The study was conducted in compliance with the principles outlined in the Declaration of Helsinki. Prior to data collection, the participants were provided with necessary information about the research and gave their informed consent.

Data collection tools

The data collection tool consisted of two sections. The first section included the Sociodemographic Characteristics Questionnaire (SCQ), while the second section utilized the GHBS.

SCQ: The questionnaire was prepared by the researchers and included questions regarding the students’ age, nationality, place of residence, eligibility for citizenship if foreign, marital status, having children, family type, social security, parental education level, student’s employment status, income status, area of residence during education, smoking status, presence of chronic disease, and questions related to genital hygiene behaviors.
GHBS: This Likert-type scale was developed by Karahan in 2017, and its reliability and validity were assessed. It consists of 23 statements rated on a scale from “Strongly agree” to “Strongly disagree,” ranging from 5 to 1. The scale comprises three subscales: “General Hygiene Habits (GHH)” (first 12 statements), “Menstrual Hygiene Habits (MHH)” (13-20 statements), and “Awareness of Abnormal Findings (AAF)” (21-23 statements). In the evaluation, statements 7, 14, 19, 20, and 23 are reverse-coded, allowing for a score range of 23 (lowest) to 115 (highest), with higher scores indicating better genital hygiene behaviors in women. The Cronbach’s alpha value of the original scale was 0.80 [3]. In our study, the Cronbach’s alpha value for the scale was 0.83.

Statistical analysis

After the researcher coded the data from this study, they were transferred to SPSS software to conduct the necessary analyses.

The statistical analysis of the study involved the use of means, standard deviations, minimum and maximum values, and percentile numbers. To determine whether the data showed a normal distribution, the Shapiro and Kolmogorov‒Smirnov tests were used. Normally distributed scores were evaluated using t tests (independent samples t tests) and one-way ANOVA.

Table 1. Sociodemographic characteristics of the participants

Characteristics		Native Students		Immigrant Students
Characteristics		Number	Percentage (%)	Number	Percentage (%)
Age	17-20 Age	33	20.0	51	30.9
	21-25 Age	108	65.5	88	53.3
	26-30 Age	12	7.3	13	7.9
	31 Age ↑	12	7.3	13	7.9
Marital status	Married	16	9.7	32	19.4
Marital status	Single	149	90.3	133	80.6
Place of residence	Province	88	53.3	84	50.9
	District	59	35.8	60	36.4
	Village/town	18	10.9	21	12.7
Having children	Yes	11	6.7	26	15.8
Having children	No	154	93.3	139	84.2
Family type	Extended	47	28.5	59	35.8
Family type	Nuclear	118	71.5	106	64.2
Mother’s education level	Illiterate	42	25.5	29	17.6
	Primary school graduate	58	35.2	36	21.8
	Secondary school graduate	25	15.2	37	22.4
	High school graduate	24	14.5	34	20.6
	Bachelor’s degree and above	16	9.7	29	17.6
Father’s education level	Illiterate	7	4.2	12	7.3
	Primary school graduate	47	28.5	18	10.9
	Secondary school graduate	29	17.6	48	29.1
	High school graduate	43	26.1	40	24.2
	Bachelor’s degree and above	39	23.6	47	28.5
Student’s employment status	Working	28	17.0	21	12.7
	Not working	124	75.2	129	78.2
	Working part-time	13	7.9	15	9.1
Income status	Income less than expenditure	57	34.5	67	40.6
	Income equals expenditure	84	50.9	85	51.5
	Income more than expenditure	24	14.5	13	7.9
Area of residence during education	Public dormitory	89	53.9	48	29.1
	Private dormitory	7	4.2	20	12.1
	Student house	15	9.1	40	24.2
	Together with family	54	32.7	57	34.5
Social security	Has social security	105	63.6	59	35.8
Social security	Hasn’t social security	60	36.4	106	64.2
Smoking status	Smoking	20	12.1	13	7.9
Smoking status	No smoking	145	87.9	152	92.1
Presence of chronic disease	Has chronic disease	18	10.9	11	6.7
Presence of chronic disease	Has no chronic disease	147	89.1	154	93.3
Total		165	100.0	165	100.0

The students’ behaviors related to genital hygiene are presented in Table 2.

Table 2. Students’ behaviors related to genital hygiene

Characteristics		Native Students		Immigrant Students
Characteristics		Number	Percentage (%)	Number	Percentage (%)
Receiving genital hygiene education	Yes	59	35.8	82	49.7
	No	77	46.7	63	38.2
	Yes, but insufficient	29	17.6	20	12.1
Pretoilet hand washing habits	Yes	104	63.0	76	46.1
Pretoilet hand washing habits	No	61	37.0	89	53.9
Type of toilet used	Alaturka toilet	112	67.9	121	73.3
Type of toilet used	Alafranga toilet (closet)	53	32.1	44	26.7
How to clean the genital area	From front to back performed at one time	106	64.2	112	67.9
	From back to front performed at one time	39	23.6	23	13.9
	Randomly	20	12.1	30	18.2
Material used for genital hygiene	Water only	9	5.5	25	15.2
	Water and toilet paper	152	92.1	133	80.6
	Toilet paper only	4	2.4	7	4.2
Having genital or urinary tract infection	Yes	67	40.6	45	27.3
Having genital or urinary tract infection	No	98	59.4	120	72.7
Regular menstruation	Yes	87.3	87.3	127	77.0
Regular menstruation	No	12.7	12.7	38	23.0
Pain during menstruation	Yes	114	69.1	112	67.9
	No	12	7.3	9	5.5
	Sometimes	39	23.6	44	26.7
Bathing during menstruation	Yes	135	81.8	124	75.2
Bathing during menstruation	No	30	18.2	41	24.8
Bathing position during menstruation	Shower style	109	66.1	120	72.7
Bathing position during menstruation	Sitting	56	33.9	45	27.3
Frequency of bathing	Everyday	18	10.9	20	12.1
	2-3 times a week	137	83.0	131	79.4
	Once a week	9	5.5	12	7.3
	At intervals longer than one week	1	0.6	2	1.2
Use of any substance, cream, perfume, etc., on the genital area	Yes	12	7.3	26	15.8
	No	153	92.7	139	84.2
The way of genital cleaning	Wax	31	18.8	46	27.9
	Razor blade	69	41.8	79	47.9
	Epilator	46	27.3	27	16.4
	Clipper	2	1.2	5	3.0
	No hair	18	10.9	8	4.8
Presence of foul-smelling discharge	Yes	41	24.8	16	9.7
Presence of foul-smelling discharge	No	124	75.2	149	90.3
Training on abnormal discharge	Yes	21	12.7	50	30.3
Training on abnormal discharge	No	144	87.3	115	69.7
Underwear color	White	39	23.6	60	36.4
Underwear color	Colored	126	76.4	105	63.6
Underwear fabric	Cotton	139	84.2	133	80.6
	Polyester	9	5.5	12	7.3
	Satin	2	1.2	12	7.3
	Other	15	9.1	8	4.8
Washing method of underwear	At high temperature in the machine	127	77.0	132	80.0
	At low temperature in the machine	31	18.8	18	10.9
	By hand/by boiling	7	4.2	15	9.1
Ironing of underwear	Yes	6	3.6	12	7.3
	No	132	80.0	118	71.5
	Sometimes	27	16.4	35	21.2
Total		165	100.0	165	100.0

The descriptive statistical distribution of the scores of the GHBS and its subscales is presented in Table 3.

Table 3. The descriptive statistical distribution of the scores of the GHBS and its subscales

Scale and subscales	Native Students					Immigrant Students
Scale and subscales	N	Min.	Max.	Mean	Sd	N	Min.	Max.	Mean	Sd
GHBS	165	51.00	114.00	90.81	11.96	165	44.00	113.00	86.50	14.01
GHH	165	24.00	60.00	46.63	6.29	165	17.00	60.00	45.24	8.21
MHH	165	17.00	40.00	33.48	4.89	165	14.00	40.00	30.07	5.28
AAF	165	3.00	15.00	10.78	3.45	165	5.00	15.00	11.18	2.53

GHH:general hygiene habit, MHH: menstrual hygiene habit, AAF: awareness of abnormal findings

In the present study, genital hygiene behaviors and its subscales were not influenced by variables such as father’s education level, mother’s education level, having children, area of residence during education, employment status, receiving genital hygiene education, type of toilet used, pain during menstruation, use of any substance, cream, perfume, etc., on the genital area, training on abnormal discharge, underwear color, and ironing of underwear (p>0.05).

Table 4 presents the comparison of total and subscale scores of the GHBS between native and immigrant students based on certain characteristics.

Table 4. Comparison of total and subscale scores between native and immigrant students based on certain characteristics

Characteristics		Native Students				Immigrant Students
Characteristics		GHBS	GHH	MHH	AAF	GHBS	GHH	MHH	AAF
Age*	17-20 Age^a	87.36±12.92	43.72±6.75	33.03±5.53	10.60±3.46	87.80±13.20	46.41±7.45	30.66±5.24	10.72±2.59
	21-25 Age^b	90.77±11.55	46.85±5.98	33.47±4.81	10.45±3.49	84.60±13.61	44.05±8.22	29.52±5.16	11.02±2.33
	26-30 Age^c	10.41±8.77	52.33±4.71	35.66±4.57	12.41±2.99	91.00±13.92	47.61±9.18	31.15±3.84	12.3±2.61
	31 Age^d ↑	92.25±9.32	46.91±5.23	32.66±3.84	12.66±2.60	89.76±18.78	46.38±9.64	30.38±7.38	13.00±2.76
	Statistical Analysis	F =3.814 p = 0.011	F =6.209 p = 0.001	F =1.003 p = 0.393	F = 2.512 p = 0.061	F = 1.377 p = 0.252	F = 1.411 p = 0.242	F = 0.724 p = 0.539	F = 3.823 p = 0.011
	Difference	a-c.b-c. c-a-b	a-b-c. b-a-c.c-a-b						a-d. bd
Income status *	Income less than expenditure^a	87.17±12.31	45.40±6.36	32.56±4.78	9.21±3.56	85.43±14.61	44.45±8.73	29.76±5.33	11.08±2.66
	Income equals expenditure^b	91.90±11.88	46.94±6.37	33.64±5.00	11.32±3.08	87.81±13.50	46.20±7.74	30.38±5.13	11.22±2.43
	Income more than expenditure^c	96.25±10.39	48.45±5.46	35.12±4.41	12.66±2.94	83.46±14.28	42.61±8.17	29.46±6.29	11.38±2.69
	Statistical Analysis	F = 5.917 p = 0.003	F = 2.227 p = 0.111	F = 2.452 p = 0.089	F = 11.911 p = 0.000	F = 0.871 p = 0.421	F = 1.487 p = 0.229	F = 0.330 p = 0.719	F = 0.096 p = 0.908
	Difference	a-b-c.b-a.c-a			a-b-c.b-a.c-a
How to clean the genital area*	From front to back performed at one time^a	92.40±11.55	47.66±6.21	33.82±5.10	10.92±3.31	88.83±13.40	46.72±7.69	30.66±5.06	11.43±2.59
	From back to front performed at one time^b	89.66±11.50	45.79±6.02	33.15±4.21	10.71±3.51	83.43±12.18	42.78±7.72	29.82±4.66	10.82±2.42
	Randomly^c	85.35±12.53	42.80±5.78	32.35±4.96	10.20±4.11	80.16±15.50	41.63±9.13	28.03±6.15	10.50±2.28
	Statistical Analysis	F = 3.366 p = 0.037	F = 5.776 p = 0.004	F = 0.876 p = 0.418	F = 0.378 p = 0.686	F = 5.441 p = 0.005	F = 6.100 p = 0.003	F = 3.041 p = 0.051	F = 1.901 p = 0.153
	Difference	a-c.c-a	a-c.c-a
Material used for genital hygiene*	Only water^a	82.00±12.44	42.66±5.89	30.33±5.43	9.00±3.70	78.48±15.00	40.60±9.03	27.80±5.86	10.08±2.34
	Water and toilet paper^b	91.60±11.70	46.92±6.30	33.73±4.90	10.94±3.39	88.37±13.41	46.24±7.86	30.68±5.09	11.45±2.56
	Only toilet paper^c	84.25±4.34	44.50±4.12	31.00±4.96	8.75±4.11	79.57±10.43	43.00±6.48	26.57±3.55	10.00±1.00
	Statistical Analysis	F = 3.351 p = 0.031	F = 2.205 p = 0.114	F = 2.638 p = 0.075	F = 2.095 p = 0.126	F = 6.556 p = 0.002	F = 5.521 p = 0.005	F = 4.958 p = 0.008	F = 4.012 p = 0.020
	Difference	a-b				a-b	a-b	a-b	a-b
Frequency of bathing*	Everyday ^a	95.16±12.98	48.38±6.04	35.22±5.47	11.55±4.17	89.80±13.34	47.15±8.34	31.40±4.61	11.25±3.09
	2-3 times a week^b	90.70±11.57	46.54±6.31	33.35±4.86	11.81±3.25	86.81±14.06	45.22±8.21	30.33±5.28	11.25±2.54
	Once a week^c	83.11±8.06	43.11±4.10	31.55±3.24	8.44±4.21	78.66±12.87	42.50±7.91	25.8±4.70	10.33±2.60
	At intervals longer than one week^d	112.00	59.00	38.00	15.00	80.00±15.55	44.00±11.31	25.00±1.41	11.00±2.82
	Statistical Analysis	F = 3.286 p = 0.022	F = 2.787 p = 0.042	F = 1.558 p = 0.202	F = 2.227 p = 0.087	F = 1.811 p = 0.147	F = 0.817 p = 0.486	F = 3.907 p = 0.010	F = 0.485 p = 0.693
	Difference							a-c. b-c.c-a-b
The way of genital cleaning*	Wax^a	89.77±14.60	45.54±7.29	33.38±5.10	10.83±3.64	88.95±15.05	46.50±8.44	30.73±5.68	11.71±2.44
	Razor blade^b	87.95±11.37	45.26±6.23	32.50±4.83	10.18±3.45	85.67±13.20	44.94±7.77	29.92±4.96	10.79±2.52
	Epilator^c	94.04 ±9.09	48.28±5.70	34.51±4.09	11.24±3.41	87.81±12.29	46.37±7.63	30.11±4.89	11.33±2.61
	Clipper^d	82.50 ±20.50	43.00±2.82	28.50±12.08	11.00±5.65	69.40±13.52	35.40±10.73	24.20±2.94	9.80±2.48
	No hair	97.22±10.17	50.00±4.22	35.38±5.08	11.83±2.93	86.87±16.50	43.37±8.81	31.25±7.06	12.25±2.37
	Statistical Analysis	F = 3.699 p = 0.007	F = 3.476 p = 0.009	F = 2.475 p = 0.046	F = 1.138 p = 0.341	F = 2.425 p = 0. 050	F = 2.397 p = 0.050	F = 1.878 p = 0.117	F = 1.748 p = 0.142
	Difference	b-e	b-e		e-b	a-d	a-d. c-d
Underwear fabric*	Cotton^a	92.23±11.35	47.56±5.89	33.75±4.89	10.92±3.44	88.54±13.61	46.44±7.96	30.70±5.18	11.39±2.44
	Polyester^b	94.33±7.59	46.33±3.70	35.77±3.30	12.22±2.90	82.58±14.43	41.83±8.06	29.91±5.63	10.83±3.09
	Satin^c	82.00±7.07	38.50±353	31.00±2.82	12.50±0.70	78.08±11.42	41.25±6.91	26.75±4.26	10.08±2.15
	Other^d	77.66±10.32	39.26±6.08	29.93±4.33	8.46±3.15	71.12±8.77	36.50±6.74	24.75±3.32	9.87±3.18
	Statistical Analysis	F = 8.506 p = 0.000	F = 10.52 p = 0.000	F = 3.794 p = 0.012	F = 3.130 p = 0.027	F = 6.498 p = 0.000	F = 6.124 p = 0.001	F = 5.306 p = 0.002	F = 1.865 p = 0.138
	Difference	a-d.b-d. a-b-d	a-d.b-d. a-b-d	a-d.b-d. a-b-d	a-d.b-d. a-b-d	a-c-d.c-. d-b	a-d	a-d
Washing method of underwear *	At high temperature in the machine^a	91.51±11.14	46.93±6.05	33.54±4.77	11.03±3.26	88.13±13. 84	46.03±8.24	30.68±5.02	11.41±2.44
	At low temperature in the machine^b	86.87±13.12	44.51±6.66	32.61±5.27	9.74±4.00	78.11±11.44	41.72±6.71	26.77±5.66	9.61±2.72
	By hand/by boiling^c	97.71±11.25	50.42±7.13	36.28±4.71	11.00±3.26	82.20±14.59	42.60±8.39	28.60±5.69	11.00±2.56
	Statistical Analysis	F = 3.214 p = 0.043	F = 3.257 p = 0.041	F = 1.663 p = 0.193	F = 1.770 p = 0.174	F = 5.070 p = 0. 007	F = 3.112 p = 0.047	F = 5.226 p = 0.006	F = 4.217 p = 0.016
	Difference				a-b	a-b		a-b	a-b
Marital status**	Married	93.50±11.87	48.18±6.02	32.62±5.76	12.68±2.57	87.59±16.60	45.28±9.86	30.09±5.58	12.21±2.81
	Single	90.62±11.83	46.46±6.32	33.57±4.80	10.58±3.47	86.24±13.37	45.24±7.81	30.06±5.23	10.93±2.40
	Statistical Analysis	t = 0.924 p = 0.357	t = 1.041 p = 0.299	t = 0.-739 p = 0.461	t = 2.348 p = 0.020	t = 0.489 p = 0.625	t = 0.25 p = 0.980	t = 0.25 p = 0.980	t = 2.384 p = 0.022
Family type**	Extended	87.76±11.42	45.61±6.16	32.46±4.51	9.68±3.84	83.94±15.76	43.40±9.50	29.69±5.92	10.84±2.67
	Nuclear	92.15±11.80	47.03±6.33	33.88±4.99	11.22±3.19	87.92±12.80	46.27±7.25	30.28±4.91	11.36±2.45
	Statistical Analysis	t = -2.174 p = 0.031	t = -1.307 p = 0.193	t = -1.695 p = 0.092	t = -2.64 7 p = 0.009	t = 1.657 p = 0.101	t = -2.013 p = 0.047	t = -0.648 p = 0.518	t = -1.266 p = 0.207
Social security**	Has social security	92.58±10.63	47.48±5.71	33.92±4.19	11.17±3.49	89.84±12.17	47.00±7.11	31.11±4.95	11.72±2.63
	Hasn’t social security	87.96±13.25	45.13±7.00	32.71±5.88	10.11±3.29	84.64±14.66	44.27±8.64	29.49±5.40	10.87±2.43
	Statistical Analysis	t = 2.305 p = 0.023	t = 2.333 p = 0.021	t = 1.400 p = 0.165	t = 1.903 p = 0.059	t = 2.443 p = 0.016	t = 2.180 p = 0.031	t = 1.910 p = 0.058	t = 2.088 p = 0.038
Pretoilet hand washing habits**	Yes	94.25±10.84	48.44±5.91	34.66±4.60	11.14±3.39	90.07±14.54	46.94±8.69	31.42±5.36	11.71±2.55
	No	85.19±11.31	43.54±5.74	31.47±4.74	10.18±3.49	83.44±12.85	43.79±7.53	28.92±4.96	10.73±2.44
	Statistical Analysis	t = 5.093 p = 0.000	t = 5.193 p = 0.000	t = 4.246 p = 0.000	t = 1.74 2 p = 0.083	t = 3.107 p = 0.002	t = 2.493 p = 0.014	t = 3.104 p = 0.002	t = 2.515 p = 0.013
Regular menstruation**	Yes	91.40±11.77	46.85±6.29	33.72±4.77	10.81±3.42	88.53±13.22	46.41±7.80	30.77±5.02	11.33±2.50
	No	87.47±11.91	45.09±6.24	31.80±5.44	10.57±3.69	79.71±14.61	41.34±8.44	27.71±5.54	10.65±2.60
	Statistical Analysis	t = 1.425 p = 0.156	t = 1.19 7 p = 0.233	t = 1.690 p = 0.093	t = 0.307 p = 0.759	t = 3.522 p = 0.001	t = 3.450 p = 0.001	t = 3.226 p = 0.002	t = 1.457 p = 0.680
Bathing during menstruation **	Yes	92.38±11.38	46.94±6.16	34.36±4.57	11.08±3.33	87.20±14.15	45.43±8.37	30.61±5.15	11.15±2.47
	No	84.23±11.68	45.23±6.79	29.53±4.35	9.46±3.72	84.39±13.53	44.68±7.78	28.43±5.41	11.26±2.74
	Statistical Analysis	t = 3.531 p = 0.001	t = 1.346 p = 0.180	t = 5.277 p = 0.000	t = 2.350 p = 0.020	t = 1.114 p = 0.267	t = 0.507 p = 0.613	t = 2.311 p = 0.022	t = -0.251 p = 0.802
Presence of foul-smelling discharge**	Yes	85.80±11.57	45.90±6.64	31.87±4.73	8.02±3.51	78.93±13.01	41.93±7.66	27.31±5.91	9.68±2.98
	No	92.58±11.46	46.87±6.19	34.01±4.84	11.70±2.91	87.31±13.91	45.60±8.21	30.36±5.15	11.34±2.44
	Statistical Analysis	t = 3.276 p = 0.001	t = -0.853 p = 0.395	t = 2.464 p = 0.015	t = 6.647 p = 0 .000	t = 2.302 p = 0.023	t = 1.706 p = 0.090	t = 2.223 p = 0.028	t = 2.521 p = 0.013
Underwear color**	White	96.51±11.08	49.48±6.13	34.79±4.57	12.23±3.25	87.96±16.38	46.41±9.68	30.38±5.73	11.16±2.45
	Colored	89.16±11.54	45.74±6.10	33.07±4.93	10.34±3.39	85.66±12.47	44.58±7.21	29.89±5.04	11.19±2.59
	Statistical Analysis	t = 3.503 p = 0.001	t =3.340 p = 0.001	t = 1.930 p = 0.055	t = 3.063 p = 0.003	t =0.943 p = 0.348	t = 1.279 p = 0.204	t = 0.569 p = 0.570	t = -0.058 p = 0.954

*One-way ANOVA, **Independent samples t test

Our study revealed that the total mean score of the GHBS for native students was 90.81 ± 11.96, while for immigrant students, it was 86.50 ± 11.96. According to various studies examining genital hygiene behaviors, health service vocational school students had a total mean score of 86.89 ± 7.12 [25], nursing students had a mean score of 87.60 ± 8.97 [2], and midwifery students had a mean score of 95.25 ± 8.57 [19]. In a study conducted on adolescent girls, the mean score was 79.28 ± 6.80 [26]. Our study findings mostly align with the literature but differ from the findings of Mamuk et al.’s study.

There was a significant difference in the mean scores of the GHBS and the general hygiene habits subscale scores among native students based on age groups. Additionally, there was a difference in the mean scores of the awareness of abnormal findings subscale among immigrant students based on age groups. Although there are studies indicating that age group may not have an impact on genital hygiene behaviors or its subscales [2, 16], the data from our study support the notion that age may be influential.

There was a difference between the income status of native students and the mean scores of the GHBS and the awareness of abnormal findings subscale scores. Studies conducted in different locations [1, 15] show that as the income level increases, the total scores also increase. This indicates that individuals’ economic status plays a role in maintaining their genital hygiene.

Both native and immigrant students showed differences in marital status and mean scores on the awareness of abnormal findings subscale. The total mean scores were higher among married participants. The marriage rate among native students was 9.70%, while it was 19.40% among immigrant students. In a study evaluating vaginal discharge and genital hygiene habits [27], the marriage rate was 59.80%, and the percentage of those who answered “yes” to the option “vagina is left dry in the presence of abnormal vaginal discharge” was 53.90%. Additionally, the mean score of the genital hygiene behaviors inventory was higher. The influence of marital status on awareness of abnormal findings is supported by the literature.

While there were significant differences between native students’ family type, general hygiene habits, and awareness of abnormal findings subscale scores, such differences were observed in immigrants’ general hygiene habits subscale scores. The total mean scores of those living in nuclear families were higher. In a study conducted with adolescent girls attending school in Nepal, 67% of the participants had a nuclear family. Among those with one to four family members, the percentage of individuals exhibiting strong menstrual hygiene practices was greater than that among those with five or more family members [28]. In a study examining the genital hygiene behaviors of women visiting the Community Health Center in Mardin, women with nuclear families had higher mean genital hygiene behavior scores [22]. The results of our study mostly align with the findings in the literature. As the number of people in the family increases, the number of people sharing toilets, bathrooms and even washing machines may also increase, which may have a negative impact on hygiene.

Our study revealed that the percentage of native students who cleaned the genital area from front to back at one time was 64.2%, while this percentage was 67.9% among immigrant students. In general, this cleaning method had a positive effect on genital hygiene behaviors and habits. Various studies have shown a reverse relationship between cleaning the genital area from front to back and complaints of vaginal infection, discharge, itching, and pain [29, 30, 31, 32]. Another study revealed a significant difference between the method of cleaning the genital area and the total mean scores of the GHBS, general hygiene behaviors, menstrual hygiene, and awareness of abnormal findings subscales. Front-to-back cleaning yielded higher total mean scores [1]. Our study aligns with the literature. Cleaning the genital area using the appropriate procedure has a positive effect on genital hygiene.

Among all students, 75.20% of native students and 90.30% of immigrant students reported that they did not have foul-smelling discharge. The presence of foul-smelling discharge generally affects genital hygiene behaviors, menstrual hygiene, and awareness of abnormal findings. Muzayyanatul et al. (2018) reported a lower rate of pathological vaginal discharge (3.50%) among students who maintained genital hygiene [33]. Al-Kotb et al. (2016) reported that among the reported complaints, vaginal discharge was present in 18.60% of the patients [34]. The pads they use during menstruation, the duration of changing pads, and the lack of bathing habits during menstruation may have affected the results. In addition, the higher rate of marriage among migrant students suggests that they perform vaginal douching after sexual intercourse.

Our study concluded that pretoilet hand washing habits generally affect genital hygiene behaviors in both native and immigrant students. Those with pretoilet hand washing habits had higher total mean scores. Pretoilet hand washing habits were present in 63.00% of the native school students and 46.10% of the immigrant students. Studies in the literature have shown that the prevalence of pretoilet hand washing habits can vary between 27.80% and 93.70% [5, 13, 21, 35]. The variability in the rates of pretoilet hand washing habits in the literature may be influenced by limited facilities in dormitories and individuals’ lack of sufficient knowledge on the subject.

The rate of using water and toilet paper was 92.10% among native students and 80.60% among immigrant students. According to the results, the material used for genital cleaning among native students affects their genital hygiene behaviors, while among immigrant students, it affects both the GHBS and its subscales. Those who use water and toilet paper have higher scores. According to previous studies, the percentage of individuals using water and toilet paper for genital cleaning ranges between 65.10% and 70.50% [1, 9, 12, 20]. The greater number of students studying in health departments in dormitories may have contributed to an increase in the awareness of students studying in other departments.

In our study, those with social security had higher scores. Similar studies have shown similar results [22, 24, 36]. The study results are consistent with the literature. The lower cost of health care for those with social security directs them to health institutions and allows them to access the necessary information from health professionals.

Among the participants, 84.20% of the native students and 80.60% of the immigrant students preferred cotton fabrics for underwear selection. The use of cotton underwear has an effect on genital hygiene behaviors and its subscales. Studies conducted in different settings and at different times have revealed relationships between vaginal infections and cotton underwear [4, 8, 20, 21, 31, 37–40]. Our finding of a preference for cotton underwear among all fabrics aligns with the literature.

Among all the students, 76.40% of the native students and 63.60% of the immigrant students wore colored underwear. Among native students, those wearing white underwear had higher total scores on the GHBS, general hygiene habits subscale, and awareness of abnormal discharge subscale. In a study conducted by Ünsal et al. (2010) examining the genital hygiene behaviors of individuals living in rural areas, 77.40% of whom were women [4]; in a study by Dalbudak and Bilgili (2013), 64.00% of whom had no vaginal infections [8]; in a study by Ergün et al. (2020), 31.00% of whom were women [20]; and in a study by Akça and Türk (2021), 34.90% of whom stated that they only wore white underwear [30]. In general, studies, including our study, indicate that colored underwear is preferred. Women may need to be informed more about this issue.

Native students who hand wash their underwear with boiling water and immigrant students who wash it at high temperatures on machines generally have higher scores on the GHBS and its subscales. In a study by Baş et al. (2016) conducted at a credit and dormitories institution, 54.80% of the students [41], and in a study by Kartal et al. (2020) conducted on midwifery students, 91.40% of the students stated that they washed their underwear in the washing machine [19]. In a study by Toraman et al. (2021) examining the genital hygiene behaviors of women living in a women guest house, 20.70% of women washed their underwear at high temperatures in the machine [38]. In a study conducted by Bahram et al., 2009 in Iran, 76.20% of women with bacterial vaginosis (BV) stated that they always wash their underwear with hot water [42]. The studies in the literature may show variabilities, which may be attributed to limited resources, cultural differences, and insufficient knowledge on the subject. In communal living spaces, washing underwear separately and in a washing machine at high temperatures is the most ideal method, but it may be difficult to do this regularly.

Regular menstruation among immigrant students had an impact on the GHBS, general hygiene habits, and menstrual hygiene subscales. Those who experienced regular menstruation had higher total scores. In a study by Janoowalla et al. (2019) conducted in Rwanda, 69.10% of adolescents [43], and in a study by Belayneh and Mekuriaw (2019) examining the menstrual hygiene knowledge of adolescents in southern Ethiopia, 40.30% reported experiencing regular menstruation [44]. The discrepancy between our study and the literature may be attributed to socioeconomic constraints leading to limitations in nutrition and resources.

The study indicated that scores on the GHBS for both native and immigrant students are not at the desired level. Variables such as age group, income status, marital status, family type, social security, method and materials used for genital cleansing, frequency of bathing, method of genital hygiene, fabric, washing method and color of underwear, pretoilet hand washing habits, regular menstruation, and presence of foul-smelling discharge were found to influence genital hygiene behaviors. To prevent reproductive health problems in both native and immigrant students at later ages, they should receive regular education on this topic. It would be beneficial to raise awareness and promote behavioral changes regarding genital hygiene through seminars, conferences, workshops, and similar events targeting all female university students.

SCQ: Sociodemographic Characteristics Questionnaire

GHBS: Genital Hygiene Behaviors Scale

GHH: General Hygiene Habit

MHH: Menstrual Hygiene Habit

AAF: Awareness of Abnormal Findings

Acknowledgement

We deeply thank the female students enrolled in nonhealth departments at Mardin Artuklu University for their support.

Author contributions

SI constructing the hypothesis or idea of research and/or article, SI and SÇ planning methodology to reach the conclusions, SI and SÇ Organizing, supervising the course of progress and taking the responsibility of the research/study, SI and SÇ taking responsibility in patient follow-up, data management and reporting, SI and SÇ taking responsibility in logical interpretation and conclusion of the results, SI and SÇ taking responsibility in necessary literature review for the study, SI and SÇ taking responsibility in the writing of the whole or important parts of the study, SI and SÇ reviewing the article before submission scientifically besides spelling and grammar.

Funding

None.

Ethics approval and consent to participate

All necessary permission was obtained from the Non-Invasive Ethics Committee of the Rectorate of Mardin Artuklu University (date: November 9, 2022, no: 2022/13-24) and from Karahan (2020), who developed the GHBS and assessed its validity and reliability. The study was conducted in compliance with the principles outlined in the Declaration of Helsinki. Prior to data collection, the participants were provided with necessary information about the research and gave their informed consent.

Consent for publications

Not applicable.

Competing interests

The authors declare having no competing interests.

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No competing interests reported.

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A Comparison of Native and Immigrant Female Students’ Genital Hygiene Behaviors: a Descriptive Cross-sectional Study

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