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Vaginal Douching


Bandolier was asked if there was any evidence connecting vaginal douching to impaired womens' health. So we did a quick search on PubMed (an essential Internet searching tool because it has papers yet to appear on MEDLINE - http://www4.ncbi.nlm.nih.gov:80/PubMed/ ) and found a recent meta-analysis on just this topic [1]. We also found an interesting relic - a pewter vaginal syringe from about 1800 - demonstrating that vaginal douching has a long history.

Search

The primary search used only MEDLINE and used only papers in the English language. To be included the papers had to address vaginal douching and association with pelvic inflammatory disease (PID), ectopic pregnancy or cervical cancer. The published relative risks adjusted for confounding factors were combined for meta-analysis (though confusingly the figures in the paper call them odds ratios!). Unfortunately the raw data were not given, so we can give you no numbers needed to harm.

Prevalence of vaginal douching

US data indicate that 37% of US women of reproductive age (15 to 44 years) douche regularly, about half at least once a week. One third of white women do so, and two thirds of black women. There was also an association between more frequent douching and lower socio-economic status, especially in white women.

Other data suggest that douching is predominantly done with commercial preparations (50%), while another 30% use a home preparation of vinegar and water, 10% use water alone and 10% use other preparations. Douching is predominantly done for hygiene or to prevent or self-treat infection.

Pelvic inflammatory disease

PID has an estimated cumulative incidence of 10% up to 45 years of age. Women who douche have a 73% increased risk while those who douche at least once a week have a risk increased by about four fold.

Ectopic pregnancy

Women who douche have a 76% increased risk while those who use commercial preparations have a risk increased by about four fold.

Cervical cancer

Overall, women who douche have no significantly increased risk of cervical cancer. But those who douche at least once a week have a significantly increased risk of about 86%.

Comment

A useful review and analysis, spoilt by restricting the searching only to English language papers, but a good place for others to start a more thorough review. It seems to have taken confounding factors properly into account, especially that of social class. There is also a useful discussion of the place of douching. It may be that when performed at an appropriate time in the menstrual cycle (not around ovulation), and infrequently, it may not be harmful. But the message from these authors is that vaginal douching is unnecessary in routine feminine hygiene.

References:

  1. J Zhang, G Thomas, E Leybovich. Vaginal douching and adverse health effects: a meta-analysis. American Journal of Public Health 1997 87: 1201-11.



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