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However, few studies have explored enema use practices. Through online surveys, we examined personal, behavioral, and environmental factors associated with enema use. Development and promotion of a non-damaging, non-water based enema specifically for use in anal sex is recommended. In addition, the seemingly contradictory recommendations that water-based lubricant is recommended for anal sex but water-based enemas are dangerous need to be reconciled into a single consistent message. Enema use or douching is an under-researched practice affecting the sexual health of men who have sex with men MSM. In addition, studies report it as a risk factor for HIV infection Winkelstein et al. Rectal biopsies from the valves of Houston showed surface epithelium loss after soapsuds and tap water enemas, but not for PEG-ES enemas.
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