Alterations in the vaginal microbiome by hormones, foreign bodies, intercourse, etc., can affect the body’s susceptibility to infection. The effect of combined contraceptive vaginal rings (CCVRs) on the vaginal microbiome needs more study. We aim to explore the outcomes of CCVRs on vaginal health and infection risk when compared to women without hormone use to better understand the effect of these devices.

De-identified data were collected from TriNetX. Using ICD-10 and RXNorm codes, populations were selected for women receiving etonogestrel and ethinyl estradiol CCVR without segesterone use, versus sexually active women of reproductive age on no hormonal contraceptives. Cohorts were matched for age at index, race, and ethnicity. Statistical analysis within 1 year of CCVR placement using risk ratios (RRs); P<.05 was considered significant.

Cohort sizes were 274,743 each. Combined contraceptive vaginal ring usage showed an increased risk of gonorrhea (RR 1.221; P=.012), HSV-2 (RR 1.229; P<.0005), acute vaginitis (RR 1.314; P<.0005), subacute/chronic vaginitis (RR 1.708; P<.0005), acute vulvitis (RR 1.708; P<.0005), subacute/chronic vulvitis (RR 1.722; P<.0005), pelvic inflammatory disease (RR 1.184; P<.0005), anogenital warts (RR 1.314; P<.0005), and candidiasis (RR 1.402; P<.0005) when compared to women receiving no hormonal contraception. Combined contraceptive vaginal ring showed significant decreased risk of chlamydia (RR 0.786; P<.0005), syphilis (RR 0.493; P<.0005), and HIV (RR 0.434; P<.0005). Trichomoniasis was statistically insignificant.

Women on etonogestrel and ethinyl estradiol CCVRs have an increased risk of gonorrhea, HSV-2, vaginitis, vulvitis, PID, anogenital warts, and candidiasis, with a decreased risk of chlamydia, syphilis, and HIV when compared to women receiving no hormonal contraception. Further investigation could be useful in developing multipurpose prevention technologies.