Talk with women about risks of douching
According to a 2006 survey, about 12% of American women say they douche on a regular basis.1 But is this practice healthy? Recent research findings suggest that sexually transmitted infections (STIs) were more common in adolescents who douched.2
What are some of the reasons why U.S. women might choose to practice douching? Sten Vermund, MD, PhD, director of the Institute for Global Health and professor of pediatrics, medicine, preventive medicine, obstetrics, and gynecology in the Vanderbilt University School of Medicine in Nashville, TN, says he has observed through his research that most women who douche think that it improves their "cleanliness." In one of Vermund's studies, women were more likely to douche if they brushed their teeth regularly and had a recent Pap smear and/or mammogram.3
Vaginal douching is practiced largely for hygienic reasons, in response to odor, after menses, and following sexual activity, says Rebecca Brotman, PhD, MPH, assistant professor in the University of Maryland School of Medicine's Department of Epidemiology and Preventive Medicine. Brotman and research associates evaluated douching practices in a 2008-published longitudinal study.4
"Many women have deeply rooted beliefs about the critical role of douching in making themselves feel clean," she notes. "Douching practice generally starts in adolescence and is reinforced by family, friends, and the media."
To perform the current study, Vermund and researchers at Vanderbilt University followed 411 persons ages 12-19 who were at high risk for STIs over a median three-year period. Using adjusted Cox proportional hazards models to calculate hazard ratios (HR), scientists report the time to acquiring an STI was shorter for adolescents who always douched [HR, 2.1; 95% confidence interval (CI), 1.2-3.4] and intermittently douched [HR, 1.5; 95% CI, 1.0-2.2], compared with those who never douched. An adjusted hazard for STI was 1.8 times larger for those who always douched (95% CI, 1.1-3.1) and 1.4 times larger for intermittent douchers (95% CI, 0.9-2.0), compared with never-douchers. When classified by follow-up after an STI-free visit, always-douchers had a shorter STI-free time than never-douchers [HR (adjusted), 2.1; 95% CI, 1.5-3.1].
"While there is a need for continued research, the aggregate weight of the evidence suggests that there is no health benefit from douching and that it is most likely harmful," the researchers conclude. "Therefore, we believe that all physicians and nurses should counsel women patients not to douche." [There is a patient education handout available.]
Previous research has linked vaginal douching with such adverse health outcomes as pelvic inflammatory disease, bacterial vaginosis, cervical cancer, low birth weight, preterm birth, HIV transmission, sexually transmitted diseases, ectopic pregnancy, recurrent vulvovaginal candidiasis, and infertility.5
The American Public Health Association in 2008 issued a policy statement calling for schools of public health, pharmacy, and medicine to include specific education around the adverse impact of douching on reproductive and maternal outcomes.6
Can women's beliefs be changed? Researchers at Emory University demonstrated in a randomized controlled trial that an intensive education program for black women in the South resulted in a decrease in nonviral STIs, human papillomavirus infections, and risk behaviors associated with acquisition of HIV.7 The intervention, which was delivered in two four-hour workshops, focused on fostering ethnic and gender pride, increasing awareness of healthy and unhealthy relationships, and introduction of a package of safer-sex options, which included abstaining from douching.
In a clinical trial among inner-city Southern adolescents, Vermund and research associates learned that behavioral education is effective in substantially reducing douching.8 "We believe that if health providers embrace the importance of discouraging vaginal douching, their educational messages may be very effective," he says.
References
- Grimley DM, Annang L, Foushee HR, et al. Vaginal douches and other feminine hygiene products: Women's practices and perceptions of product safety. Matern Child Health J 2006; 10:303-310.
- Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009; 200:38.e1-8.
- Funkhouser E, Pulley L, Lueschen G, et al. Douching beliefs and practices among black and white women. J Womens Health Gend Based Med 2002; 11:29-37.
- Brotman RM, Klebanoff MA, Nansel T, et al. Why do women douche? A longitudinal study with two analytic approaches. Ann Epidemiol 2008; 18:65-73.
- Martino JL, Vermund SH. Vaginal douching: Evidence for risks or benefits to women's health. Epidemiol Rev 2002; 24:109-124.
- American Public Health Association. Vaginal Douching and Adverse Health Outcomes. Policy Number: 20074. Accessed at www.apha.org/advocacy/policy/policysearch/default.htm?id=1362.
- Wingood G, DiClemente R, Simpson Robinson L, et al. Efficacy of an intervention in reducing HIV risk behaviors, non-viral STIs and HPV among African-American women: Results of a randomized controlled trial. Presented at the AIDS 2008: XVII International AIDS Conference. Mexico City, Mexico; August 2008.
- Grimley DM, Oh MK, Desmond RA, et al. An intervention to reduce vaginal douching among adolescent and young adult women: A randomized, controlled trial. Sex Transm Dis 2005; 32:752-758.
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