To the Editor:
Monif (OBSTET GYNECOL 1999;94:630–1) notes that observational studies cannot demonstrate a causal relationship between vaginal douching and adverse health effects. However, the data supporting such a relationship are more extensive than presented. In 1997 Zhang et al1 drew the following conclusions from a meta-analysis of 13 studies: “Frequent douching appears to be highly associated with pelvic inflammatory disease and modestly associated with ectopic pregnancy and cervical cancer.” Other health problems that have been associated with douching are bacterial vaginosis,2 chla-mydial infection,3,4 and low birth weight.5
A clinical trial has been initiated to study douching and clinically detected pelvic inflammatory disease (PID). However, other health outcomes also need to be investigated, especially because silent PID can cause infertility and ectopic pregnancy. Experimental work is needed to understand more fully the effects of douching on vaginal ecology. An estimated 27% of women in the United States douche regularly,6 so answering the question “To douche or not to douche?” deserves high priority. In the meantime, women need to be informed that douching is not required for normal vaginal hygiene and may involve health risks.
1. Zhang J, Thomas AG, Leybovich E. Vaginal douching and adverse health effects: A meta-analysis. Am J Public Health 1997;87:1207–11.
2. Hawes SE, Hillier SL, Benedette J, Stevens CE, Koutsky LA, Wolner-Hanssen P, Holmes KK. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis 1996;174:1058–63.
3. Scholes D, Stergachis A, Ichikawa LE, Heidrich FE, Holmes KK, Stamm WE. Vaginal douching as a risk factor for cervical Chlamydia trachomatis
infection. Obstet Gynecol 1998;91:993–7.
4. Beck-Sague CM, Farshy CE, Jackson TK, Guillory L, Edelkind D, Bullard JC, et al. Detection of Chlamydia trachomatis
cervical infection by urine tests among adolescents clinics. J Adolesc Health 1998;22:197–204.
5. Fiscella K, Franks P, Kendrick JS, Bruce FC. The risk of low birth weight associated with vaginal douching. Obstet Gynecol 1998;92:913–7.
6. Abma J, Chandra A, Mosher W, Peterson L, Piccinino L. Fertility, family planning, and women's health: New data from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 1997;23:1–114.