Group issues policy on vaginal douching
The American Public Health Association (APHA) has just 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.1
Douching continues to be a popular practice; according to a 2006 national survey, 11.8% of women ages 18-44 said they douche on a regular basis.2
Research has linked vaginal douching with such adverse health outcomes as pelvic inflammatory disease, bacterial vaginosis (BV), cervical cancer, low-birth weight, preterm birth, HIV transmission, sexually transmitted diseases, ectopic pregnancy, recurrent vulvovaginal candidiasis, and infertility.3
The organization also is advocating increased public health efforts to provide culturally competent education to women about the risks associated with douching. It also is asking the Food and Drug Administration to review existing data and require additional studies on the safety of douching and the prevalence of adverse health outcomes.
There is a need to reach out to women about the risks of douching, says Toni Bond Leonard, co-founder, president and CEO of African American Women Evolving, a women's health advocacy group in Chicago.
"What we know from the body of research that is out there, African-American women douche more frequently than any other ethnic population," says Leonard, author of the APHA policy statement. "Given the connections between douching and reproductive tract infection, preterm low birth weight, and preterm delivery, we know that it makes it a huge problem."
In the United States, a large percentage of women continue to perceive vaginal douching to be a necessary part of feminine hygiene, observes Rebecca Brotman, PhD, MPH, visiting assistant professor at the Institute for Genome Sciences in the University of Maryland School of Medicine. Women report that they douche in response to vaginal symptoms such as discharge, irritation, or malodor, as well as after menses and with increased sexual activity, she states.
"Women should be better informed that douching is not required for normal vaginal hygiene, and vaginal symptoms may represent an underlying infection," she notes.
Brotman and research associates recently published results of a study designed to evaluate the risk for bacterial vaginosis (BV) in a douching cessation trial. Thirty-nine reproductive-age women who reported use of douche products were enrolled into a 20-week study consisting of a four-week douching observation, followed by 12 weeks of douching cessation. In the final phase of the study, participants then chose to resume douching or continue cessation for the remainder of the study. Research findings indicate that vaginal douching cessation may reduce the risk for BV in a subset of women.4
Women may ask "What is the best way to clean the vagina?" Counsel that it is best to let the vagina clean itself. Explain that the vagina cleans itself naturally by producing mucous. Women do not need to douche to wash away blood, semen, or vaginal discharge.5
Regular washing with warm water and mild soap during baths and showers will keep the outside of the vagina clean and healthy. Counsel that women avoid scented tampons, pads, powders, and sprays. The chemicals in these scented products may increase a woman's chances of getting vaginal infections.5
If women say they douche to cover a "terrible odor," explain that douching only covers the smell but does not clear the underlying cause. Educate women to call your office right away if they have any of the following conditions:
- a vaginal discharge with a bad smell;
- thick, white, or yellowish-green discharge with or without a smell;
- burning, redness, and swelling of the vagina or the area around it;
- pain when urinating;
- pain or discomfort during sex.5
References
- American Public Health Association. Vaginal Douching and Adverse Health Outcomes. Policy Number: 20074. Accessed at www.apha.org.
- 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.
- Martino JL, Vermund SH. Vaginal douching: Evidence for risks or benefits to women's health. Epidemiol Rev 2002; 24:109-124.
- Brotman RM, Ghanem KG, Klebanoff MA, et al. The effect of vaginal douching cessation on bacterial vaginosis: A pilot study. Am J Obstet Gynecol 2008; doi:10.1016/j.ajog.2007.11.043.
- U.S. Department of Health and Human Services. Office on Women's Health. National Women's Health Information Center. Douching. Fact sheet. Accessed at www.4woman.gov/faq/douching.htm.
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