Douches

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Douching has a long and ancient history, reaching as far back as 1500 B.C., when an Egyptian papyrus recommended a garlic and wine douche for the treatment of menstrual disorders. In the days of Hippocrates, vaginal rinsing was thought to be the only method of curing vaginal infections. Different ethnic groups have used douching off and on throughout history, but in America, douching had its heyday beginning in the early 1920s and carried on through the 1950s, when women's magazines regularly featured advertisements for douche brands such as Lysol® (Lehn and Fink Products Company, Montvale, New Jersey, U.S.A.), Sterizol® (Sterizol Company, Ossining, New York, U.S.A.), and Zonite® (Lee Pharmaceuticals, El Monte, California, U.S.A.). As recently as the early 20th century, the medical community recommended douching for the treatment of specific gynecological conditions (9).

Douching is a common practice in the United States and the sale of commercial douche products has tripled since 1974 (10). Some of the studies that have been conducted on the prevalence of douching are summarized in

Table 1 Summary of Selected Studies on the Prevalence of Douching

Type of study

Findings

References

United States

Summarized from the 1995 National Survey of Family Growth

Telephone survey of 535 adult women in the southeastern U.S.

Summarized from the 1988 National Survey of Family Growth

Survey of 169 adolescents attending a family planning clinic in a small southern town.

Other Countries

Survey of 552 women in an antenatal clinic in the Ivory Coast.

Survey of 543 female sex workers in Nairobi.

Indonesian study among 599 pregnant women.

55% of African American women, (10) 33% of Hispanic women, and 21% of Caucasian women douche.

59% of African American women (11) and 36.5 % of Caucasian women responded that they engage in this practice.

36.7% of women overall engage in (12) this practice (66.5% of African American women and 32% of Caucasian women).

African American women and 64% of Caucasian women) reported a history of douching

98% reported vaginal douching as a (14) common practice.

72% douche regularly. (15)

91% had douched at least once in the (16) month prior to the survey.

Table 1. In the United States, the practice is generally more prevalent among African American women than Caucasian women (17,18).

Differences in the estimated occurrence of this practice in the United States may be related to geographic location and socioeconomic status. Geographic differences exist, with the highest overall percentage in the south (35-48%), followed by the midwest (24-32%), northeast (23-31%), and the west (20-28%) (10,12). Education, income levels, and age at first intercourse were inversely related to douching (12). Sixty-nine percent of adolescent females attending a family planning clinic in a small southern town reported douching (13).

Compared to the United States, vaginal douching is less common in Europe and the United Kingdom (about 7% of women, overall) (19). Studies in African nations indicated that the percentage of women who engage in this practice is extremely high (Table 1).

Gazmararian, et al. (10), found that douching starts at a young age in the United States and its practice is reinforced by family, friends, and the media. There are a number of reasons women give for douching, including the perception that the practice kills germs, prevents pregnancy (20), prevents sexually transmitted disease (21), and helps ameliorate vaginal itching and discharge (11). Some women douche after menstruation and/or intercourse for cleanliness and odor control (17). In some cultures, there are additional perceived benefits to douching. In sub-Saharan Africa, it is perceived that the astringent properties of vaginal douches enhance sexual pleasure (15).

The composition of douches can range from homemade solutions of salt, vinegar and water, or water alone, to purchased douches marketed expressly for the purpose. In the United States, of women who reported current douching, about one-third use a homemade product (11). In a study conducted in the United States by Oh et al., in 2002 (20), a majority of adolescent women surveyed used commercially marketed products. However, baking soda, Betadine® (Purdue Frederick Company, Norwalk, Connecticut, U.S.A.), Pine-Sol® (The Clorox Company, Oakland, California, U.S.A.), and Lysol were also used. In the Nairobi study, Fonck, et al. (15) found that water with soap was used most commonly (81%) followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). In Indonesia, soap and water (63%), water (19%), betel leaf (8%), and a commercial agent (2%) were used (16). Betel leaf is a traditional plant used for medicine. It contains antiseptic and irritant properties and is often used for cleaning the vagina in the postpartum period.

It is now recognized that douching is associated with a host of negative consequences. Douching kills beneficial bacteria that live in the vagina (Lactoba-cilli). Stripped of Lactobacilli, the pH balance of the vagina is altered, creating a risk for infection and a variety of adverse health effects. The adverse effects that have been associated with douching are outlined in Table 2 and have been reviewed in additional publications (27,28). Effects include adverse reproductive

Table 2 Negative Health Consequences Associated with Douching

Consequence

References

Impaired fertility

(9)

Preterm birth

(18)

Low birth weight

(22)

Ectopic pregnancy

(23)

Bacterial vaginosis

(15)

Pelvic inflammatory disease

(24)

Upper genital tract infection

(24)

Endometritis

(24)

Vulvovaginal candidiasis, STDs

(17)

Cervical cancer

(25)

HIV infection

(26)

Abbreviation: STDs, sexually transmitted diseases.

Abbreviation: STDs, sexually transmitted diseases.

effects, an increase in the occurrence of sexually transmitted diseases (STDs) and pelvic inflammatory disease, and an increase in risk for HIV and cervical cancer. Rajamanoharan, et al. (19) found that any douching agent (proprietary products, vinegar and water, soap, bubble bath, or antiseptics) was associated strongly with bacterial vaginitis. Baird, et al. (9) showed that regular douching with water only, water and vinegar, or commercial solutions was associated with reductions in fertility.

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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