In any woman's medicine cabinet you're likely to find an array of perfumes and soaps designed to make her smell good. Tucked behind the toiletries there's also a good chance you'll find douches. But is douching good for you or does it compromise women’s health?
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About 40 million women in the United States douche, according to SmithKline Beecham, manufacturer of Massengill douches.
Even though so many women are discreetly doing it, some health professionals say douching might lead to health problems. Douching is not only medically unnecessary, but it also can mask, or even worsen, conditions such as bacterial vaginosis or a yeast infection, says Jeanne S. Merchant, project coordinator for the University of Alabama at Birmingham School of Public Health.
Douching is strongly associated with increased risk of pelvic inflammatory disease and ectopic pregnancy, according to an article in a recent issue of the Archives of Pediatric and Adolescent Medicine that analyzed more than 40 studies on douching.
Although the link has not been conclusively established, doctors should discourage adolescent girls and young women from douching until more research is done, says Merchant, lead author of the article.
"We are not saying that douching causes disease. We are saying that there is evidence that could be the case," Merchant says.
Some doctors contend, however, that there's not enough evidence yet to recommend that women abandon the practice.
"At this point, we don't have any research saying it's dangerous if done in moderation," says Dr. Albert G. Thomas, assistant professor of obstetrics and gynecology at New York University Medical Center. "Before we try to change patients' habits, which may not be all that bad, we need much stronger data."
More research recommended
Most research on douching has been "retrospective," meaning the women who had various medical problems were asked about their douching habits, Thomas says. To conclude douching actually caused those problems, a study would have to be "controlled prospective," meaning women who douche and those who don't would be studied at various points in their lives.
"Just because we found an association doesn't mean douching itself is causing the adverse health effects," Thomas says. "There could be other factors."
The reasons why women douche are not well understood, but most report cleanliness is their main goal, according to the study.
Gloria, a 35-year-old Los Angeles woman, has been douching about once a month since she was a teenager.
"It's the last step to feeling really, really clean," she says.
Some doctors think Gloria's douching routine - about once or twice a month - is probably not putting her at much of a health risk.
Also not well understood are the reasons why douching could be harmful. But they may be due, in part, to the mixture of vinegar, water, acidifiers and antibacterial agents found in most commercial douches.
Douching washes away "vaginal flora," or the bacteria normally found in the vagina, which may leave women susceptible to bacterial vaginosis, the most prevalent vaginal infection in women. Douching can also push harmful bacteria into the cervix, the uterus and the fallopian tubes, increasing the risk of pelvic inflammatory disease, a painful condition that can lead to sterility or ectopic pregnancy, Merchant says.
It's also believed that naturally occurring bacteria provide some protection from sexually transmitted diseases. By changing the environment in the vagina, douching may make women more susceptible to such diseases, she says.
Masking potential problems
"The worrisome thing is that if women are douching because they feel they have an unpleasant odor, sometimes that is a sign of a sexually transmitted disease or an infection," Merchant says. "Douching could be covering up the symptoms to a disease she needs to be treated for and could even aggravate the disease."
Still, lots of women douche. About 15.5 percent of adolescent girls ages 15 to 19 in the United States douche regularly, and 28 percent of women ages 20 to 24 use douche products, according to the 1995 National Survey of Family Growth. About 50 percent of them do so at least once a week.
The practice is even more common among African-American women -- 37 percent of girls ages 15 to 19 and 60 percent between the ages of 20 and 24 reported douching regularly.
While decades ago some women were encouraged to douche before a gynaecological exam, that is discouraged today, says Dr. Gerald Joseph Jr., an obstetrician-gynaecologist at Ochsner Clinic in New Orleans. Never douche before a gynaecological exam because it can mask a problem and make it difficult for the doctor to identify the source. In fact, the vagina cleanses itself through normal secretions.
"Given normal hygiene, douching is not necessary for health," Joseph says.
SmithKlein Beecham's douches come with a warning label and a package insert about sexually transmitted disease and vaginal health, says Nancy Lovre, director of communications for SmithKlein Beecham Consumer Healthcare. The company is funding the largest prospective clinical study on douching, although results will not be out until later this year.
"We believe douching is a matter of personal choice," Lovre says. "We also feel very strongly that women have a right to make informed decisions about their health and hygiene products based on sound scientific information."
What To Do
If you douche because you feel you have an odour, consult your doctor - it may be a sign of a more serious problem.
A recent Canadian study has found that almost a quarter of women ovulate more than once every 28 days, which is why the rhythm method is ineffective as contraception for many couples.
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