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It is interesting to learn that, although Amstey abandoned the vaginal “prep” long ago, he does value vaginal antisepsis. His novel technique of “immediate postexposure antisepsis” may indeed lower bacterial counts at the appropriate time better than the usual preoperative wash with povidone-iodine solution. I would look forward to seeing more rigorous comparative data on this approach.
Incidentally, we do not use stirrups or the lithotomy position to prepare the vagina. We simply abduct and flex the thighs, keeping the heels resting together on the operating table mattress in the “frog-leg” position.