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PubMedDate not supplied

Vaginal douching.

OBJECTIVE: To review current literature on vaginal douching. DATA SOURCES: MEDLINE, CINAHL, and Cochrane databases from 1997 to 2001, using keywords douche or douching; 2001 Web sites of the Centers for Disease Control and Prevention; and Internet search engines for information about current retail sales of douches. STUDY SELECTION: MEDUNE included 67 records, CINAHL 18, and Cochrane 2. Abstracts of articles in English were reviewed, and those pertaining to vaginal douching practices were included. MEDLINE had 44 pertinent articles, CINAHL 11, and Cochrane 1. References from these articles were reviewed and included when appropriate. DATA EXTRACTION: Articles were reviewed and summarized. DATA SYNTHESIS: Vaginal douching is a common practice for women in the United States. Douching is associated with adverse reproductive and gynecologic outcomes including bacterial vaginosis, preterm birth, low-birth-weight infants, pelvic inflammatory disease, chlamydial infection, tubal pregnancy, higher rates of HIV transmission, and cervical cancer. Cultural beliefs and educational factors strongly influence douching practices. CONCLUSIONS: Nursing assessment of women should include information on vaginal douching practices and beliefs. Nurses should use culturally appropriate educational strategies to discourage women of all ages from using vaginal douches as part of routine feminine hygiene because of the associated risks. Further research is needed on factors that influence women's beliefs and douching practices.

Attitude to Health↗
PubMed2000

Vaginal douching in adolescents attending a family planning clinic

Background: One of the variables most consistently associated with vaginal douching is race, with African-American women douching more regularly. Sparse data exists in the medical literature about the practice of vaginal douching among adolescents. The purpose of this study was to assess the prevalence, knowledge, attitude, and practices of vaginal douching among adolescent females attending a public family planning clinic, and determine whether African-American (AA) females douche to a greater degree than Caucasian females.Methods: In this cross-sectional study, a one-page questionnaire was administered to all adolescent females (</=19 years of age) presenting to a public family planning clinic in a small southern city. Participant charts were abstracted for demographic and clinical information. Chi-square analysis, Pearson's correlation coefficient, and odds ratio were used in data analysis conducted in SPSS for Windows software.Results: Of the 169 participants, the mean age was 17.0 years (+/-1.5 years), 53% were Caucasian, 47% were AA, and 74% were nulliparous. Sixty-nine percent of participants reported vaginal douching, mostly for hygienic reasons (68%). Those reporting vaginal douching were more likely to have a history of one or more sexually transmitted diseases (O.R. 3. 7, 95% C.I. 1.5-9.0, p < 0.01). Age of first douche correlated positively with age of first sexual intercourse (r = 0.34, p < 0. 001). African-Americans did not douche to a greater degree than Caucasians. Among those who douched, AA females were more likely than Caucasians to believe that the reason women douche was after a period (p < 0.01) and after sex (p < 0.05), and to agree that douching clears up a discharge (p < 0.05) and odor (p < 0.01) from the vagina. Caucasians were more likely than AA to believe that some discharge from the vagina is normal (p < 0.05), and most women never need to douche (p < 0.01).Conclusions: Vaginal douching was a common practice among adolescent females attending a public family planning clinic in a small southern city, and racial differences were noted in knowledge of and attitude toward vaginal douching. This suggests development of a culturally-based educational program to convince AA and Caucasian adolescent females to cease vaginal douching.

Journal Article↗
PubMed2001

Racial differences in vaginal douching knowledge, attitude, and practices among sexually active adolescents.

STUDY OBJECTIVE: The study sought to assess knowledge of, attitude toward, and practices of vaginal douching among adolescent females attending a public family planning clinic, in order to better understand racial influences on douching. DESIGN, SETTING, PARTICIPANTS: In this descriptive, cross-sectional study, a one-page questionnaire was administered to all adolescent females (< or=19 years) presenting to a public family planning clinic in a small southern city between March 1 and May 31, 1999. RESULTS: Of the 169 participants, the mean age was 17.0 years (+/-1.5 years), 53% were Caucasian, and 47% were African-American. Sixty-nine percent of participants reported vaginal douching, mostly for hygienic reasons (68%). Those reporting vaginal douching were more likely to have a history of sexual intercourse (P < 0.01) and a history of one or more sexually transmitted diseases (P < 0.05). Age of first douche correlated positively with age of first sexual intercourse (r = 0.34, P < 0.001). African-Americans did not douche to a greater degree than Caucasians. However, racial differences were noted in knowledge of and attitude toward vaginal douching. CONCLUSIONS: Vaginal douching was a common practice among adolescent females attending a public family planning clinic in a small southern city. Culturally appropriate educational strategies for African-American and Caucasian adolescent females should improve awareness of adverse events associated with vaginal douching, despite family and personal beliefs about this practice.

Adolescent↗
PubMed1997

HIV infection and vaginal douching in central Africa.

OBJECTIVE: To determine whether vaginal douching is associated with HIV infection. METHODS: A total of 397 female patients who attended the referral clinic for sexually transmitted diseases in Bangui, Central African Republic, from August 1994 to February 1995, were interviewed regarding sexual behavior, sexual history, and vaginal douching during the previous 3 years. Pelvic examinations were conducted and vaginal and cervical fluids evaluated for genital infections. Blood was drawn for HIV and syphilis serologic testing. RESULTS: The seroprevalence of HIV infection in the study population was 34%. Twenty-one per cent of the 115 HIV-seropositive women had a consistent practice of douching with commercial antiseptics versus 35% of the 223 HIV-seronegative women [odds ratio (OR), 0.6; 95% confidence interval (CI), 0.4-0.9; after adjusting for lifetime number of sexual partners, marital status, and condom use]. In contrast, a higher percentage of HIV-seropositive than HIV-seronegative women had a consistent practice of douching with a non-commercial preparation (14.8 versus 6.7%; adjusted OR, 1.7; 95% CI, 1.0-3.0). CONCLUSION: Our results suggest that vaginal douching with non-commercial preparations is associated with an increased prevalence of HIV, whereas douching with commercial antiseptic preparations was associated with a lower prevalence of HIV. The findings from this cross-sectional survey require confirmation in prospective studies.

Adolescent↗
PubMed1990

Association between vaginal douching and acute pelvic inflammatory disease.

The vaginal douching habits of 100 consecutive municipal hospital patients with verified pelvic inflammatory disease (cases) were compared with those of 762 randomly selected controls (random controls) and 119 women thought to have pelvic inflammatory disease but in whom the diagnosis was not confirmed by laparoscopy and/or endometrial biopsy specimen (internal controls). Because patients had been symptomatic for no more than 3 weeks, current douching was arbitrarily defined as any douching during the previous 2 months. Current douching was more common among those with pelvic inflammatory disease than among random controls or internal controls. Among current douchers, pelvic inflammatory disease was significantly related to frequency of douching. For example, when cases were compared with random controls, those who douched three or more times per month were 3.6 times more likely than those who douched less than once per month to have confirmed pelvic inflammatory disease. A logistic regression model was used to adjust for demographic, behavioral, and other possible confounding variables. Even after adjustments, douching during the previous 2 months remained associated with pelvic inflammatory disease. These data suggest that among these women vaginal douching may be a risk factor for pelvic inflammatory disease.

Acute Disease↗
PubMed1984

Vaginal douching. Pros, cons, and proper technique.

Vaginal douching is not necessary in routine feminine hygiene. When performed infrequently it is not harmful, but frequent douching may lead to recurrent vaginitis and mucosal irritation or ulceration. Douching should not be performed during pregnancy.

Female↗
PubMed2002

Risk of preterm birth that is associated with vaginal douching.

OBJECTIVE: The purpose of this study was to examine the association between vaginal douching and preterm birth. STUDY DESIGN: We enrolled hospitalized women after delivery in a case-control study. Women who were delivered of a live preterm singleton infant were assigned as cases. Women who were delivered at term were randomly selected as control subjects. We surveyed women about their douching habits and risk factors for preterm birth and abstracted data from the records. RESULTS: After adjustment, vaginal douching within 6 months of pregnancy was not significantly associated with preterm birth (odds ratio, 1.1; 95% CI, 0.8-1.6). However, in secondary analyses, douching more than once per week (odds ratio, 4.0; 95% CI, 1.0-15.5) or longer than 10 years (odds ratio, 1.9; 95% CI, 1.1-3.2) was associated with preterm birth. CONCLUSION: Vaginal douching does not appear to be a strong risk factor for preterm birth. Further study is needed to confirm the risk that is associated with frequent or long-term douching.

Adult↗
PubMed1991

Is vaginal douching related to cervical carcinoma?

The association between cervical carcinoma and vaginal douching was examined in a population-based case-control study conducted in the low-risk population of Utah between 1984 and 1987. The authors compared 266 cases of in situ and invasive cervical carcinoma with 408 group-matched controls by vaginal douching behavior, controlled for age, lifetime number of sex partners, cigarette smoking history, religious activity, and educational level. Essentially no association was found in women who douched once per week or less, but in those who douched more than once per week, a consistent relation was demonstrated (adjusted odds ratio = 4.7, 95% confidence interval 1.9-11). Few differences were found with type of douching preparation used. The authors hypothesize that frequent douching alters the vaginal chemical environment, making the cervix more susceptible to pathologic change.

Carcinoma↗
PubMed1991

Vaginal douching. Who and why?

Despite the long history of vaginal douching and its estimated practice by more than 67 million U.S. women, little is known about who those women are or why they douche. We addressed these questions by studying 618 women from urban gynecology practices. Fifty-nine percent had douched at some time, with the most frequent reason given as hygiene. The solutions used were evenly divided between commercial and home preparations. Three characteristics stood out among the women who douched: lower socioeconomic status, greater risk of sexually transmitted diseases and symptoms suggestive of vaginal infection. These characteristics were most common among women who douched frequently. The results suggest that douching has a strong cultural component but also raise the possibility that douching may be done in response to a perceived infection, possibly one transmitted through sexual contact.

Adolescent↗
PubMed2003

Early onset of vaginal douching is associated with false beliefs and high-risk behavior.

BACKGROUND: Vaginal douching in young women has been linked to a variety of adverse reproductive health consequences. OBJECTIVES: To explore associations with early onset (< or =15 years old) of douching. STUDY DESIGN: A confidential survey was self-administered to convenience samples of women attending seven primary care clinics. RESULTS: The mean age of the 726 evaluable participants was 27.9 years (ranges, 14-63 years). Twenty-two percent of participants believed douching "kills germs that cause infections," and 27% agreed that "women believe douching prevents pregnancy." A history of having ever used douching products was reported by 73%. Of those who had douched, 24% began the practice at age < or =15 years. Compared with those who began at a later age, those who began at age < or =15 years were also more likely to have begun sexual intercourse under 16 years of age (AOR 2.63; P<0.001), to believe that douching kills germs that cause STDs (AOR=2.15 P=0.004), and to currently douche more than once per month (AOR=2.08; P=0.009). CONCLUSION: This study indicates that early onset of vaginal douching is associated with false beliefs and sexual debut at younger age.

Adolescent↗
PubMed1997

Vaginal douching and adverse health effects: a meta-analysis.

OBJECTIVES: The meta-analysis described here reviewed the current literature on adverse health effects of vaginal douching. METHODS: Papers published in English from 1965 through 1995 were potentially eligible. RESULTS: One third of White women and two thirds of Black women of reproductive age reported douching regularly. Analyses indicated that vaginal douching increases the overall risk of pelvic inflammatory disease by 73% and the risk of ectopic pregnancy by 76%. Frequent douching was shown to be highly associated with pelvic inflammatory disease and modestly associated with cervical cancer. CONCLUSIONS: Current literature suggests that frequent douching increases the risk of pelvic inflammatory disease, ectopic pregnancy, and, possibly, cervical cancer.

Female↗
PubMed2001

Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya.

OBJECTIVE: To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya. METHODS: This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs. Consenting women were administered a questionnaire and screened for STIs. RESULTS: The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV infection was significantly associated with bacterial vaginosis (BV), trichomoniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was the fluid most often used (81%), followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). Douching in general and douching with soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increased frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs. CONCLUSION: The widespread habit of douching among African female sex workers was confirmed. The association between vaginal douching and BV is of concern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a direct association between douching and HIV infection. Further research is required to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.

Adult↗
PubMed1997

Vaginal douching and the risk of ectopic pregnancy among black women.

OBJECTIVE: Our goal was to determine whether vaginal douching was associated with ectopic pregnancy among black women and whether specific douching behaviors were associated with differences in risk. STUDY DESIGN: We analyzed data from a case-control study of ectopic pregnancy conducted between October 1988 and August 1990 at a major public hospital in Atlanta, Georgia. Case subjects were 197 black women with surgically confirmed ectopic pregnancies; the control group included 882 black women who were delivered of live or stillborn infants and 237 black women who were seeking to terminate a pregnancy. RESULTS: The adjusted odds ratio for ectopic pregnancy associated with ever having douched was 3.8 (95% confidence interval 1.6 to 8.9). The risk increased with increasing number of years of douching at least once per month. No douching behavior was found to be without risk; even women who douched for routine cleanliness were at increased risk of ectopic pregnancy. CONCLUSIONS: Vaginal douching is a modifiable behavior that may greatly increase a woman's risk of ectopic pregnancy.

Adolescent↗
PubMed1998

Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection.

OBJECTIVE: To evaluate the association between vaginal douching and cervical Chlamydia trachomatis infection. METHODS: We analyzed cross-sectional data from a study conducted at Group Health Cooperative of Puget Sound, a nonprofit health maintenance organization in western Washington state. Participants were nonpregnant women Group Health enrollees between the ages of 18 and 34 years who were attending two primary care clinics either for nonurgent visits, primarily routine preventive health visits, or in response to an invitation from the study. Before the clinical examination, all completed a self-administered survey assessing demographic and behavioral characteristics, including the timing, frequency, products used, and reasons for douching. Chlamydial infection was ascertained via cell culture isolation of C trachomatis from endocervical specimens obtained at the same visit. RESULTS: Chlamydia trachomatis was isolated from cervical cultures in 58 (3.4%) of 1692 study participants. Women who reported douching in the 12 months before their clinic visit had an increased likelihood of chlamydial infection compared with women who did not douche (prevalence odds ratio [OR] 2.29, 95% confidence interval [CI] 1.22, 4.30, after adjusting for confounding factors). The likelihood was higher for women who reported douching more often: OR 2.60 (95% CI 1.29, 5.24) for women who douched one to three times per month, and OR 3.84 (95% CI 1.26, 11.70) for those douching four times or more per month. These associations were slightly stronger when women who reported douching because of an infection were excluded from the analysis. CONCLUSION: These results support the hypothesis that vaginal douching predisposes to acquisition of cervical chlamydial infection and are compatible with previous studies that report associations between douching and sequelae of chlamydial infection, including pelvic inflammatory disease, ectopic pregnancy, and infertility.

Adult↗
PubMed1998

The risk of low birth weight associated with vaginal douching.

OBJECTIVE: To examine the association between vaginal douching and low birth weight (LBW) after accounting for known risk factors. METHODS: We used cross-sectional interview data from the 1988 National Survey of Family Growth, a nationally representative sample of 4665 women of child-bearing age and 11,553 singleton live births. We compared the risk of LBW among women who reported they douched regularly with the risk among women who did not douche, after controlling for potential confounders including maternal age, race, household income, marital status, total number of pregnancies, smoking, alcohol use, drug use during the pregnancy, year of birth of each infant, geographic region, and self-reported history of pelvic inflammatory disease. RESULTS: In multivariate analysis, regular douching was associated with an increased risk of LBW (adjusted odds ratio [OR], 1.29; 95% confidence interval [CI] 1.06, 1.57). Frequency of douching and LBW exhibited a dose-response. The adjusted OR for the association between daily douching and LBW was 2.49 (95% CI 1.23, 5.01) compared with an adjusted OR of 1.13 (95% CI 0.83, 1.55) for the association between monthly douching and LBW. There was no racial difference in the risk of LBW associated with douching. CONCLUSION: These preliminary data suggest an association between douching and LBW risk. If these findings are replicated in future studies, douching may represent a major preventable risk factor for LBW.

Black or African American↗
PubMed1989

Vaginal douching in teenagers attending a family planning clinic.

This study assessed the knowledge and usage patterns of vaginal douching in sexually active teenagers attending a family planning clinic. A questionnaire was administered consecutively to 94 black, 36 Hispanic, and 12 Anglo females ranging in age from 13 to 19 years. The survey showed that vaginal douching is a common practice, with almost two thirds learning about douching from their mother. The technique is primarily used for hygienic reasons with few using it to prevent pregnancy or infection. Age of first douche correlated with age of first intercourse (p less than 0.001). Almost 23% had douched within 2 days of the clinic visit, and 56% reported douching one or more times a week.

Adolescent↗
PubMed1993

Vaginal douching as a risk factor for acute pelvic inflammatory disease.

OBJECTIVE: To conduct a population-based evaluation of vaginal douching as a risk factor for acute pelvic inflammatory disease (PID), emphasizing timing, frequency, and reasons for douching. METHODS: A population-based case-control study was conducted at Group Health Cooperative of Puget Sound, a staff-model health maintenance organization located in western Washington state. The cases (N = 131) were women 18-40 years of age who experienced a first episode of clinically diagnosed acute PID. Both hospitalized and ambulatory-care patients were identified. Medical records were reviewed for clinical inclusion criteria and for additional evidence of inflammation/infection. Controls (N = 294) were chosen from a population-based series of randomly selected women from a concurrent Group Health study of ectopic pregnancy. Of the women identified, 72.4% of cases and 73.4% of controls agreed to participate. RESULTS: Relative to women who reported never having douched, women who douched during the previous 3 months had a risk of PID of 2.1 after controlling for other measured risk factors (95% confidence interval [CI] 1.2-3.9). Women who douched at least once a week had a higher estimated risk (odds ratio 3.9, 95% CI 1.4-10.9) than those who douched less often (odds ratio 1.8, 95% CI 1.0-3.4). The risk was highest in the small group of women who gave infection as the reason for douching (odds ratio 7.9, 95% CI 2.6-24.2). However, exclusion of this group did not eliminate the association among the remaining women (odds ratio 3.0, 95% CI 1.0-9.1 for douching at least once a week). CONCLUSION: These population-based data lend added support to the hypothesis that vaginal douching can predispose a woman to PID.

Acute Disease↗
PubMed2000

Vaginal douching and preterm birth: an intriguing hypothesis.

The rate of preterm birth has risen in recent years and is twice as high among black women as among white women. Neither the underlying causes nor the reasons for the racial disparity are clearly understood. Further, preventable risk factors have not been identified. We hypothesize that vaginal douching plays a key role in the risk of infection-related spontaneous preterm birth. Vaginal douching is a common behavior, twice as prevalent among black women as among white women. Douching may be an important mechanism by which vaginal pathogens gain access to the upper genital tract. Douching increases the risk of acquiring bacterial vaginosis. It may also facilitate the ascent of microorganisms into the upper genital tract, resulting in a chronic bacterial colonization inside the uterus. During pregnancy, the host inflammatory response is initiated, which stimulates preterm labor and birth. Douching, a potentially preventable risk factor, may explain a substantial proportion of the black-white disparity in preterm birth.

Female↗