American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 38.e1-38.e8 , January 2009

Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents

  • Cynthia S. Tsai, MPH

      Affiliations

    • Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN
    • Division of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT
    • ,
  • Bryan E. Shepherd, PhD

      Affiliations

    • Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
    • ,
  • Sten H. Vermund, MD, PhD

      Affiliations

    • Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN
    • Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN

Received 17 January 2008 ,Revised 30 March 2008 ,Accepted 5 June 2008.

References 

  1. 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
  2. Martino J, Youngpairoj S, Vermund SH. Vaginal douching: personal practices and public policies. J Womens Health. 2004;13:1048–1065
  3. Martino J, Vermund SH. Vaginal douching: evidence for risks or benefits to women's health. Epidemiol Rev. 2002;24:109–124
  4. Ness R, Hillier S, Richter H, et al. Why women douche and why they may or may not stop. Sex Transm Dis. 2003;30:71–74
  5. Cottrell B. Vaginal douching practices of women in eight Florida Panhandle counties. J Obstet Gynecol Neonatal Nurs. 2006;35:24–33
  6. Ness R, Soper D, Holley R, et al. Douching and endometritis: results from the PID evaluation and clinical health (PEACH) study. Sex Transm Dis. 2001;28:240–245
  7. Wolner-Hanssen P, Eschenbach D, Paavonen J, et al. Association between vaginal douching and acute pelvic inflammatory disease. JAMA. 1990;263;:1936–1941
  8. Aral S, Wasserheit J. Social and behavioral correlates of pelvic inflammatory disease. Sex Transm Dis. 1998;25:378–385
  9. Baird D, Weinberg C, Voigt L, et al. Vaginal douching and reduced fertility. Am J Public Health. 1996;86:844–850
  10. Kendrick J, Atrash H, Strauss L, et al. Vaginal douching as a risk factor of ectopic pregnancy among black women. Am J Obstet Gynecol. 1997;176:991–997
  11. Fiscella K, Franks P, Kendrick J, et al. The risk of low birth weight associated with vaginal douching. Obstet Gynecol. 1998;92:913–917
  12. Bruce F, Fiscella K, Kendrick J. Vaginal douching and preterm birth: an intriguing hypothesis. Med Hypotheses. 2000;54:448–452
  13. Fiscella K, Franks P, Kendrick J, et al. Risk of preterm birth that is associated with vaginal douching. Am J Obstet Gynecol. 2002;186:1345–1350
  14. Gardner J, Schuman K, Slattery M, et al. Is vaginal douching related to cervical carcinoma?. Am J Epidemiol. 1991;133:368–375
  15. Annang L, Grimley D, Hook E. Vaginal douche practices among black women at risk: exploring douching prevalence, reasons for douching, and sexually transmitted disease infection. Sex Transm Dis. 2006;33:215–219
  16. Fonck K, Kaul R, Keli F, et al. Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya. Sex Transm Infect. 2001;77:271–275
  17. Holzman C, Leventhal JM, Jones NM, Wang J B.V. Study Group. Factors linked to bacterial vaginosis in nonpregnant women. Am J Public Health. 2001;91:1664–1670
  18. Scholes D, Stergachis A, Ichikawa L, et al. Vaginal douching as a risk factor for cervical Chlamydia trachomatis infection. Obstet Gynecol. 1998;91:993–997
  19. Blythe M, Fortenberry J, Orr D. Douching behaviors reported by adolescent and young adult women at high risk for sexually transmitted infections. J Pediatr Adolesc Gynecol. 2003;16:95–100
  20. Joesoef M, Sumampouw H, Linnan M, Schmid S, Idajadi A, St Louis M. Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia. Am J Obstet Gynecol. 1996;174:115–119
  21. Myer L, Denny L, De Souza M, Barone M, Wright T, Kuhn L. Intravaginal practices, HIV and other sexually transmitted diseases among South African women. Sex Transm Dis. 2004;31:174–179
  22. Chacko M, Kozinetz C, Regard M, Smith P. The relationship between vaginal douching and lower genital tract infection in young women. Adolesc Pediatr Gynecol. 1992;5:171–176
  23. Beck-Sague C, Farshy C, Jackson T, et al. Detection of Chlamydia trachomatis cervical infection by urine tests among adolescents. J Adolesc Health. 1998;22;:197–204
  24. Stergachis A, Scholes D, Heidrich FE, Sherer DM, Holmes KK, Stamm WE. Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol. 1993;138:143–153
  25. La Ruche G, Messou N, Ali-Napo L. Vaginal douching: association with lower genital tract infections in African pregnant women. Sex Transm Dis. 1999;26:191–196
  26. Peters SE, Beck-Sague CM, Farshy CE, et al. Behaviors associated with Neisseria gonorrhoeae and Chlamydia trachomatis: Cervical infection among young women attending adolescent clinics. Clin Pediatr (Phila). 2000;39:173–177
  27. Ness B, Hillier S, Kip K, et al. Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women. Am J Epidemiol. 2005;161:186–195
  28. Hawes SE, Hillier SL, Benedetti J, et al. Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. J Infect Dis. 1996;174:1058–1063
  29. Onderdonk A, Delaney M, Hinkson P, DuBois A. Quantitative and qualitative effects of douche preparations on vaginal microflora. Obstet Gynecol. 1992;80:333–338
  30. Ness R, Hillier S, Richter H, et al. Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Obstet Gynecol. 2002;100:765–772
  31. Hillier SL, Krohn MA, Nugent RP, Gibbs RS. Characteristics of three vaginal flora patterns assessed by gram stain among pregnant women (Vaginal Infections and Prematurity Study Group). Am J Obstet Gynecol. 1992;166:938–944
  32. Hillier SL, Krohn MA, Klebanoff SJ, Eschenbach DA. The relationship of hydrogen peroxide-producing lactobacilli to bacterial vaginosis and genital microflora in pregnant women. Obstet Gynecol. 1992;79:369–373
  33. Sewankambo N, Gray R, Wawer M, et al. HIV-1 infection associated with abnormal vaginal flora morphology and bacterial vaginosis. Lancet. 1997;350:546–550
  34. Monif G. The great douching debate: to douche, or not to douche. Obstet Gynecol. 1999;94:630–631
  35. Myer L, Denny L, de Souza M, et al. Distinguishing the temporal association between women's intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women. Am J Epidemiol. 2006;163:552–560
  36. McClelland R, Lavreys L, Hassan W, et al. Vaginal washing and increased risk of HIV-1 acquisition among African women: a 10-year prospective study. AIDS. 2006;20:269–273
  37. Wilson C, Houser J, Partlow C, et al. The REACH (Reaching for Excellence in Adolescent Care and Health) Project: study design, methods, and population profile. J Adolesc Health. 2001;29:8–18
  38. Rogers A, Futterman D, Moscicki A, Wilson C, Ellenberg J, Vermund S. The REACH Project of the Adolescent Medicine HIV/AIDS Research Network: design, methods and selected characteristics of participants. J Adolesc Health. 1998;22:300–311
  39. Vermund S, Sarr M, Murphy DA, et al. : Douching practices among HIV-infected and uninfected adolescents in the United States. J Adolesc Health. 2001;295:80–86
  40. Vermund SH, Wilson CM, Rogers AS, Partlow C, Moscicki AB. Sexually transmitted infections among HIV infected and HIV uninfected high-risk youth in the REACH study: reaching for Excellence in Adolescent Care and Health. J Adolesc Health. 2001;29(3 Suppl):49–56
  41. Peralta L, Durako SJ, Yong M. Correlation between urine and cervical specimens for the detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction in a cohort of HIV infected and uninfected adolescents. J Adolesc Health. 2001;29(Suppl):87–92
  42. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–130
  43. Nugent B, Krohn M, Hillier S. Reliability of diagnosing bacterial vaginosis by a standardized method of Gram stain interpretation. J Clin Microbiol. 1991;29:297–301
  44. Murphy DA, Durako SJ, Moscicki Abet al. No change in health risk behaviors over time among HIV-infected adolescents in care: role of psychological distress. J Adolesc Health. 2001;29(Suppl 3):57–63
  45. McClelland R, Lavreys L, Katingima C, et al. Contribution of HIV-1 infection to acquisition of sexually transmitted disease: a 10-year prospective study. J Infect Dis. 2005;191:333–338
  46. Grimley D, Oh K, Desmond R, Hook E, Vermund S. An intervention to reduce vaginal douching among adolescent and young adult women: a randomized, controlled trial. Sex Transm Dis. 2005;32:752–758
  47. Crosby R, Yarber W, Meyerson B. Prevention strategies other than male condoms employed by low-income women to prevent HIV infection. Public Health Nurs. 2000;17:53–60

 Cite this article as: Tsai CS, Shepherd BE, and Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol 2009;200:38.e1-38.e8.

 Ms Tsai is now a medical student at Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL.

 The REACH study was funded by grant U01-HD32842 from the National Institute of Child Health and Human Development with cofunding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, and the National Institute of Mental Health. Support for the analytic work was received from the Vanderbilt-Meharry Center for AIDS Research through grant P30AI054999 from the National Institute of Allergy and Infectious Diseases.

 Reprints not available from the authors.

PII: S0002-9378(08)00636-4

doi: 10.1016/j.ajog.2008.06.026

American Journal of Obstetrics & Gynecology
Volume 200, Issue 1 , Pages 38.e1-38.e8 , January 2009

Article Tools

* Image Usage & Resolution