Vaginal douching has been practiced by women for many years as a means of “cleansing” the vagina. The makers of douches encourage women to douche after menses, and the practice has continued despite recent studies showing that douching induces changes in vaginal flora and may predispose women to pelvic inflammatory disease and ectopic pregnancy. Merchant and colleagues reviewed the current status of this practice in the United States.

A 1995 National Survey of Family Growth found that about 16 percent of adolescent girls (15 to 19 years of age) and 28 percent of young women (20 to 24 years of age) practiced douching on a regular basis. The prevalence was much higher among black women than white women (37 percent versus 11 percent). Two studies of patients attending family planning clinics in Texas found the overall rates of douching to be 70 percent, with 51 percent of women douching at least once a week. Again, the rates were much higher among black teenagers (80 percent) than white (46 percent) or Hispanic (49 percent) teenagers.

Another study found that a high percentage of women seen at a sexually transmitted diseases clinic were also likely to douche. Proposed reasons that a high proportion of teenagers and young women douche include “a goal of cleanliness,” sexual self-image issues and the influence of advertisers.

The authors cite a published study finding that changes in vaginal microflora occur just 10 minutes after douching with normal saline or acetic acid. The flora revert to normal by 72 hours. However, if bactericidal compounds such as povidone-iodine are used, short- and long-term changes occur that allow overgrowth of pathogenic organisms that suppress Lactobacillus species.

The changes in vaginal flora have been found to favor the development of bacterial vaginosis. This condition is the most common vaginal infection occurring in women of reproductive age. Apart from producing a malodorous vaginal discharge, bacterial vaginosis has been associated with preterm labor, endometritis and complications following invasive gynecologic procedures. In a study of 175 women and girls between 14 and 21 years of age seen at a family planning clinic, 25 percent who douched were found to have bacterial vaginosis.

Studies have also found a strong association between pelvic inflammatory disease and vaginal douching. The authors cite a 1993 study finding that young women and adolescents who douched because of symptoms of infection were eight times more likely to have pelvic inflammatory disease than women who douched for other reasons. In addition, this overall risk increased threefold if douching was done at least once a week.

A case-control study found that douching in general was associated with an increased risk of ectopic pregnancy. The risk increases with the number of years and the frequency with which a woman carried out this practice.

The authors found that no public position has been taken on the issue of douching by the U.S. Food and Drug Administration, the American College of Obstetrics and Gynecology or the American Academy of Pediatrics. This absence may be due to a lack of definitive prospective studies. However, no data show that douching confers any benefits. The authors encourage physicians to discuss the practice of douching with their patients and to discourage this practice. They note that gross U.S. sales for douching products totaled $144 million in 1994. Continued advertising and marketing will make it difficult to discourage this practice among young women.