THE HAZARDS OF DOUCHING

In Death Caps, an investigative feature in Loving Couple asserts that vaginal douching is hazardous to women’s health. The novel is fiction, but the hazards of douching are all too real.

Behind “that clean, fresh feeling” touted in ads for feminine hygiene products is a nasty lie that the vagina is a dirty, malodorous organ. It isn’t. Gynecologists agree that the vagina is self-cleansing. Regular bathing, cervical mucus and natural vaginal lubrication during lovemaking keep the organ clean. University of Washington gynecologist David Eschenbach, M.D., says, “Douching is completely unnecessary.”

But the ads have persuaded about one-quarter of U.S. women aged 15 to 44 to douche regularly, according to the Centers for Disease Control and Prevention (21 percent of white women, 33 percent of Hispanics, and 55 percent of African-Americans).(1) Some use home-made water-vinegar douches, but most spring for disposable, commercial products, more than 200 million of which are purchased each year at a cost of some $450 million.(2)

Douching is not only unnecessary. It’s also harmful. While a few studies show no danger from douching,(3) many more, in fact, dozens, have linked it with:

* Increased risk of ectopic pregnancy.(4) Ectopic pregnancy involves the fetus implanting in a fallopian tube instead of in the uterus. In a study at Mt. Sinai Medical Center in New York, regular douching almost doubled ectopic pregnancy risk.(5) In another, compared with women who never douched, those who did had 3.8 times the risk of ectopic pregnancy.(6) Ectopic pregnancy is a potentially life-threatening medical emergency.

* Increased risk of pelvic inflammatory disease (PID).(7) This is a serious, often fertility-impairing infection of the fallopian tubes that strikes up to 1 million American women a year.(8) In one study, researchers at Mount Sinai School of Medicine in New York City discovered that routine douching raises risk of PID 73 percent.(9) Frequent douching raises it even more. Compared with women who never douche, those who douche at least once a week had four times the risk of PID.(10) Another study by University of Washington scientists in Seattle compared the douching habits of 100 women hospitalized for PID and 762 healthy controls. Those with PID douched significantly more. Women who douched three times a month or more were 3.6 times more likely to develop PID.(11)

* Reduced chance of conception.(12) Researchers in Washington, D.C., have discovered that douching less than twice a year has no impact on fertility, but beyond that, the more you douche, the longer it takes to get pregnant.(13)

* Increased risk of bacterial vaginal infections (bacterial vaginosis, BV). Florida State University researchers analyzed the health and douching habits of 483 women. Monthly douching more than doubled risk of BV. Weekly douching almost tripled it.(14) University of Pittsburgh scientists followed 1,116 women for six months. Compared with non-douchers, women who douched regularly were almost three times more likely to develop BV.(15) An Italian study also shows that regular douching doubles risk of BV.(16) Another at Michigan State found that frequent douching triples BV risk.(17)

* Increased risk of Chlamydia infection. Chlamydia is among the most prevalent sexually transmitted infections. In a study of 1,692 women, compared with women who never douched, University of Washington researchers discovered that those who did one to three times a month had 2.6 times the risk of Chlamydia, while those who douched four or more times a month at 3.8 times the risk.(18)

* Increased risk of preterm delivery. Scientists with the Centers for Disease Control and Prevention compared douching habits among 804 women who delivered at term and 262 who had premature deliveries. Douching at all during pregnancy almost doubled risk of preterm delivery.(19) University of Rochester researchers found that douching more than once a week within six months of getting pregnant quadrupled risk of preterm birth.(20)

* Increased risk of low-birth-weight babies. Researchers in Rochester, New York, analyzed 11, 553 live births to 4,665 women. As douching frequency increased, so did the risk of having a low-birth-weight baby.(21)

It’s not entirely clear why douching would raise risk for all these problems. The leading theory is that it pushes harmless bacteria normally confined to the vagina up into the uterus, where they don’t belong.(22) Of course, douche manufacturers dispute the anti-douching studies.(23)

A few years ago, a group of concerned gynecologists petitioned the Food and Drug Administration to ban commercial douches as unnecessary and dangerous. An FDA advisory panel noted the mounting evidence against douching, but called it “indirect.” The panel suggested that perhaps douches should carry warning labels.

Currently, the case against douching is not epidemiologically air-tight. But why buy a product that’s at best, a worthless waste of money, and at worst, hazardous? “There is no good reason to douche, and many good reasons not to,” says Johns Hopkins gynecologist Jean Anderson, M.D. She says doctors should “actively discourage” douching. (24)

1. “A Look at Douches' Safety,” NY Times, May1, 1997.
2. “A Look at Douches' Safety,” NY Times, May1, 1997.
3. Ness, RB et al. “Douching Pelvic Inflammatory Disease, and Gonococcal and Chlamydial Genital Infection in a Cohort of High-Risk Women,” American Journal of Epidemiology (2005) 161:186. Rothman, KJ et al. “Randomized Field Trial of Vaginal Douching, Pelvic Inflammatory Disease, and Pregnancy,” Epidemiology (2003) 14:340.
4. Kendrick, J.S. et al “Vaginal Douching and the Risk of Ectopic Pregnancy Among Black Women,” American Journal of Obstetrics and Gynecology (1997) 176:991.
5. Zhang, J et al. “Vaginal Douching and Adverse Health Effects: A Meta-Analysis,” American Journal of Public Health (1997) 87:1207.
6. Kendrikck JS et al. “Vaginal Douching and the Risk of Ectopic Pregnancy,” American Journal of Obstetrics and Gynecology (1997) 176:991.
7. Woler-Hanssen, P. et al. “Association Between Vaginal Douching and Acute Pelvic Inflammatory Disease,” Journal of the American Medical Association (1990) 263:1936.
8. “A Look at Douches’ Safety,” NY Times, May 1, 1997.
9. Zhang, J et al. “Vaginal Douching and Adverse Health Effects: A Meta-Analysis,” American Journal of Public Health (1997) 87:1207.
10. “Frequent Douching is Associated with PID” Modern Medicine, Sept. 1997.
11. Wolner-Hanssen, P. et al. “Association Between Vaginal Douching and Acute PID,” Journal of the American Medical Association (1990) 263:1936.
12. Baird, DD. et al. “Vaginal Douching and Reduced Fertility,” American Journal of Public Health (1996) 86:845.
!3. Baird, DD et al. “Vaginal Douching and Reduced Fertility,” American Journal of Public Health (1996) 86:844.
14. Cottrell, BH. “Vaginal Douching Practices of Women in Eight Florida Panhandle Counties,” Journal of Obstetrics, Gynecology, and Neonatal Nursing (2006) 35:24.
15. Jancin. B. “Douching, Smoking Tied to BV,” Family Practice News, Sept. 1, 2000.
16. Chiaffarino, F et al. “Risk Factors for Bacterial Vaginosis,” European Journal of Obstetrics, Gynecology, and Reproductive Biology,” (2004) 117:222.
17. Holzman, C et al. “Factors Linked to Bacterial Vaginosis in Nonpregnant Women,” American Journal of Public Health (2001) 91:1664.
18. Scholes, D et al. “Vaginal Douching as a Risk Factor for Cervical Chlamydia Trachomatis Infection,” Obstetrics and Gynecology (1998) 91:993.
19. Bruce, FC et al. “Is Vaginal Douching Associated with Preterm Delivery?” Epidemiology (2002) 13:328.
20. Fiscella, K et al. “Risk of Preterm Birth Is Associated with Vaginal Douching,” American Journal of Obstetrics and Gynecology (2002) 186:1345.
21. Fischella, K et al. “The Risk of Low Birth Weight Associated with Vaginal Douching,” Obstetrics and Gynecology (1998) 92:913.
22. Woler-Hanssen, P. et al. “Association Between Vaginal Douching and Acute Pelvic Inflammatory Disease,” Journal of the American Medical Association (1990) 263:1936.
23. “A Look at Douches' Safety,” NY Times, May 1. 1997, and “Douching May Raise Risk of PID, Ectopic Pregnancy, Panel Concludes,” Medical Tribune, May 22. 1997.
24. Jean Anderson, MD quoted in “Douching Raises PID Risk,” Family Practice News. Aug. 15. 1996.