Douching: Not only unnecessary, but possibly harmful
October 18, 1999
Web posted at: 4:35 PM EDT (2035 GMT)
By Carol Kopf
(WebMD) -- Vaginal douching -- "rinsing out" the vagina with a homemade or over-the-counter solution or water -- is not uncommon among American women: Over 60 million American women between the ages of 15 and 44 douche, according to a Center for Disease Control Vital Statistics report from 1995. But many physicians and researchers say most douching is useless and may, in fact, be harmful.
A study published in this past August's Archives of Pediatrics & Adolescent Medicine confirms that, because douching has been shown to be associated with several serious health conditions -- bacterial vaginosis (BV); pelvic inflammatory disease (PID); ectopic pregnancy (where an embryo implants outside of the uterus); and infertility -- it should be discouraged among adolescent girls and young women.
Odor shouldn't be masked, but investigated
In some cultures women teach young girls to douche for cleanliness, a custom passed down for generations. Modern-day advertising reinforces that outdated belief, encouraging women to wash away secretions that cause odor. But experts say that the vagina is self-cleaning, and the American College of Obstetricians and Gynecologists (ACOG) recommends that women avoid douching, the practice of which can hide the symptoms of an infection, or push an infection farther up into the body.
"(Odor and unusual discharge) could be a symptom of a number of things, including a tampon left inside or a condom left inside -- we've seen this happen -- as well as a number of sexually transmitted diseases ... (or) bacterial vaginosis," says Dr. M. Kim Oh, associate professor in the department of pediatrics/adolescent services at the University of Alabama at Birmingham and co-author of the August study. Instead of douching to get rid of discharge or an odor, Oh says a complete gynecological examination and screening for sexually transmitted diseases should be done to determine the diagnosis and treatment of vaginal disorders.
Some amount of discharge is normal. "Normal, healthy women should have some moisture and discharge," explains Oh. "The appearance of discharge and amount of flow may vary depending on the type of birth control used and the time of menstrual cycle."
Douching can disrupt the natural state of the vagina
Not only can douching mask an infection, but it can actually throw things out of balance. "In general, regular douching ... is unnecessary and not recommended ... because the practice tends to alter the normal vaginal pH and vaginal flora, which can weaken the natural defenses of the vagina," says Dr. Jonathan S. Berek, professor and chief of gynecology at the University of California at Los Angeles School of Medicine. In addition, he explains, "If douching is performed too soon after intercourse when spermicides are used, it can decrease the contraceptive efficacy." (Douching is not an effective method to prevent pregnancy after intercourse.)
Douching is medically warranted in only a few, rare instances
Berek says rare circumstances where douches are prescribed would include immediately after radiation therapy for endometrial or cervical cancer. Surgeons may prescribe medicated douches to prevent vaginal infection, for example, after an episiotomy (a surgical cut made at the opening of the vagina during childbirth), says Oh. But most doctors agree that regular douching is unnecessary and potentially harmful.
What do the manufacturers of douches say?
Nancy Lovre, a spokesperson for SmithKline Beecham (SB), makers of Massengill douche products, acknowledges that many doctors discourage douching. However, some doctors recommend it, she says. "We have doctors who call us and ask for product so they can hand it out," says Lovre. Ultimately, "Its a woman's choice whether to douche or not," she says.
Massengill alerts users, via an extensive package insert, that douching is linked with PID and doesn't prevent pregnancy. The insert also describes STDs, other vaginal disorders and lists 800 numbers to get more information.
The need for more research
Although Oh and her colleagues conclude in their study that douching should be discouraged, Oh also says there is a need for more study. "It is controversial ... whenever there is a controversy, particularly when there are products involved, then evidence-based recommendations are necessary," she says.
"The persistence of douching despite its potential adverse effects is probably due to aggressive advertising by manufacturers of douching products and to the absence of cautionary statements by authoritative medical and public-health organizations," write Oh and her colleagues.
Douches are labeled as cosmetics by the Food and Drug Administration (FDA) and are therefore not as stringently regulated as drugs. The FDA reopened its records in 1997 to review new data about douching but has not yet issued a final ruling.
Copyright 1999 WebMD, Inc. All rights reserved.
RELATEDS AT :
Pelvic Inflammatory Disease
Archives of Pediatrics & Adolescent Medicine -- Douching: A problem for adolescent girls and young women
CDC -- Vaginal douching and the risk of ectopic pregnancy among black women
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